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Biomedical subjects

T Ostbye

Publications and source records attributed to T Ostbye.

At least 37 records · Page 2Linked to original sources
PubMed1999

Predictors of five-year mortality in older Canadians: the Canadian Study of Health and Aging.

OBJECTIVE: Based on the Canadian Study of Health and Aging (CSHA), to determine the importance of cognitive status, sociodemographic factors, functional status, and other health related factors as predictors of 5-year overall mortality in older Canadians. DESIGN, SETTING AND PARTICIPANTS: Two partially overlapping groups from the Canadian Study of Health and Aging (1991) were identified: (1) older people living in the community (n = 8949) who had a screening interview (larger sample, fewer variables) and (2) older people who underwent an extensive clinical examination (smaller sample, more objective variables; n = 2914). Deaths in the subsequent 5 years were determined from death certificates and interviews with the caregivers. Multivariate logistic regression models, with death within 5 years as the outcome, were developed separately for men and women. Predictor variables were introduced in the following groups: sociodemographic factors, physical and cognitive status, and physical illnesses and life style factors. Parallel models were developed for the screening sample and for the clinical sample. RESULTS AND DISCUSSION: Five-year mortality ranged from 10.0% (women aged 65-74 living in the community) to 88.1% (men aged 85 and older living in institutions). Multivariate models showed that the odds of death within 5 years increased with age. This effect remained after adjustment for all other variables. Odds of death increased with institutionalization and with increasing cognitive and physical impairment. Although vision and hearing problems and the presence of heart disease, stroke, and diabetes were all strongly related to 5-year mortality in univariate, unadjusted analyses, their contributions were minimal in the multivariate analyses. Increased Body Mass Index was associated with lower mortality in both univariate and multivariate analyses. CONCLUSIONS: This population-based study supported the importance of gender, age, functional status, cognition, and health status in predicting 5-year mortality, and after accounting for cognitive status, physical status, and specific disease variables, the difference in mortality between older people in the community and in institutions was reduced. Knowledge about survival and prognosis is important not only for the planning of long-term facilities and home care, but it can also be helpful for clinical decision-making and for family and caregivers.

Aged↗
PubMed1999

Plasma exchange in rapidly progressive renal failure due to multiple myeloma. A retrospective case series.

BACKGROUND/AIMS: To evaluate the effect of plasma exchange on renal function in patients with rapidly progressive renal failure secondary to multiple myeloma. METHODS: The study was done through a retrospective chart review using a standardized form at a tertiary care centre in southwestern Ontario. Patients were included in the study if they had a diagnosis of multiple myeloma and rapidly progressive renal failure. Multiple myeloma was defined by a bone marrow aspirate >15% plasma cells plus one of the following: serum monoclonal paraproteins, monoclonal light-chain excretion, or lytic lesions. Patients were excluded if they had evidence of chronic renal failure or failed to complete three plasma exchanges. Twenty-six patients were reviewed; of these 24 were followed up to 1 year. All patients received hydration, standard chemotherapy, and plasma exchange. The plasma exchange volume was 50 ml/kg of 50% normal saline and 50% human serum albumin. Primary outcome measures included (1) prevention of acute dialysis and (2) prevention of progression from acute to chronic dialysis; secondary end points included (1) a decrease in creatinine of 25% or more within 3 months of the last plasma exchange and (2) survival at 1 year. RESULTS: Sixteen of 24 patients, followed up to 1 year, did not require dialysis. Two patients required dialysis initially, but were able to come off dialysis after 3 months. Fourteen patients were alive at 1 year, 13 of whom were dialysis independent. Twelve of 13 dialysis-independent patients had a >25% reduction in creatinine at 3 months. Two patients were lost to follow-up after discharge and were not included in the analysis. CONCLUSIONS: This retrospective study suggests that plasma exchange may offer some benefit in preventing the initiation or continuation of dialysis in patients with rapidly progressive renal failure secondary to multiple myeloma. A randomized controlled prospective study is needed to determine whether plasma exchange should be recommended as a standard treatment for patients with rapidly progressive renal failure due to multiple myeloma.

Acute Kidney Injury↗
PubMed1999

Testing an instrument to screen for fibromyalgia syndrome in general population studies: the London Fibromyalgia Epidemiology Study Screening Questionnaire.

OBJECTIVE: To develop and test an instrument to screen for fibromyalgia syndrome (FM) in general population surveys. METHODS: We designed a questionnaire with 4 pain and 2 fatigue items. A positive screen was defined 2 ways: (1) positive responses to all 4 items on pain, and (2) positive responses to all pain and fatigue items. Sensitivity was tested in the clinic on 31 outpatients with FM, specificity on 30 outpatients with rheumatoid arthritis (RA) and 30 healthy controls. Test-retest reliability (TRR) was estimated in a community survey of 672 noninstitutionalized adults. Positive predictive value (PPV) was estimated as part of a community survey of 3395 noninstitutionalized adults, in which 100 cases of FM were confirmed by examination. RESULTS: For pain criteria alone sensitivity was 100% (95% confidence intervals 90.3%, 100%); in patients with RA specificity was 53.3% (35.4%, 71.2%). For the pain plus fatigue criteria, sensitivity was 93.5% (83.8%, 100%), and specificity in patients with RA 80% (65.7%, 94.3%). In nonpatient controls, specificity was 100% (89.3%, 100%) using either definition of a positive screen. For those initially screening negative, TRR was 100% (93.2%, 100%) using either definition. For positive screens, TRR was 95.0% (88.8%, 100%) for the pain criteria alone, and 81.0% (69.1%, 92.8%) for the combined criteria. PPV was 56.8% (53.0%, 60.6%) using the pain criteria alone, and 70.6% (CI 55.3%, 85.9%) using the combined criteria. CONCLUSION: The instrument appears to be useful in screening for FM in general population surveys of noninstitutionalized adults. Confirmation of FM among those who screen positive requires a personal interview to reestablish pain duration and distribution, and an examination for tender points.

Adult↗
PubMed1999

The London Fibromyalgia Epidemiology Study: direct health care costs of fibromyalgia syndrome in London, Canada.

OBJECTIVE: To estimate direct health care costs associated with fibromyalgia (FM) within a representative community sample. METHODS: A random sample of 3395 noninstitutionalized adults was screened for widespread pain. Individuals screening positive were examined for FM. Direct health care costs were compared among those with confirmed FM (FM cases, FC), those with widespread pain not having FM (pain controls, PC), controls without widespread pain (general controls, GC), and a random sample of age, sex and geographically matched controls from the Ontario Health Insurance Plan database (OHIP controls, OC). RESULTS: One hundred FC (86 women) were compared to 76 PC subjects, 135 GC, and 380 OC. FC used more medications and outpatient health services than PC subjects, and about twice the health services at twice the cost compared to GC and OC. The mean difference in direct costs for health services between FC and OC was $493 Cdn annually (p<0.001). CONCLUSION: FM has a major effect on direct health care costs.

Adult↗
PubMed1999

The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario.

OBJECTIVE: To estimate the point prevalence of fibromyalgia syndrome (FM) among noninstitutionalized Canadian adults; and to assess the effect of demographic variables on the odds of having FM. METHODS: A screening questionnaire was administered via telephone to a random community sample of 3395 noninstitutionalized adults residing in London, Ontario. Individuals screening positive were invited to be examined by a rheumatologist to confirm or exclude FM using the 1990 American College of Rheumatology classification criteria. RESULTS: One hundred confirmed cases of FM were identified, of whom 86 were women. Mean age among FM cases was 49.2 years among women, 39.3 years among men (p < 0.02). FM affects an estimated 4.9% (95% CI 4.7%, 5.1%) of adult women and 1.6% (1.3%, 1.9%) of adult men in London, for a female to male ratio of roughly 3 to one. In women, prevalence rises steadily with age from < 1% in women aged 18-30 to almost 8% in women 55-64. Thereafter, it declines. The peak prevalence in men also appears to be in middle age (2.5%; 1.1%, 5.7%). FM affects 3.3% (3.2%, 3.4%) of noninstitutionalized adults in London. Female sex, middle age, less education, lower household income, being divorced, and being disabled are associated with increased odds of having FM. CONCLUSION: FM is a common musculoskeletal disorder among Canadian adults, especially among women and persons of lower socioeconomic status.

Adolescent↗
PubMed1999

The London Fibromyalgia Epidemiology Study: comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia versus controls.

OBJECTIVE: To identify demographic and clinical features that distinguish fibromyalgia (FM) from other chronic widespread pain. METHODS: We identified 100 confirmed FM cases, 76 widespread pain controls, and 135 general controls in a random community survey of 3395 noninstitutionalized adults living in London, Ontario. FM cases were distinguished from pain controls using the 1990 American College of Rheumatology (ACR) classification criteria for FM. RESULTS: The mean age of FM cases was 47.8 years (range 19 to 86), the same as for pain controls; 86% of FM cases were female versus 67.1% of pain controls (p < 0.01). FM cases were less educated than general controls (p = 0.03). Male and female FM cases were similar, except females were older and reported more major symptoms (both p = 0.02). FM cases reported more severe pain and fatigue, more symptoms, more major symptoms, and worse overall health than pain controls or general controls. The most commonly reported major symptoms among FM cases were musculoskeletal pain (77.3%), fatigue (77.3%), severe fatigue lasting 24 h after minimal activity (77.0%), nonrestorative sleep (65.7%), and insomnia (56.0%). Subjects with 11-14 tender points were more similar to those with 15-18 tender points than to those with 7-10 points in 11 of 14 clinical variables. On multivariate analysis, 4 symptoms distinguished FM cases from pain controls: pain severity (p = 0.004), severe fatigue lasting 24 h after minimal activity (p = 0.006), weakness (p = 0.008), and self-reported swelling of neck glands (p = 0.01). CONCLUSION: In the general population, adults who meet the ACR definition of FM appear to have distinct features compared to those with chronic widespread pain who do not meet criteria.

Adult↗
PubMed1998

[Electronic house call].

Telemedicine technology will soon be widely available in physicians' surgeries and patients' homes. In this article we discuss the broader implications of its widespread use among physicians, patients, and society as a whole, focusing on the main vehicle of communication between physician and patient; the "electronic home visit" or "electronic house call". After exploring the new relationship that is likely to develop between patients and physicians as a consequence of the use of telemedicine, we then discuss the anticipated broader social, economic and legal consequences of the widespread use of this technology.

Home Care Services, Hospital-Based↗
PubMed1997

The effect of different diagnostic criteria on the prevalence of dementia.

BACKGROUND: There are several widely used sets of criteria for the diagnosis of dementia, but little is known about their degree of agreement and their effects on estimates of the prevalence of dementia. METHODS: We examined 1879 men and women 65 years of age or older who were enrolled in the Canadian Study of Health and Aging and calculated the proportion given a diagnosis of dementia according to six commonly used classification systems: the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), third edition (DSM-III), the third edition, revised of the DSM (DSM-III-R), the fourth edition of the DSM (DSM-IV), the World Health Organization's International Classification of Diseases (ICD), 9th revision (ICD-9) and 10th revision (ICD-10), and the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). The degree of concordance among classification schemes and the importance of various factors in determining diagnostic agreement or disagreement were examined. RESULTS: The proportion of subjects with dementia varied from 3.1 percent when we used the criteria of the ICD-10 to 29.1 percent when the DSM-III criteria were used. The six classification systems identified different groups of subjects as having dementia; only 20 subjects were given a diagnosis of dementia according to all six systems. The classifications based on the various systems differed little according to the patients' age, sex, educational level, or status with respect to institutionalization. The factors that most often caused disagreement in diagnosis between DSM-III and ICD-10 were long-term memory, executive function, social activities, and duration of symptoms. CONCLUSIONS: The commonly used criteria for diagnosis can differ by a factor of 10 in the number of subjects classified as having dementia. Such disagreement has serious implications for research and treatment, as well as for the right of many older persons to drive, make a will, and handle financial affairs.

Aged↗
PubMed1997

A new primary care rostering and capitation system in Norway: lessons for Canada?

Providing every patient with a personal primary care physician or, from the physician's perspective, establishing a stable roster or list of patients is currently being actively debated in Canada. Norway's system of primary care medicine, similar to Canada's, faces many of the same problems. In 1992 a trial rostering system with blended funding (capitation, fee-for-service and user fees) was established in 4 Norwegian municipalities. After 3 years of close monitoring, the results of system evaluations have attracted strong interest. This article reports on the benefits and problems encountered with the new rostering system in Norway. If Canada is moving in the same direction, some of the lessons learned may be helpful.

Canada↗
PubMed1997

Post-term birth: risk factors and outcomes in a 10-year cohort of Norwegian births.

OBJECTIVE: To identify factors associated with post-term birth and factors associated with adverse outcomes in post-term births. METHODS: The sample was a 10-year cohort (1978-1987) of term (n = 379,445) and post-term (n = 65,796) births from the Medical Birth Registry of Norway. Gestational age was based on mothers' recall of the last menstrual period. Multivariate analyses included proportional hazards regression and binomial logistic regression. RESULTS: After controlling for covariates, there was only a slightly increased risk of perinatal mortality in post-term as compared with term births (adjusted relative risk [RR] 1.11; 95% confidence interval [CI] 0.97, 1.27). For post-term births, risk factors for perinatal mortality were small size for gestational age (SGA) (adjusted RR 5.68; 95% CI 4.37, 7.38) and maternal age 35 years or older (adjusted RR 1.88; 95% CI 1.22, 2.89), whereas large size for gestational age (LGA) was a protective factor (adjusted RR 0.51; 95% CI 0.26, 1.00). Similar risk factor RRs were found for perinatal mortality in term births. Fetal distress was associated with both SGA and post-term birth; labor dysfunction and obstetric trauma were associated with both LGA and post-term birth; shoulder dystocia and maternal hemorrhage were associated with LGA only. CONCLUSIONS: Among post-term births, maternal complications were generally associated with larger fetal size, and fetal complications were associated with smaller fetal size. The evidence for an adverse impact on perinatal mortality of post-term birth is weak once other factors are taken into account.

Adult↗
PubMed1997

Throw that epidemiologist out of the emergency room! Using the television series ER as a vehicle for teaching methodologists about medical issues.

BACKGROUND: Epidemiology and biostatistics graduate students have diverse backgrounds, but many have little prior training in medicine or biology. This lack of content knowledge in future health researchers has recently been raised as a concern. METHODS: As part of a graduate course on the epidemiology of major diseases, the television series ER was used as a vehicle for learning more about diseases in general, and to become familiar with medical terminology and the ICD-10 by practicing coding on the patients seen. Furthermore, we wanted to provide human faces to the type of disease data students usually work with. RESULTS: In this article, the authors discuss how the ER sessions were organized and the problems that were encountered. The course evaluation concluded that the students found the exercise to be an interesting break from regular teaching.

Adult↗
PubMed1997

Health behaviours and socio-economic status in Ontario, Canada.

Data from the 1990 Ontario Health Survey were used to investigate the association of socioeconomic status with the likelihood of meeting current recommendations for four health behaviours (smoking, fat intake, alcohol consumption, and physical activity level) in adults living in Ontario (Canada). Health behaviours were categorised as 'unhealthy' if they did not meet current recommendations in Ontario (smoking, fat intake > 30% of dietary energy, alcohol intake > 14 units per week, low level of leisure-time physical activity). Two summary variables based on the number of 'unhealthy' behaviours were also examined: the crude number of 'unhealthy' behaviours reported and the likelihood of reporting 3 or 4 'unhealthy' behaviours. Four measures of socio-economic status were used: educational achievement, household income status, source of household income, and occupational prestige. Multiple logistic and linear regression analyses were performed to explore the association of each 'unhealthy' behaviour and of the summary variables with socio-economic status indicators (taken independently or simultaneously), controlling for demographic characteristics. Except for the positive relationship between income status and high alcohol intake, measures of 'unhealthy' behaviours were inversely associated with the socio-economic indices, suggesting that individuals in lower socioeconomic groups are at an increased risk for health problems.

Adult↗
PubMed1997

Introducing a module for laboratory test order entry and reporting of results at a hospital ward: an evaluation study using a multi-method approach.

The medical record system DocuLive EPR was installed at a "typical" ward at the Central Hospital of Akershus. Modules for laboratory order entry and reporting of results were evaluated prospectively using several information sources (hospital information systems, telephone records, user survey, semi-structured interviews with key informants). The main findings are discussed, and the lessons learned from the evaluation project are presented.

Attitude of Health Personnel↗
PubMed1997

Reported activities of daily living: agreement between elderly subjects with and without dementia and their caregivers.

OBJECTIVES: to determine how accurately information on disability provided by a caregiver (proxy respondent) reflected the opinion of subjects themselves, and if this agreement varied by severity of dementia or relationship of the caregiver to the subject. SETTING AND PARTICIPANTS: the study was based on data from the Canadian Study of Health and Aging, a multicentre study of dementia and health of Canadians age 65 and over. Eight hundred study subjects and their caregivers were independently interviewed regarding the subjects' activities of daily living (ADL). MEASUREMENTS: the percentage of subjects who were independent for individual ADL items and the agreement in these reports between subjects and caregivers were investigated using three-level kappa statistics. RESULTS: index subjects with caregivers other than spouses or offspring required more assistance with ADL. The reported percentage of independence decreased with increasing severity of dementia. There was more agreement between self- and proxy-reported level of independence for physical ADL than for instrumental ADL items. Agreement decreased with increasing severity of dementia. Few statistically significant differences were noted between level of agreement and caregiver relationship. CONCLUSION: satisfactory levels of agreement on ADL between cognitively normal subjects and their caregivers indicate that proxy respondents are a reasonable source of information on ADL when data collection from the subjects themselves is not feasible. Since agreement decreases as the severity of dementia increases, caregiver reports may be preferred for elderly patients even with mild dementia in order to facilitate longitudinal assessment of ADL ratings as the dementia progresses.

Activities of Daily Living↗
PubMed1997

Hospitalization and case-fatality rates for subarachnoid hemorrhage in Canada from 1982 through 1991. The Canadian Collaborative Study Group of Stroke Hospitalizations.

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) has a different epidemiological profile from other types of stroke and a different etiology. Although there has been a general decline in overall stroke incidence since the 1950s, secular trends for SAH have been modest. In contrast to other stroke types, changes in incidence over the last few decades have been less clear. The purpose of this study was to estimate hospitalization and case-fatality rates of SAH according to age, sex, calendar year, and season. METHODS: Data were obtained for each of Canada's 10 provinces for the 10 fiscal years 1982 through 1991. All hospitalizations of persons 15 years of age or older with a primary diagnosis at discharge coded 430 according to the International Classification of Diseases, 9th Revision, were included. Rates of SAH per 100,000 population were calculated for men and women for 5-year age groups, by calendar year, and by season. Annual age- and sex-specific (hospital) case-fatality rates up to 30 days were also calculated. Additionally, hospital deaths from this study were related to national SAH mortality statistics. RESULTS: A total of 14145 women and 8995 men were discharged with a primary diagnosis of SAH during the 10-year period. In contrast to other types of stroke, the rates of SAH were higher for women than for men at all ages. The age-standardized rates of SAH in 1991-1992 were 11.2 per 100000 women and 8.0 per 100000 men. For women, there was a 6% (95% confidence interval [CI], -12% to 0%) decline in hospitalization rates over that period; for men, the decline was 15% (95% CI, -21% to -8%). The peak season for SAH among women was winter; for men the peaks were in the fall and spring. For both sexes, the lowest occurrence was in the summer. Over this period, 30-day case-fatality rates declined somewhat (statistically significant only in the age group of 35 to 44 years). The number of deaths enumerated from hospital discharges was 20% to 50% lower than the number recorded on national mortality statistics, indicating that a proportion of SAH deaths occurred before (or after) the hospital stay. CONCLUSIONS: Although rates of hospitalization for SAH declined over this period, SAH remains an important neurological event affecting individuals at relatively young ages. The rates were higher for women than for men at all ages. Total (in-hospital) case-fatality rate remains high.

Adolescent↗
PubMed1997

A randomized controlled trial to compare the efficacy of cyclical parathyroid hormone versus cyclical parathyroid hormone and sequential calcitonin to improve bone mass in postmenopausal women with osteoporosis.

Short cycles of human (h) PTH-(1-34) may have an anabolic effect to increase bone mass in patients with osteoporosis. As PTH also stimulates bone resorption, it is theoretically possible to enhance the anabolic effects of PTH by using a sequential antiresorptive agent in the treatment cycle. To test this hypothesis, 30 women with osteoporosis, aged 67 +/- 8 yr, completed a 2-yr protocol that comprised 28-day courses of hPTH-(1-34) (800 U) given by daily sc injections; each course was repeated at 3-month intervals. By random allocation, patients either received sequential calcitonin (CT) immediately following the cycle of hPTH-(1-34) (75 U/day, sc; PTH + CT; n = 16) or placebo CT (PTH alone; n = 14) for 42 days. Baseline bone mineral density (BMD) at the lumbar spine site revealed t scores of -3.7 +/- 1.2 (+/-SD) for the PTH alone group and -3.0 +/- 1.4 for the PTH + CT groups, who had 2.0 +/- 2.3 and 1.8 +/- 2.4 vertebral fractures, respectively, at entry to the study. At the end of the 2 yr, the lumbar spine BMD increased from 0.720 +/- 0.130 to 0.793 +/- 0.177 g/cm2 (10.2%) in the PTH group and from 0.760 +/- 0.168 to 0.820 +/- 0.149 g/cm2 (7.9%) in the PTH + CT group. These changes were significant over time in both groups (P < 0.001). Although the final 2-yr lumbar spine BMD was not significantly different between the two treatment groups, those patients receiving sequential CT injections gained bone mass at a consistently slower rate. Changes in BMD at the femoral neck averaged +2.4% and -1.8% in the PTH and PTH + CT groups, respectively, neither of which was significant. In the group receiving only cyclical hPTH-(1-34), the observed 2-yr vertebral fracture incidence was 4.5 compared to 23.0/100 patient yr in the PTH + CT group (P = 0.078). During the first two cycles, changes in biochemical markers of bone formation (serum total alkaline phosphatase, bone-specific alkaline phosphatase, and osteocalcin) and bone resorption (fasting urinary hydroxyproline and N-telopeptide excretion) were significantly increased over pretreatment values after 28 days of hPTH-(1-34) injections (P < 0.05 to P < 0.01 for both groups). Even end of cycle values remained elevated over the study baseline across time (P < 0.01). There were no significant differences for any outcome parameter between the two treatment groups. We conclude that short cycles (28 days) of daily hPTH-(1-34) injections result in significant increases in lumbar spine BMD, without significant changes in cortical bone mass at the femoral neck. Very low incident vertebral fracture rates were documented over 2 yr. However, there is no evidence that sequential antiresorptive therapy with CT is of any benefit over that conferred by cyclical PTH alone.

Aged↗