Aims: To determine the test-retest reliability and responsiveness of a new computerized 20-item pain measure, SUPER-KIDZ, in children with juvenile idiopathic arthritis (JIA). Methods: A single centre prospective cohort study of JIA patients aged 8-18 years was performed. For each SUPER-KIDZ item, test-retest reliability analysis was done in patients expected to have stable pain, and responsiveness was evaluated after intra-articular steroid injection(s). Results: Fifty-one subjects were included. Good internal consistency (α=0.73-0.92) was demonstrated for the 3 SUPER-KIDZ domains. Acceptable test-retest reliability (intraclass correlation coefficient or kappa ≥0.80) was found for 15 SUPER-KIDZ items. At 2 weeks post-injection, 16 items were responsive to change in pain (standardized response mean=0.66-0.82, significant Wilcoxon signed rank and linear mixed model). Conclusions: The majority of the SUPER-KIDZ items have acceptable test-retest reliability and responsiveness properties. If validity is demonstrated, this measure could be implemented as a standardized comprehensive pain tool for JIA patients.

Background: Standardized outcome measures used in assessment of chronic disease need to be relevant to the client if interventions based on the results are to be meaningful. The Modified Health Assessment Questionnaire (MHAQ) (Pincus et al., 1983) is an eight-item questionnaire used commonly with individuals with Rheumatoid Arthritis (RA) to assess self-reported function. This scale has been translated and validated in multiple languages and cultures but has never been evaluated for its relevance with a Canadian Indigenous population despite its frequent application in clinical and health research settings. Purpose: The primary objective of the following study was to determine whether or not the MHAQ is an appropriate measurement tool to adequately document the lived experiences of activity and participation in First Nations individuals diagnosed with RA. Methodology: A mixed methods sequential explanatory approach was utilized. The quantitative component consisted of secondary analysis of an existing clinical database developed at the University of Manitoba Health Sciences Arthritis Centre (UMHSAC). MHAQ scores and other indicators of disease activity of First Nations (n=252) and Caucasian (n=633) individuals with RA were examined for significant differences. The results informed a qualitative phase using interpretive description methodology whereby semi-structured interviews were held with 25 First Nations individuals with RA. Results: A significant relationship was observed between ethnicity and MHAQ score (p<0.001) where the First Nations cohort demonstrated significantly higher scores in pain and MHAQ scores (p<0.001), as well as physician global assessment and morning stiffness (p<0.05). Pain was the single greatest predictor of MHAQ score (p<0.001). In contrast, a convergence coding matrix comparing MHAQ scores to first-hand narratives found only 65% agreement in responses. The thematic analysis of the qualitative component resulted in three key themes: Ka-wachi-wa-pinaywin (“Coldness in the bones”), Adaptive Resilience, and Family Relations. Conclusion: Concurrent validity of the MHAQ in a First Nations population was supported through statistical analyses but convergent validity was not supported by subsequent qualitative and mixed methods approaches. The assessment of disability requires an integrated approach that takes into consideration an individual’s personal context. Both barriers and facilitators in the environment, as well as personal factors, must be addressed. / February 2016

No description available.

The current study was conducted to examine the effects of telephone intervention on arthritis self-efficacy, depression, pain and fatigue in older adult patients in different clinical settings. Eighty-five subjects from two clinics were randomly assigned to either the control (n = 45) or intervention (n = 40) groups. The study was a mixed quantitative/qualitative design. Each subject completed several pre-tests including the Arthritis Self-Efficacy (ASE) scale, the Geriatric Depression scale (GDS), and numeric rating scales for both pain and fatigue. All subjects received an informational packet on self-management of arthritis and developed an action plan and personal goals for self-management of their arthritis over the next six weeks. Subjects in the intervention groups also received a brief educational session on the packet and were called once weekly for the next five weeks. The calls followed a script, addressing different sections of the informational packet. The calls were designed to be both instructional and motivational. Subjects in the control groups were not contacted until the sixth week. At that time all subjects were called and the assessment tools were re-administered. Quantitative data analysis (repeated measures ANOVA) showed a significant increase in ASE scores over time for both intervention and control groups. Qualitative data analysis revealed the emergence of several major themes that were supported by the subjects' responses. The telephone interventions helped many of the participants initiate exercise programs for the first time in their lives. Participants also indicated that they were determined to adhere to these programs, that they would make other lifestyle changes that would assist their arthritis self-management, and that the telephone interventions were helpful in facilitating medical care for arthritis exacerbations and other medical problems. Telephone intervention was helpful in promoting adherence to exercise programs and other lifestyle changes that may assist older patients in the self-management of their arthritis, and was helpful in facilitating medical care. Arthritis education classes have been developed which have been shown to enhance the self-management of arthritis in older patients. Telephone intervention may be an alternative means of enhancing self-management for these individuals.

Introduction The association of the HLA shared epitope with rheumatoid arthritis (RA) in black South Africans is well established. The aims of the thesis were to identify non-HLA risk loci associated with RA using the Immunochip array and to assess the association of specific amino acids at specific positions of the DRB1 locus with the risk for developing RA in black South Africans. Methods Ethnically and geographically matched RA cases (n=435) and controls (n=463) were genotyped using the Immunochip array which has ~196 000 single nucleotide polymorphisms (SNPs) previously associated with 12 autoimmune diseases. After quality control, 103 700 SNPs were tested for association in 263 cases and 374 controls. For the amino acid study, DNA sequencing of exon 2 of the DRB1 locus was performed on the seropositive cases (n=261) using the Allele SEQR HLA-DRB1 (Abbot) assay and four digit HLA typing was assigned using the Assign software (Conexio Genomics). The amino acid sequences were inferred from the called allele type. Association testing and conditional analysis were performed. Results A total of 72 HLA SNPs reached statistical significance (p< 5x10-8) of which 71 SNPs locate to the HLA-DR or DQ genes or to the intergenic region between these two genes. Specifically, 4 SNPs in the intergenic region between HLA-DRB1 and HLA-DQA1 (rs3104413, OR=3.88, p=5.49x10-21; rs3129769, OR=3.91, p=4.60x10-21; rs6931277, OR=3.97, p=1.03x10-21; rs9272353, OR=4.1, p=3.01x10-21) were highly associated. Ten non-HLA SNPs on chromosome 6 reached significance of which 7 SNPs locate to the intergenic region between BTNL2 and HLA-DRA and confer protection. Four “SNPs” on chromosome 1 locating to a copy number variant region of the intergenic region between PLD5 and LOC400723 were significantly associated with RA in this study (rs2809867, OR=0.33, p=5.01x10-08; rs12738883, OR=0.33, p=3.98x10-08; rs78352781, OR=0.33, p=3.98x10-08; rs12739315, OR=0.33, p=3.98x10-08) and showed an even stronger association with the rheumatoid factor positive subgroup. Valine at amino acid position 11 of DRB1 demonstrated the strongest associated with RA (OR=5.1(3.7, 7.0), p=1.63x10 -27) and serine at this position was protective (OR=0.4(0.3, 0.5), p=2.46x10 -16). Interestingly, the frequency of valine in black South African RA cases was much lower than in Caucasians with RA. Using principal component analysis, black South Africans were found to be genetically distinct from west and east African populations. Conclusion This study demonstrated both similarities and differences in the risk for RA between Caucasians and black South Africans. Similar to Caucasians, the HLA region confers the strongest genetic risk for RA in black South Africans. More specifically, valine at position 11 of DRB1 confers the strongest risk for RA in black South Africans and serine confers protection. Four novel non-HLA RA-associated SNPs in the intergenic region between LOC400723 and PLD5 were identified. Variants of the PTPN22 gene, although strongly associated with RA in Caucasians, are not associated with RA in this population. Since this population is genetically distinct, the findings need to be independently validated in other African populations.

Thesis (M.P.H.)--University of Hong Kong, 2006.

Complementary and alternative medicine (CAM) has become very popular with populations internationally and in the United States. CAM is defined as “a group of diverse medical and health systems, practices and products that are not generally considered as part of conventional medicine”. CAM is described as having five specific divisions: whole medical systems, mind-body medicine, biologically-based practices, manipulative- or body-based practices, and energy medicine. Recent studies have shown that CAM use is increasing. In the US 33% of the population reported using CAM in 1990, but 1997 usage rates increased to over 41%. The popularity of CAM is one of the reasons for the creation of the National Center for Complementary and Alternative Medicine (NCCAM) by the National Institutes of Health the Federal Government's lead agency for scientific research on the diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine”. NCCAM information was the foundation for this project. The goals of this project are to evaluate the interest of dietitians in Georgia in CAM and introduce participants of this project to a segment of CAM treatments. The primary research question is: Are dietitians in the state of Georgia interested in using CAM as part of their practice? There were three distinct portions to this project; the initial survey of the dietitian participants, the development and use of the introductory CAM lesson, and the evaluation of this lesson and final survey. The data from both the first and second surveys as well as the post test does support a positive answer to the research question, “Are registered dietitians in the state of Georgia interested in CAM? The results clearly indicate an interest from both the survey 1 and survey 2/ post test group. Some may ask, “Is this really of any importance to the dietetics profession?” The answer to this can be found in the nutrition literature. Conducting a topic search of “Complementary and alternative medicine” in three predominant nutrition journals: the American Journal of Clinical Nutrition, The Journal of Nutrition and The Journal of the American Dietetic Association, revealed more than 17,000 articles. These articles range for original research to review of original research to commentary articles evaluating the use of CAM to the dietetics practice. A number of articles addressed the importance of CAM in dietetics education as well as its importance to the practice and reimbursement for services.

Thesis (M.A.) - Simon Fraser University, 2005. / Theses (School of Communication) / Simon Fraser University. Also issued in digital format and available on the World Wide Web.

No description available.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences