When You Can't Walk a Mile: Walking Limitation Prevalence and Associations Among Middle-Aged and Older US Adults with Arthritis: A Cross-Sectional, Population-Based Study.

OBJECTIVE: We examined walking limitations and associated characteristics among middle-aged and older US adults with arthritis, overall, and by sex. METHODS: Using 2005-2006 Arthritis Conditions and Health Effects Survey (ACHES) data (n = 1793), we estimated "a lot" and "any" ("a lot" or "a little" combined) walking limitation for more than 1 mile (1.6 km) among US adults 45 years or older with arthritis and examined associations (sociodemographics, arthritis symptoms and effects, psychosocial measures, and physical health) with walking limitations in unadjusted and multivariable (MV) adjusted logistic regression models using prevalence ratios (PRs) and 95% confidence intervals, accounting for the complex survey design. RESULTS: Respondents frequently reported "a lot" (48%) and "any" (72%) limitation for more than 1 mile. Women reported higher prevalence of all levels of walking limitation versus men (eg, 51% vs 42% for "a lot" overall); additionally, the gap for walking limitations between women and men widened with age. Limitation was high for both sexes at all ages, affecting 1-in-3 to 4-in-5, depending on level of walking limitation. The strongest MV associations for "a lot" of walking limitation among all respondents included substantial and modest arthritis-attributable life interference (PR = 2.5 and 1.6, respectively), age 75 years or older (PR = 1.5), and physical inactivity and fair/poor self-rated health (PR = 1.4 for both). CONCLUSION: Walking limitations among middle-aged and older adults are substantial. Existing proven interventions that improve walking ability and physical function may help this population to reduce and delay disability.

Associations of Arthritis-Attributable Interference with Routine Life Activities: A Modifiable Source of Compromised Quality-of-Life.

OBJECTIVE: Arthritis patients experience the impact of disease beyond routinely assessed clinical measures. We characterized arthritis-attributable interference in four important routine life domains: 1) recreation/leisure/hobbies; 2) household chores; 3) errands/shopping; and 4) social activities. METHODS: Participants were from the Arthritis Conditions Health Effects Survey (2005-2006), a cross-sectional survey of noninstitutionalized US adults 45 years or older with doctor-diagnosed arthritis (n = 1793). We estimated the prevalence of "a lot" of arthritis-attributable interference and quantified the associations between sociodemographic, clinical, and psychological characteristics and "a lot" of arthritis-attributable interference (vs "a little" or "none") in each domain using prevalence ratios (PRs) in multivariable (MV)-adjusted logistic regression models. RESULTS: An estimated 1 in 5 to 1 in 4 adults with arthritis reported "a lot" of arthritis-attributable interference in recreation/leisure/hobbies (27%), household chores (25%), errands/shopping (22%), and social activities (18%). The highest prevalence of "a lot" of arthritis-attributable interference was for those unable to work/disabled or reporting severe arthritis symptoms (pain, stiffness, fatigue), anxiety, depression, or no/low confidence in ability to manage arthritis, across domains. In MV-adjusted models, those unable to work/disabled, currently seeing a doctor, or reporting fair/poor self-rated health, severe joint pain, anxiety, or no/low confidence in ability to manage arthritis were more likely to report arthritis-attributable interference than their respective counterparts. Magnitudes varied by domain but were consistently strongest for those unable to work/disabled (MV PR range = 1.8-2.5) and with fair/poor health (MV PR range = 1.7-2.7). CONCLUSION: Many characteristics associated with arthritis-attributable interference in routine life activities are potentially modifiable, suggesting unmet need for use of existing evidence-based interventions that address these characteristics and reduce interferences to improve quality of life.

Annual incidence rates of hip symptoms and three hip OA outcomes from a U.S. population-based cohort study: the Johnston County Osteoarthritis Project.

OBJECTIVE: Estimate annual incidence rates (IRs) of hip symptoms and three osteoarthritis (OA) outcomes (radiographic, symptomatic, and severe radiographic) overall and by race, sociodemographic characteristics, and hip OA risk factors. DESIGN: Analyze baseline (1991-1997) and first follow-up (1999-2003) data (n = 1446) from the Johnston County Osteoarthritis Project, a population-based, prospective study of adults ≥45 years in North Carolina. Hip symptoms were pain, aching, and/or stiffness on most days, or groin pain. Radiographic and severe radiographic OA were Kellgren-Lawrence (KL) grades ≥2 and ≥3, respectively. Symptomatic OA was radiographic OA with symptoms in the same hip. Sociodemographics were age, gender, race, highest attained education, and annual household income. Hip OA risk factors were self-reported body mass index (BMI) at age 18 years, clinically measured BMI at baseline, and history of hip injury. RESULTS: Annual IRs (median = 5.5 years follow-up) were 37, 23, 13, and 2.9 per 1000 person-years for hip symptoms, and radiographic, symptomatic, and severe radiographic hip OA, respectively. We found low IRs of radiographic and symptomatic hip OA among African Americans and high IRs of hip symptoms among the obese and the very poor. Across outcomes, IRs were highest for those with hip injury. CONCLUSION: No prior studies have reported IRs of hip symptoms; IRs of radiographic and severe radiographic hip OA were similar to, and the IR of symptomatic hip OA was higher than, previous estimates. Prevention efforts should target low socioeconomic status (SES) populations and obese adults; interventions for hip OA and hip symptoms are imperative for those with hip injuries.

Meeting physical activity guidelines and the risk of incident knee osteoarthritis: a population-based prospective cohort study.

OBJECTIVE: Knee osteoarthritis (OA) is a leading cause of disability and joint pain. Although other risk factors of knee OA have been identified, how physical activity affects incident knee OA remains unclear. METHODS: Using data from the first (1999-2004) and second (2005-2010) followup periods of the Johnston County Osteoarthritis Project study, we tested the association between meeting physical activity guidelines and incident knee outcomes among 1,522 adults ages ≥45 years. The median followup time was 6.5 years (range 4.0-10.2 years). Physical activity at baseline (moderate-equivalent physical activity minutes/week) was calculated using the Minnesota Leisure Time Physical Activity questionnaire. Incident knee radiographic OA (ROA) was defined as the development of Kellgren/Lawrence grade ≥2 in a knee at followup. Incident knee symptomatic ROA (sROA) was defined as the development of ROA and symptoms in at least 1 knee at followup. Weibull regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for interval-censored data. RESULTS: In multivariable models, meeting the 2008 Department of Health and Human Services (HHS) physical activity guidelines (≥150 minutes/week) was not significantly associated with ROA (HR 1.20 [95% CI 0.92-1.56]) or sROA (HR 1.24 [95% CI 0.87-1.76]). Adults in the highest level (≥300 minutes/week) of physical activity had a higher risk of knee ROA and sROA compared with inactive (0 to <10 minutes/week) participants; however, these associations were not statistically significant (HR 1.62 [95% CI 0.97-2.68] and HR 1.42 [95% CI 0.76-2.65], respectively). CONCLUSION: Meeting the HHS physical activity guidelines was not associated with incident knee ROA or sROA in a cohort of middle-aged and older adults.

One in four people may develop symptomatic hip osteoarthritis in his or her lifetime.

OBJECTIVE: To estimate the lifetime risk of symptomatic hip osteoarthritis (OA). DESIGN: We analyzed data from the Johnston County Osteoarthritis Project [a longitudinal population-based study of OA in North Carolina, United States (n=3068)]. The weighted baseline sample comprised 18% blacks and 54% women, and the mean age was 63 years (range=45-93). Symptomatic hip OA was defined as a Kellgren-Lawrence (K-L) radiographic score of ≥ 2 (anterior-posterior pelvis X-rays) and pain, aching or stiffness on most days, or groin pain, in the same hip. Lifetime risk, defined as the proportion who developed symptomatic hip OA in at least one hip by age 85, among people who live to age 85, was modeled using logistic regression with repeated measures (through generalized estimating equations). RESULTS: Lifetime risk of symptomatic hip OA was 25.3% [95% confidence interval (CI)=21.3-29.3]. Lifetime risk was similar by sex, race, highest educational attainment, and hip injury history. We studied lifetime risk by body mass index (BMI) in three forms: at age 18; at baseline and follow-up; and at age 18, baseline and follow-up and found no differences in estimates. CONCLUSION: The burden of symptomatic hip OA is substantial with one in four people developing this condition by age 85. The similar race-specific estimates suggest that racial disparities in total hip replacements are not attributable to differences in disease occurrence. Despite increasing evidence that obesity predicts an increased risk of both hip OA and joint replacement, we found no association between BMI and lifetime risk.

Characterization of monoclonal antibodies raised against recombinant respiratory syncytial virus nucleocapsid (N) protein: identification of a region in the carboxy terminus of N involved in the interaction with P protein.

To investigate structure and biological properties of the nucleocapsid (N) protein of respiratory syncytial virus (RSV), we have generated a panel of 16 monoclonal antibodies, raised against recombinant N protein, and epitope mapped seven of these to three antigenic sites (Site I aa 16-30; Site II aa 341-350; Site III aa 351-365). Characterization by immunofluorescence and by immunoprecipitation assay demonstrated that a monoclonal antibody to antigenic site I can detect N protein complexed with phospho (P) protein. Antibodies to antigenic sites II and III, which are adjacent to each other near the carboxyl terminus of the N protein, have distinct properties. A site III monoclonal antibody detected N protein in cytoplasmic inclusion bodies and in the cytosol, but not when N was complexed to P protein, while the site II antibody reacted with N protein in the nucleocapsid fraction but did not detect cytosolic N protein. Further investigation into the reactivities of the antibodies after binding of P to N in vitro demonstrated that antigenic sites II and III were blocked by the interaction, indicating an involvement for the carboxy domain of N in the N-P interaction. This was confirmed by the ability of peptides from the carboxy terminus of N to inhibit the N-P interaction in vitro.

The effects of event rate and signal probability on children's vigilance.

Using the study of vigilance in adults as their model, the researchers examined task parameters and their interactions in a study of sustained attention in children from a non-clinical population. Two levels of event rate (low and high) were combined with two levels of signal probability (low and high) in 14-minute vigilance tasks in which children viewed small and large squares presented successively on a computer screen. Seven- and eight-year-old children were instructed to press a button whenever a small square appeared. Signal detection analyses were employed, as well as the traditional measures identifying hits, false alarms, and reaction time. The results support the traditional findings in adult tasks: participants performed most accurately and quickly in the high event rate and high probability condition; low probability elicited a more conservative decision-making criterion, a standard characterized by less willingness to risk false alarms; such conservatism increased over the periods of watch; and the vigilance decrement emerged over time. However, the finding that the high event rate condition improved perceptual sensitivity reversed the event rate effect consistently reported in the adult literature. The above findings are discussed in light of both research and clinical implications.

Screening for child-reported behavioral and emotional problems in primary care pediatrics.

In light of the findings that mother-completed checklists do not adequately reflect children's perceptions of their own adjustment, two child-completed questionnaires were assessed as screening measures for behavioral or emotional problems with 50 children seen for well-child examinations. Case criterion was child-reported DSM-III symptoms through a clinical interview. Support was provided for the Revised Children's Manifest Anxiety Scale but not the Children's Depression Inventory as a child-reported screening measure. Moreover, the findings indicated that both mother-completed and child-completed measures are needed to screen adequately for behavioral or emotional problems of children seen in a primary care pediatric clinic.

Screening for behavioral and emotional problems in primary care pediatrics.

Case identification indexes based on the mother-completed Missouri Children's Behavior Checklist (MCBC) were compared with pediatrician identification of behavioral and emotional problems in 41 children seen for well-child examinations. Case identification indexes also were examined as a function of child gender and age and maternal education. The criterion was presence of DSM-III diagnoses determined through Child Assessment Schedule interviews of child or mother. The MCBC yielded better case identification indexes and improvements in both overidentification and underidentification rates. Pediatrician identification indexes were directly related to maternal education and MCBC identification indexes were inversely related to child age. The findings indicate the necessity for including child report, as well as mother report, in screening procedures that are incorporated into primary care pediatric practice.

Mother-child agreement on the child assessment schedule with nonreferred children: a research note.

This study replicated with nonreferred children the finding with psychiatrically referred children that mother-child concordance was a function of symptom type. Low mother-child concordance for internalizing problems and moderate concordance for externalizing problems characteristic of psychiatric samples was found to generalize to nonreferred children. Furthermore, mother-child concordance was also found to be a function of child gender and age. The implications of these findings for screening or assessment of nonreferred children were examined.

The Missouri Children's Behavior Checklist behavioral classification system: a construct validity study with nonreferred children.

This study provides validity information about the Missouri Children's Behavior Checklist (MCBC) classifications system with nonreferred children. MCBC behavior patterns of 41 children were related to DSM-III symptomatology ascertained through a structured clinical interview, the Child Assessment Schedule, conducted with the mother. The findings indicated that considering the Undifferentiated Disturbance pattern as an indicator of poor adjustment may be unwarranted with nonreferred children.

Movement of broiler chickens reared in commercial conditions.

1. Bird movement was studied at various ages in two flocks of 18,200 broiler chickens. 2. One-d-old chicks placed in corners of a 29 x 14 m brooding area dispersed evenly over the whole area in a period of 48 h. 3. At 15 d of age, when released from the brooding area, birds which were among the first to move to the far end of the house did not necessarily remain in that area of the house. 4. Starting at 4 and 5 weeks of age, birds marked individually were variable in their movement throughout the house during a 16- and 9-d period respectively. Even the least mobile individual covered an area of the house containing several thousand birds. 5. Closer scrutiny of movement by individual birds showed that some moved over areas of 20 m2 in an hour. Birds moved further than was necessary simply to reach food and water. No agonistic interactions were observed and there was no evidence that crowding was a physical restraint on bird movement. 6. Results indicated that birds were not generally attached to a particular site in the shed and that social factors did not restrict movement. Some implications of bird movement are discussed with regard to performance, welfare and leg abnormalities.

Food availability and the feeding and drinking behaviour of broiler chickens grown commercially.

1. Field observations were made on the effect of food depth in pans on the feeding and drinking behaviour of commercially grown broiler chickens aged between 17 and 43 d. 2. The group of birds receiving less food in pans had longer visits to the pans, occupied their feeding space more completely, evicted each other more often from pans and were more 'competitive' and less 'relaxed' when feeding. 3. These observations provide data about the feeding and drinking behaviour of broiler chickens reared in commercial conditions and emphasise how environmental factors, particularly food management, can influence bird behaviour. 4. The potential for qualitative and quantitative changes of feeding behaviour to affect performance is also discussed.

The objective structured interview for medical student selection.

An objective structured interview is an integral part of the process of selecting and admitting applicants to study medicine at this university. During the nine years (to the end of 1986) that the interview has been used 1600 candidates were interviewed out of roughly 13,000 applicants, and from these, 584 students were admitted to the course. Analysis of the interview data was carried out based on two aspects of student progress: graduation with honours and failure to complete the course of study. The interview as a whole, and especially some of the subscales, appears to identify students who may fail to complete the course: it may also help to predict which students are likely to graduate with honours.