Discordance between Patient and Physician Assessments of Disease Severity in Systemic Sclerosis

2010 ◽  
Vol 37 (11) ◽  
pp. 2307-2312 ◽  
Author(s):  
MARIE HUDSON ◽  
ANN IMPENS ◽  
MURRAY BARON ◽  
JAMES R. SEIBOLD ◽  
BRETT D. THOMBS ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Disease Severity ◽  
Disease Duration ◽  
Intraclass Correlation ◽  
Gastrointestinal Symptoms ◽  
The United States ◽  
Relative Importance ◽  
Shortness Of Breath ◽  
Future Studies ◽  
The Us

Objective.To describe the magnitude and correlates of discordance between patient and physician assessments of disease severity in patients with systemic sclerosis (SSc).Methods.Subjects were patients enrolled in the Canadian Scleroderma Research Group Registry. The outcomes of interest were patient and physician global assessments of disease severity (scales ranging from 0–10). Predictors of disease severity represented the spectrum of disease in SSc (skin involvement, severity of Raynaud’s phenomenon, shortness of breath, gastrointestinal symptoms and pain, number of fingertip ulcers, tender and swollen joints, creatinine, and fatigue). The results of the analysis were validated in an independent sample of patients with SSc from the United States.Results.Patients perceived greater disease severity than physicians (mean difference 0.78 ± 2.65). The agreement between patient and physician assessments of disease severity was, at best, modest (intraclass correlation 0.3774; weighted κ 0.3771). Although both patients and physicians were influenced by skin scores, breathlessness, and pain, the relative importance of these predictors differed. Patients were also influenced by other subjective symptoms, while physicians were also influenced by disease duration and creatinine. The predictors explained 56% of the deviance in the patient global assessments and 29% in the physician assessments. These findings were confirmed in the US dataset.Conclusion.Patients and physicians rate SSc disease severity differently in magnitude and are influenced by different factors. Patient-assessed and physician-assessed measures of severity should be considered as complementary and used together in future studies of SSc.

Comparing the COVID-19 Responses in Cuba and the United States

2021 ◽  
Vol 111 (12) ◽  
pp. 2186-2193
Author(s):  
Mary Anne Powell ◽  
Paul C. Erwin ◽  
Pedro Mas Bermejo
Keyword(s):  
United States ◽  
Death Rate ◽  
Health Inequities ◽  
The United States ◽  
Death Rates ◽  
Excess Death ◽  
Future Studies ◽  
Effective Strategies ◽  
The Us ◽  
Case Rate

The purpose of this analytic essay is to contrast the COVID-19 responses in Cuba and the United States, and to understand the differences in outcomes between the 2 nations. With fundamental differences in health systems structure and organization, as well as in political philosophy and culture, it is not surprising that there are major differences in outcomes. The more coordinated, comprehensive response to COVID-19 in Cuba has resulted in significantly better outcomes compared with the United States. Through July 15, 2021, the US cumulative case rate is more than 4 times higher than Cuba’s, while the death rate and excess death rate are both approximately 12 times higher in the United States. In addition to the large differences in cumulative case and death rates between United States and Cuba, the COVID-19 pandemic has unmasked serious underlying health inequities in the United States. The vaccine rollout presents its own set of challenges for both countries, and future studies can examine the comparative successes to identify effective strategies for distribution and administration. (Am J Public Health. 2021;111(12):2186–2193. https://doi.org/10.2105/AJPH.2021.306526 )

Determinants of Migration-Related Decision Making among the Asian Indian Community in the United States

2015 ◽  
pp. 94-109
Author(s):  
Babu P. George
Keyword(s):  
United States ◽  
Decision Making ◽  
Asian Indian ◽  
Exploratory Study ◽  
Complex Dynamics ◽  
The United States ◽  
Relative Importance ◽  
Related Factors ◽  
Indian Community ◽  
The Us

This chapter examines the complex dynamics underlying Indian immigrants' decision to continue to stay in the United States or to counter migrate back to India. In a reversal of fortunes, the specific set of conditions that once triggered a massive inflow of economic migrants from India to the US has been causing a counter migration to India. Based on a review of literature and an exploratory study involving focus groups, the authors identify some of the major migration-/counter migration-related factors. Then, employing a survey, the relative importance of each of these factors is gauged for migrant individuals associated with different professions.

Explaining varying lobbying styles across the Atlantic: an empirical test of the cultural and institutional explanations

2016 ◽  
Vol 37 (4) ◽  
pp. 459-486 ◽  
Author(s):  
Marcel Hanegraaff ◽  
Arlo Poletti ◽  
Jan Beyers
Keyword(s):  
United States ◽  
World Trade Organization ◽  
World Trade ◽  
Empirical Test ◽  
The United States ◽  
Relative Importance ◽  
Observational Equivalence ◽  
The Us ◽  
United Nation ◽  
International Diplomatic Conferences

AbstractThere is consensus in the literature that policymaking in the United States (US) and Europe generates different lobbying styles. Two explanations for these differences have been developed so far. The first posits that distinct lobbying styles reflect differentpolitical cultures. The second attributes distinct lobbying styles to variation in theinstitutionalcontext in which lobbyists operate. Studies that have analysed lobbying within the US and Europe and assessed the relative importance of these arguments are problematic because both explanations are consistent with observed differences in lobbying style. In this article, we circumvent problems of observational equivalence by focussing on European and American lobbyists who are active in a similar institutional venue – that is, international diplomatic conferences. Relying on evidence collected at World Trade Organization Ministerial Conferences and United Nation Climate Summits, we tested the relevance of alternative explanations for the variation in lobbying styles between European and American lobbyists. Our results give robust support to the institutional argument.

Work Disability in Systemic Sclerosis

2009 ◽  
Vol 36 (11) ◽  
pp. 2481-2486 ◽  
Author(s):  
MARIE HUDSON ◽  
RUSSELL STEELE ◽  
YING LU ◽  
BRETT D. THOMBS ◽  
MURRAY BARON
Keyword(s):  
Systemic Sclerosis ◽  
Disease Severity ◽  
Work Disability ◽  
Disease Duration ◽  
Multisystem Disease ◽  
Cross Sectional ◽  
Diffuse Disease ◽  
Short Disease Duration ◽  
Medical Examinations ◽  
The Relationship

Objective.Systemic sclerosis (SSc) is a multisystem disease associated with significant morbidity and increased mortality. Little is known about work disability in SSc. We undertook this study to determine the prevalence and demographic and clinical correlates of work disability in a large cohort of patients with SSc.Methods.Cross-sectional, multicenter study of patients from the Canadian Scleroderma Research Group Registry. Patients were assessed with detailed clinical histories, medical examinations, and self-administered questionnaires. The primary outcome was self-reported work disability. Multiple logistic regression was used to assess the relationship between selected demographic and clinical variables and work disability.Results.Of the 643 patients available for this study, 133 (21%) reported that they were work disabled. Work disability in SSc was common, even in people with short disease duration, and increased steadily with increasing disease duration: among those who were ≤ 65 years and who reported being either disabled or working, 28.0% and 44.8% of patients with disease duration of < 2 and 10–15 years, respectively, reported that they were work-disabled. The significant correlates of work disability included co-morbidities, disease duration, diffuse disease, disease severity, pain, fatigue, and physical function.Conclusion.Work disability is prevalent, occurs early, and is associated with markers of disease severity and functional status. Further research is needed to identify other, potentially modifiable, risk factors for work disability in SSc.

scholarly journals COVID-19 Symptoms and Deaths Among Health Care Workers in the United States

2021 ◽  
Author(s):  
Shao Lin ◽  
Xinlei Deng ◽  
Wangjian Zhang ◽  
Ian Ryan ◽  
Kai Zhang ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Temporal Trends ◽  
The United States ◽  
Outcome Variable ◽  
Shortness Of Breath ◽  
Medical Conditions ◽  
Older Individuals ◽  
Care Workers ◽  
The Us

Abstract Background: While most COVID-19 research has focused on older individuals with multi-comorbidities, few studies have assessed the predictors of fatality among health care workers (HCWs). This study evaluated if demographics and COVID-19 symptomatology predicted COVID-19 fatality and the temporal trends and spatial distribution among HCWs.Methods: We used a case-control design to compare HCW deaths related to COVID-19 (laboratory-confirmed) with three control groups (i.e., Non-HCW deaths, HCW non-deaths, and non-HCW non-deaths). Patient-level data with 33 variables, including COVID-19 confirmed cases, deaths, demographics, and various specific COVID symptoms reported by all states in the US, have been obtained from the Restricted Access Dataset by the US CDC since January 2020. A logistic regression model was used by regressing the outcome variable against each predictor while controlling for gender, age group, race, and ethnicity.Results: The percentages of 50-69 years old, Hispanics (8.7%), Black (32%), and Asian (23.1%) in HCW death were significantly higher than in their respective controls. The fatality and all severe indicators were higher among the deaths than non-deaths, but not different for HCWs than non-HCWs. Significantly increased risks for deaths were observed with pre-existing medical conditions (RR: 7.24, 95% CI: 5.40-9.70), shortness of breath (RR: 5.73, 95% CI:4.50-7.31), fever (RR:3.52, 95% CI: 2.71-4.56), cough (RR:2.02, 95% CI: 1.54-2.65), and diarrhea (RR: 1.57, 95% CI:1.20-2.05). Conclusion: Older and minority HCWs experienced relatively higher COVID-19 fatality. Severe symptoms are similarly prevalent among HCW deaths and non-HCW deaths. Pre-existing medical conditions, shortness of breath and fever symptoms may be critical COVID indicators for HCWs.

Summed and Weighted Summary Scores for the Medsger Disease Severity Scale Compared with the Physician’s Global Assessment of Disease Severity in Systemic Sclerosis

2016 ◽  
Vol 43 (8) ◽  
pp. 1510-1518 ◽  
Author(s):  
Daphna Harel ◽  
Marie Hudson ◽  
Alexandra Iliescu ◽  
Murray Baron ◽  
Russell Steele ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Disease Severity ◽  
Global Assessment ◽  
Intraclass Correlation ◽  
Measurement Properties ◽  
Observational Research ◽  
Severity Scale ◽  
Patient Reported ◽  
Weighted Score ◽  
Disease Severity Scale

Objective.To develop a weighted summary score for the Medsger Disease Severity Scale (DSS) and to compare its measurement properties with those of a summed DSS score and a physician’s global assessment (PGA) of severity score in systemic sclerosis (SSc).Methods.Data from 875 patients with SSc enrolled in a multisite observational research cohort were extracted from a central database. Item response theory was used to estimate weights for the DSS weighted score. Intraclass correlation coefficients (ICC) and convergent, discriminative, and predictive validity of the 3 summary measures in relation to patient-reported outcomes (PRO) and mortality were compared.Results.Mean PGA was 2.69 (SD 2.16, range 0–10), mean DSS summed score was 8.60 (SD 4.02, range 0–36), and mean DSS weighted score was 8.11 (SD 4.05, range 0–36). ICC were similar for all 3 measures [PGA 6.9%, 95% credible intervals (CrI) 2.1–16.2; DSS summed score 2.5%, 95% CrI 0.4–6.7; DSS weighted score 2.0%, 95% CrI 0.1–5.6]. Convergent and discriminative validity of the 3 measures for PRO were largely similar. In Cox proportional hazards models adjusting for age and sex, the 3 measures had similar predictive ability for mortality (adjusted R2 13.9% for PGA, 12.3% for DSS summed score, and 10.7% DSS weighted score).Conclusion.The 3 summary scores appear valid and perform similarly. However, there were some concerns with the weights computed for individual DSS scales, with unexpected low weights attributed to lung, heart, and kidney, leading the PGA to be the preferred measure at this time. Further work refining the DSS could improve the measurement properties of the DSS summary scores.

scholarly journals Ozone trends over the United States at different times of day

2018 ◽  
Vol 18 (2) ◽  
pp. 1185-1202 ◽  
Author(s):  
Yingying Yan ◽  
Jintai Lin ◽  
Cenlin He
Keyword(s):  
United States ◽  
Climate Variability ◽  
The United States ◽  
Anthropogenic Emissions ◽  
Relative Importance ◽  
Annual Average ◽  
The Us ◽  
Ozone Trends ◽  
Interannual Climate Variability ◽  
Detrended Fluctuation

Abstract. In the United States, the decline of summertime daytime peak ozone in the last 20 years has been clearly connected to reductions in anthropogenic emissions. However, questions remain about how and through what mechanisms ozone at other times of day have changed over recent decades. Here we analyze the interannual variability and trends of ozone at different hours of day, using observations from about 1000 US sites during 1990–2014. We find a clear diurnal cycle both in the magnitude of ozone trends and in the relative importance of climate variability versus anthropogenic emissions to ozone changes. Interannual climate variability has mainly been associated with the detrended fluctuation in the US annual daytime ozone over 1990–2014, with a much smaller effect on the nighttime ozone. Reductions in anthropogenic emissions of nitrogen oxides have led to substantial growth in the US annual average nighttime ozone due to reduced ozone titration, while the summertime daytime ozone has declined. Environmental policymaking might consider further improvements to reduce ozone levels at night and other non-peak hours.

Malnutrition Is Common in Systemic Sclerosis: Results from the Canadian Scleroderma Research Group Database

2009 ◽  
Vol 36 (12) ◽  
pp. 2737-2743 ◽  
Author(s):  
MURRAY BARON ◽  
MARIE HUDSON ◽  
RUSSELL STEELE
Keyword(s):  
Systemic Sclerosis ◽  
Nutritional Status ◽  
Disease Severity ◽  
Research Group ◽  
Disease Duration ◽  
Physician Global Assessment ◽  
Multisystem Disease ◽  
Cross Sectional ◽  
Oral Aperture ◽  
Gi Symptoms

Objective.Systemic sclerosis (SSc) is a multisystem disease associated with significant morbidity and increased mortality. Little is known about nutritional status in SSc. We investigated the prevalence and demographic and clinical correlates of nutritional status in a large cohort of patients with SSc.Methods.This was a cross-sectional multicenter study of patients (n = 586) from the Canadian Scleroderma Research Group Registry. Patients were assessed with detailed clinical histories, medical examinations, and self-administered questionnaires. The primary outcome was risk for malnutrition using the “malnutrition universal screening tool” (MUST). Multiple logistic regression was used to assess the relationship between selected demographic and clinical variables and MUST categories.Results.Of the 586 patients in the study, MUST scores revealed that almost 18% were at high risk for malnutrition. The significant correlates of high malnutrition risk included the number of gastrointestinal (GI) complaints, disease duration, diffuse disease, physician global assessment of disease severity, hemoglobin, oral aperture, abdominal distension on physical examination, and physician-assessed possible malabsorption. Among 14 GI symptoms, only poor appetite and lack of a history of abdominal swelling and bloating predict MUST. These factors accounted for 24% of the variance in MUST scores.Conclusion.The risk for malnutrition in SSc is moderate and is associated with shorter disease duration, markers of GI involvement, and disease severity. Patients with SSc should be screened for malnutrition, and potential underlying causes assessed and treated when possible.

scholarly journals Ozone trends over the United States at different times of day

2017 ◽  
Author(s):  
Yingying Yan ◽  
Jintai Lin ◽  
Cenlin He
Keyword(s):  
United States ◽  
Climate Variability ◽  
The United States ◽  
Anthropogenic Emissions ◽  
Relative Importance ◽  
Annual Average ◽  
Substantial Growth ◽  
The Us ◽  
Ozone Trends ◽  
Interannual Climate Variability

Abstract. In the United States, the decline of summertime daytime peak ozone in the last 20 years has been clearly connected to reductions in anthropogenic emissions. Yet questions remain on how and through what mechanisms ozone at other times of day have changed over the recent decades. Here we analyze the interannual variability and trends of ozone at different hours of day, using observations from about 1000 US sites during 1990–2014. We find a clear diurnal cycle both in the magnitude of ozone trends and in the relative importance of climate variability versus anthropogenic emissions to ozone changes. Interannual climate variability has mainly been associated with the de-trended fluctuation in the US annual daytime ozone over 1990– 2014, with a much smaller effect on the nighttime ozone. Reductions in anthropogenic emissions of nitrogen oxides have led to substantial growth in the US annual average nighttime ozone due to reduced ozone titration, while the summertime daytime ozone has declined. Environmental policymaking might consider further improvements to reduce ozone levels at night and other non-peak hours.

scholarly journals US Policy towards the Maghreb: An Arduous Combination of Strategic Interests and Economic Stakes

2021 ◽  
Vol 1 (1) ◽  
pp. 10-47
Author(s):  
Belkacem Iratni
Keyword(s):  
United States ◽  
Middle East ◽  
North Africa ◽  
United States Of America ◽  
The United States ◽  
Energy Resources ◽  
Relative Importance ◽  
Policy Makers ◽  
The Us ◽  
Economic Assets

The relations of the United States of America (USA) with the Maghreb States are ancient, though intermittent and not very substantial. Globally, the Maghreb does not constitute a vital region for US strategic concerns. It is included broadly in what the American policy makers depict as the Middle East and North Africa (MENA) configuration and thus does not represent a specific or a peculiar zone for American involvement or responsibility.However, the Maghreb presents a relative importance in the US designs whether in terms of strategic concerns or economic assets, particularly with the worldwide emergence of terrorism. This care remains only provisory.Strategic alignments (Morocco and Tunisia) and energy resources (Algeria and Libya) have relatively attracted US attention to the Maghreb, but security matters, linked to the widespread of terrorism, have strengthened the relations between the two parties, without, however, upgrading their partnership to the level of vitally crucial dynamics, interdependent needs, and promising prospects.

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