Gender, body mass index and rheumatoid arthritis disease activity: results from the QUEST-RA Study.

OBJECTIVES: To investigate whether body mass index (BMI), as a proxy for body fat, influences rheumatoid arthritis (RA) disease activity in a gender-specific manner. METHODS: Consecutive patients with RA were enrolled from 25 countries into the QUEST-RA program between 2005 and 2008. Clinical and demographic data were collected by treating rheumatologists and by patient self-report. Distributions of Disease Activity Scores (DAS28), BMI, age, and disease duration were assessed for each country and for the entire dataset; mean values between genders were compared using Student's t-tests. An association between BMI and DAS28 was investigated using linear regression, adjusting for age, disease duration and country. RESULTS: A total of 5,161 RA patients (4,082 women and 1,079 men) were included in the analyses. Overall, women were younger, had longer disease duration, and higher DAS28 scores than men, but BMI was similar between genders. The mean DAS28 scores increased with increasing BMI from normal to overweight and obese, among women, whereas the opposite trend was observed among men. Regression results showed BMI (continuous or categorical) to be associated with DAS28. Compared to the normal BMI range, being obese was associated with a larger difference in mean DAS28 (0.23, 95% CI: 0.11, 0.34) than being overweight (0.12, 95% CI: 0.03, 0.21); being underweight was not associated with disease activity. These associations were more pronounced among women, and were not explained by any single component of the DAS28. CONCLUSIONS: BMI appears to be associated with RA disease activity in women, but not in men.

Mobile health and wellness application framework.

OBJECTIVES: There is an increasing need for user-friendly and interoperable mobile applications in health and wellness domain. The objective of this work has been to provide support for rapid and cost-effective development of such applications. METHODS: We have introduced an application framework which provides a generic tool for mobile application designers. We have demonstrated the usage of the application framework by providing an example implementation and demonstrating its usage in a Tele-ECG use case. In order to support interoperability we propose a solution compatible with clinical document standards such as the HL7 CDA. RESULTS: A new mobile platform applicable for a wide range of telemedicine and wellness applications is introduced. The platform provides connectivity between healthcare professionals, patients and measurement devices. It is based on an open application framework that provides interfaces for measurement, user interface, database and network connectivity implementations. CONCLUSIONS: Mobile application development based on the application framework was demonstrated successfully. The developed UPHIAC platform adopts a new technical approach using a local database solution for caching of information at the mobile terminal. The platform applies a document-based approach providing a versatile and reliable way of sharing and collaboratively complementing of health information including standard information model documents (HL7/CDA), and integration with health information systems and personal storages. The implemented mobile tele-ECG case demonstrates the overall function of the platform. The platform can be used as a basis for developing new applications for specific purposes.