Journal of Chronic Diseases (J Chron Dis)

Publications in this journal

• Article: Controlled clinical trials: an ethical imperative?

  W J Mackillop, P A Johnston
  Journal of Chronic Diseases 02/1987; 40(4):363-4.
• Article: Time-dependency in Cox's regression analysis.

  P G Mulder
  Journal of Chronic Diseases 02/1987; 40(4):365-6.
• Article: Screening and breast cancer.

  P Silcocks
  Journal of Chronic Diseases 02/1987; 40(4):367-8.
• Article: Etiologic fraction in case-control studies for the evaluation of screening.

  A J Sasco
  Journal of Chronic Diseases 02/1987; 40(4):368.
• Article: The science of quality of life.

  S Katz
  Journal of Chronic Diseases 02/1987; 40(6):459-63.
• Article: The place of psychosocial studies in medicine and surgery.

  R G Margolese
  Journal of Chronic Diseases 02/1987; 40(6):627-8.
• Article: Quality of life measurement in the clinical realm.

  D S Greer
  Journal of Chronic Diseases 02/1987; 40(6):629-30.
• Article: Clinimetric perspectives.

  A R Feinstein
  Journal of Chronic Diseases 02/1987; 40(6):635-40.
• Article: Whither preventive medicine?

  P R Burch
  Journal of Chronic Diseases 02/1987; 40(7):737-9.
• Article: Epidemiology's triple crown.

  D L Weed
  Journal of Chronic Diseases 02/1987; 40(9):905-6.
• Article: Ethics and informed consent.

  L Lasagna
  Journal of Chronic Diseases 02/1987; 40(3):277-8.
• Article: The concept of cause in disease.

  R A Stallones
  Journal of Chronic Diseases 02/1987; 40(3):279-80.
• Article: Using insurance claims to measure health status: The illness scale

  Jana M. Mossey, Leslie L. Roos
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  ABSTRACT: Health insurance systems are generating large numbers of claims filed by physicians and hospitals for reimbursement and accounting purposes. This paper describes and evaluates a measure of health status derived from physician and hospital claims filed for a sample of older Canadians during 1970–1977. Information on the number, type, and seriousness of reported diagnoses and the number and duration of hospitalizations and surgeries during each year were combined to generate annual Illness Scales ranging from 0 to 24. Alpha coefficients, measures of internal consistency, were between 0.82 and 0.84. Consistent with high validity, Illness Scale scores increased with age, were significantly associated with other health measures, and were strongly predictive of death and hospitalization in the following year. The ability to develop valid and reliable health status measures from insurance claims substantially expands the potential use of these data for research and evaluation.
  Journal of Chronic Diseases 02/1987;
• Article: Evaluation of quality of life in clinical trials of cardiovascular disease.

  A E Fletcher, B M Hunt, C J Bulpitt
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  ABSTRACT: There is an increasing interest in the use of quality of life methods to assess the benefits of treatment in cardiovascular disease. When selecting dimensions of quality of life and the instruments to measure these dimensions, the key issue is the detection of a response to treatment during the trial. The sensitivity of a variety of instruments appropriate to hypertension, angina and congestive heart failure is reviewed. Quality of life should be assessed in double blind randomized controlled trials. A Health Index must be included to take into account any mortality and morbidity occurring during the trial. Data are presented on the measurement of quality of life in patients taking placebo prior to entering trials of antihypertensive treatment. The variation with age, sex and nationality is discussed. Also reported are the results arising from observer bias in a single-blind trial.
  Journal of Chronic Diseases 02/1987; 40(6):557-69.
• Article: Health status and utility measurement viewed from the right brain: experience from the rheumatic diseases.

  M H Liang, C Robb-Nicholson
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  ABSTRACT: Questionnaires for measuring function, health status, and quality of life have been developed for the rheumatic and musculoskeletal disorders. These new measures are as valid and as reliable as traditional measures of clinical status in clinical trials and health services research and add a valuable dimension to outcome assessment. However, they have limitations for use in patient care. Questionnaires cannot determine the etiologic basis of functional disability; nor cover any one function in enough depth; nor deal with the relative nature of function; nor account for the differences in functional priorities. Questionnaires are statistical approaches and based on normative model; patient care is humanistic emphasizing differences. Nevertheless, the interaction between psychometric approaches and concerns of patient care is a necessary and desirable goal for all we seek to accomplish with clinical investigation.
  Journal of Chronic Diseases 02/1987; 40(6):579-83.
• Article: Morbidity during hospitalization: can we predict it?

  M E Charlson, F L Sax, C R MacKenzie, R L Braham, S D Fields, R G Douglas
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  ABSTRACT: Physicians use the concept of stability to estimate the likelihood that a patient will deteriorate during a hospitalization. To determine whether physicians can accurately predict a patient's risk of morbidity, 603 patients admitted to the medical service during a one month period were rated prospectively as to how stable they were. Overall, 15% of patients had deterioration of already compromised systems, while 17% had new complications, such as sepsis. Eight percent of patients had both. Twelve percent of stable patients experienced morbidity; 39% of the somewhat unstable and 61% of the most unstable. When all of the demographic and clinical variables were taken into account including the reason for admission and comorbid diseases, the residents' estimates of the patient's stability was the most significant predictor of morbidity (p less than 0.001). The judgment that a patient was stable had an 87% negative predictive accuracy, while the judgment unstable had a 46% positive predictive accuracy.
  Journal of Chronic Diseases 02/1987; 40(7):705-12.
• Article: Mortality in the beta blocker heart attack trial: circumstances surrounding death.

  R W Peters, R Byington, D Arensberg, L M Friedman, D W Romhilt, A Barker, C Laubach, G W Wilner, S Goldstein
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  ABSTRACT: In the Beta Blocker Heart Attack Trial, a double blind, randomized, controlled study, patients taking propranolol (180 or 240 mg/day) initiated 5-21 days post myocardial infarction had 26% fewer deaths than those taking placebo over a 25 month (mean) followup. Detailed analysis of the circumstances surrounding the BHAT deaths failed to reveal any striking difference between propranolol and placebo in the type of clinical event preceding death, the incidence and type of acute and prodromal signs and symptoms, the location of death, the activity preceding death or the percentage of deaths that were sudden or instantaneous, suggesting that propranolol may exert an "across the board" effect and improve survival by a combination of mechanisms. An unexpected finding was that the protective effect of propranolol appeared to occur during the hours of 10 p.m. to 7 a.m.
  Journal of Chronic Diseases 02/1987; 40(1):75-82.
• Article: Reintegration to Normal Living as a proxy to quality of life.

  S Wood-Dauphinee, J I Williams
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  ABSTRACT: The impact of disease and treatment on patients' lives is frequently measured by endpoints such as health status, well being and quality of life. The objective of this paper is to introduce a new but related outcome concept termed "reintegration to normal living" and to compare it to the quality of life. The concept of "reintegration" is closely allied to functional performance. Like quality of life, it is important to measure when therapeutic goals cannot include a cure but are directed at controlling the disease process or fostering compensation for impairment. A Reintegration to Normal Living (RNL) Index has been developed. Although more limited in conceptual focus, its content is similar to global quality of life measures. It is internally consistent, demonstrates content and construct validity, can be completed by patients or significant others and is sensitive to changes in patient status. The degree of reintegration achieved by patients after an incapacitating illness is seen as contributing to the quality of their lives.
  Journal of Chronic Diseases 02/1987; 40(6):491-502.
• Article: Estimation of myocardial infarction mortality from routinely collected data in Western Australia.

  C A Martin, M S Hobbs, B K Armstrong
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  ABSTRACT: The accuracy of routinely collected mortality data for ischemic heart disease (IHD) as indicators of death from acute myocardial infarction (AMI) was assessed in ages 25-64 years, according to the WHO criteria defined in 1983. Cases were identified from computer records (linked for individuals) of all death certificates and hospital discharges in Western Australia between 1971 and 1982. Where the official cause was IHD about 90% of deaths fulfilled the WHO criteria for definite or possible AMI. Up to 10% of fatal cases of definite or possible AMI were coded to other causes in the official death statistics, however it appeared that variations in this figure with changes in coding practices could cause appreciable bias in the estimation of secular trends in IHD mortality. This problem could largely be overcome by reviewing fatal events where the death certificate was coded to one of a limited number of other ICD rubrics.
  Journal of Chronic Diseases 02/1987; 40(7):661-9.
• Article: Representativeness of the Framingham risk model for coronary heart disease mortality: a comparison with a national cohort study.

  P E Leaverton, P D Sorlie, J C Kleinman, A L Dannenberg, L Ingster-Moore, W B Kannel, J C Cornoni-Huntley
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  ABSTRACT: The Framingham Heart Study has been the foundation upon which several national policies regarding risk factors for coronary heart disease mortality are based. The NHANES I Epidemiologic Followup Study is the first national cohort study based upon a comprehensive medical examination of a probability sample of United States adults. The average follow-up time was 10 years. This study afforded an opportunity to evaluate the generalizability of the Framingham risk model, using systolic blood pressure, total cholesterol, and cigarette smoking, to the U.S. population with respect to predicting death from coronary heart disease. The Framingham model predicts remarkably well for this national sample. The major risk factors for coronary heart disease mortality described in previous Framingham analyses are applicable to the United States white adult population.
  Journal of Chronic Diseases 02/1987; 40(8):775-84.