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Personality change in older adults with dementia: Occurrence and association with severity of cognitive impairment  [PDF]
Edward Helmes, Maria C. Norton, Trulsstbye
Advances in Aging Research (AAR) , 2013, DOI: 10.4236/aar.2013.21004

Personality change is among criteria for the diagnosis of dementia. We examine first whether personality changes are related to severity of cognitive impairment in a linear or an inverted-U fashion in 1132 demented older people from the Canadian Study of Health and Aging (CSHA) and 921 unimpaired older people. The proportion with reported change was larger for all measures in the demented group than in the cognitively unimpaired group, and was more consistent with a linear increase in personality change with increasing cognitive impairment than with an inverted-U relationship, as seen in only one variable. In our second (longitudinal) study, we evaluate which aspects of personality change most in dementia; changes in mood and an exaggeration of existing traits were the variables most closely related to the development of dementia.

Neighborhood Environment and Self-Rated Health among Adults in Southern Sri Lanka
Bilesha Perera,Trulsstbye,Chandramali Jayawardana
International Journal of Environmental Research and Public Health , 2009, DOI: 10.3390/ijerph6082102
Abstract: The prevalenceof different neighborhood environmental stressors and associations between the stressors and self-rated health are described in a representative sample of 2,077 individuals, aged 18-85 years, in southern Sri Lanka. Mosquito menace (69.4%), stray dog problems (26.8%), nuisance from neighbors (20.3%), and nuisance from drug users (18.7%) were found to be the most prevalent environmental stressors. None of the stressors investigated were associated with self-rated physical health, but nuisance from neighbors, nuisance from drug users, shortage of water and having poor water/ sewage drainage system were associated with self-rated mental health among the respondents.
Reproductive and family planning history, knowledge, and needs: A community survey of low-income women in Beijing, China
Hong He, Trulsstbye, Anne K Daltveit
BMC Women's Health , 2009, DOI: 10.1186/1472-6874-9-23
Abstract: 1642 low-income women age 18–49 from Haidian district, Beijing were selected. All were interviewed via a standardized questionnaire in 2006.Most women reported at least one pregnancy and delivery (97.7%, 98.3%). Deliveries in hospitals (97.3%) by medical personnel (98.5%) were commonplace, as was receipt of antenatal care (86.0%). Nearly half had at least one abortion, with most (56.0%) performed in district hospitals, by physicians (95.6%), and paid for out-of-pocket (64.4%). Almost all (97.4%) used contraception, typically IUDs or condoms. Reproductive knowledge was limited. Health needs emphasized by the participants included popularizing reproductive health information, being able to discuss their reproductive health concerns, free reproductive health insurance, examination and treatment.Among poor urban women in Beijing, antenatal care and contraceptive use were common. However, abortions were also common. Knowledge about reproductive health was limited. There is a need for better reproductive health education, free medical care and social support.Living conditions for low-income urban populations in China is, in general, less favorable than for other urban dwellers. In the largest cities, Beijing and Shanghai, the physical environment is often poor and there is a lack of stable and safe housing arrangements [1,2]. The low-income population in urban areas is mostly comprised of individuals affected by the recent economic transition. They include laid-off workers from state owned enterprises, registered unemployed urban residents, retired workers without pension, and disabled persons who are usually unemployed [3].Since 1993, China has gradually implemented a system of income guarantees, which provides relief for citizens whose per capita income is under the minimum income level. Between January and June 2003, more than 7.1 billion Yuan (about 855 million US dollars) was distributed to 21.8 million poor urban Chinese people with less than the minimum income leve
The prevalence of urinary incontinence in elderly Canadians and its association with dementia, ambulatory function, and institutionalization
Trulsstbye,Michael J. Borrie,Steinar Hunskaar
Norsk Epidemiologi , 2009,
Abstract: Study objectives: Design and setting: Main results: Conclusion: Key words: urinary incontinence; dementia; institutionalization; community-institutional relationsUrinary incontinence is a prevalent condition among the elderly, and is associated with age, dementia, and ambulatory function. Although incontinence is highly prevalent among institutionalized
Fifteen Dimensions of Health among Community-Dwelling Older Singaporeans
Chetna Malhotra,Angelique Chan,Rahul Malhotra,Trulsstbye
Current Gerontology and Geriatrics Research , 2011, DOI: 10.1155/2011/128581
Abstract: This paper aims to present a broad perspective of health of older Singaporeans spanning 15 health dimensions and study the association between self-rated health (SRH) and other health dimensions. Using data from a survey of 5000 Singaporeans (≥60 years), SRH and health in 14 other dimensions were assessed. Generalized logit model was used to assess contribution of these 14 dimensions to positive and negative SRH, compared to average SRH. About 86% reported their health to be average or higher. Prevalence of positive SRH and “health” in most other dimensions was lower in older age groups. Positive and negative SRH were associated with mobility, hearing, vision, major physical illness, pain, personal mastery, depressive symptoms, and perceived financial adequacy. The findings show that a majority of older Singaporeans report themselves as healthy overall and in a wide range of health dimensions. 1. Introduction Over the last 40 years, Singapore, a small island country with a population of about 5 million [1], has made a rapid transition from a developing to a developed economy, with concurrent improvements in civic and health infrastructure. Life expectancy at birth increased from 72 years in 1980 to 80.9 years in 2008 [2], chiefly owing to reduction in mortality due to communicable diseases [3]. Today, Singapore is one of the most rapidly aging countries in Asia. The proportion of older adults (aged 65 years and over) in the population, currently about 8%, is projected to increase to 19% by 2030 [4]. With increase in the proportion of older adults in Singapore and in their life expectancy, their health has become a priority. Data from several countries shows that older adults are spending larger proportions of their lifetimes free from illness and disability [5–9]. Thus, traditional health indicators that measure morbidity in terms of physical health status alone and of mortality are inadequate yardsticks to evaluate the health of older adults. A broader perspective of health is increasingly commonplace, stemming from the World Health Organization's (WHO) definition, “Health is not simply absence of disease or infirmity, but is the presence of a complete physical, mental and social well-being’’ [10]. The related constructs of successful and healthy aging, though ill-defined, are also considered to consist of multiple dimensions [11–13]. A key dimension of health widely used by researchers to gauge the overall health status of older adults is self-rated health (SRH). Several studies have assessed SRH in surveys using a single question asking the
Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study
Petter Hurlen, Trulsstbye, Arne S Borthne, P?l Gulbrandsen
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-262
Abstract: Data describing hospital stays and diagnostic imaging were collected retrospectively from the EMR during periods of equal duration before and one year after the introduction of ICT. The post-ICT period was chosen because of the documented improvement in clinical access to radiology results during that period. The data set was randomly split into an exploratory part used to establish the hypotheses, and a confirmatory part. The data was used to compare the pre-ICT and post-ICT status, but also to compare differences between groups.There was no general reduction in LOS one year after ICT introduction. However, there was a 25% reduction for one group - patients with CT scans. This group was heterogeneous, covering 445 different primary discharge diagnoses. Analyses of subgroups were performed to reduce the impact of this divergence.Our results did not indicate that improved access to radiology results reduced the patients' LOS. There was, however, a significant reduction in LOS for patients undergoing CT scans. Given the clinicians' interest in CT reports and the results of the subgroup analyses, it is likely that improved access to CT reports contributed to this reduction.The implementation of a Radiology Information System (RIS) and a Picture Archiving and Communication System (PACS), and the integration of these systems with the Electronic Medical Record (EMR), may improve the use of diagnostic imaging in clinical practice. This Information and Communication Technology (ICT) can reduce the radiologists' reporting time, and make the reports and images instantly available to clinicians hospital-wide [1-10].In May 2005, RIS and PACS (Siemens MagicSAS ? and MagicView ?, Erlangen, Germany) were introduced to radiologists at a Norwegian five-hundred bed university-affiliated hospital. Both systems were integrated with the EMR (DIPS EPJ ?, Bod?, Norway). This complete technology shift will be referred to below as 'the ICT introduction'. Before the ICT introduction, radiolo
Racial differences in influenza vaccination among older americans 1996–2000: longitudinal analysis of the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey
Trulsstbye, Donald H Taylor, Ann Marie M Lee, Gary Greenberg, Lynn van Scoyoc
BMC Public Health , 2003, DOI: 10.1186/1471-2458-3-41
Abstract: The purpose of the study was to determine whether frequencies of receipt vary by race, age group, gender, and time (progress from 1995/1996 to 2000), and whether any racial differences remain in age groups covered by Medicare. Subjects were selected from the Health and Retirement Study (HRS) (12,652 Americans 50–61 years of age (1992–2000)) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (8,124 community-dwelling seniors aged 70+ years (1993–2000)). Using multivariate logistic regression, adjusting for potential confounders, we estimated the relationship between race, age group, gender, time and the main outcome measure, receipt of influenza vaccination in the last 2 years.There has been a clear increase in the unadjusted rates of receipt of influenza vaccination for all groups from 1995/1996 to 2000. However, the proportions immunized are 10–20% higher among White than among Black elderly, with no obvious narrowing of the racial gap from 1995/1996 to 2000. There is an increase in rates from age 50 to age 65. After age 70, the rate appears to plateau. In multivariate analyses, the racial difference remains after adjusting for a series of socioeconomic, health, and health care related variables. (HRS: OR = 0.63 (0.55–0.72), AHEAD: OR = 0.55 (0.44–0.66))There is much work left if the Healthy People 2010 goal of 90% of the elderly immunized against influenza annually is to be achieved. Close coordination between public health programs and clinical prevention efforts in primary care is necessary, but to be truly effective, these services must be culturally appropriate.Influenza frequently causes several days of incapacitating malaise for otherwise healthy individuals. In the elderly and persons with chronic medical conditions, it increases risk for serious complications and death. Twenty to 40 thousand deaths are attributed to influenza each year, with 90 percent of these in patients over age 65. [1] Influenza also has a large economic impact, in t
Estimated time spent on preventive services by primary care physicians
Kathryn I Pollak, Katrina M Krause, Kimberly SH Yarnall, Margaret Gradison, J Lloyd Michener, Trulsstbye
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-245
Abstract: We analyzed a large dataset of primary care (family and internal medicine) visits using the National Ambulatory Medical Care Survey (2001–4); analyses were conducted 2007–8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates.Preventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively). New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA), cholesterol, Papanicolaou (Pap) smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence") services, tobacco cessation and Pap smear (in preventive visits), and one "B" rated ("at least fair evidence") service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness"), PSA and exercise counseling.Even with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.Inadequate delivery of preventive health services is well documented [1]. Only 50% of smokers report receiving smoking cessation counseling beyond simple advice [2-4] and less than one-third of patients over 50 have had a blood stool test in the past two years [5].Although there are numerous reasons for this lack of adequate care delivery, limited available time is one of the main barriers. If physicians were to provide all services recommended by preventive service guidelines, it has been estimated that it would require 7.4 working hours per day [6]. Because physicians clearly cannot spend this amount o
Barriers to adopting a healthy lifestyle: insight from postpartum women
Lori Carter-Edwards, Trulsstbye, Lori A Bastian, Kimberly SH Yarnall, Katrina M Krause, Tia-Jane'l Simmons
BMC Research Notes , 2009, DOI: 10.1186/1756-0500-2-161
Abstract: Cases are presented for three postpartum women who declined to participate in a postpartum weight loss intervention.Despite their desire to engage in healthier behaviors, or partake in an intervention uniquely designed to promote healthy lifestyles for postpartum women, some find it too difficult to make such commitments. Barriers women face in adopting a healthier lifestyle in this period include 1) time availability; 2) prioritizing other competing life responsibilities above their own health; 3) support from family members, friends, and/or co-workers; and 4) lack of flexibility in the intervention structure. These illustrations describe their perspectives in the context of life balance, perceived health, and support, and reflect the multi-dimensional nature of their lives during the life cycle change of the postpartum period.Postpartum women face difficult and complex challenges to prioritizing their health and their weight management.The postpartum period is a transitional phase involving lifestyle and body weight changes. Postpartum weight retention is common [1,2] and can have long-term impacts on health [2,3]. This weight retention is as much associated with modifiable lifestyle factors, including diet and physical activity, as with characteristics such as prepregnancy body weight [4-6]. Thus, behavioral interventions to reduce postpartum weight retention are warranted.Participating in such programs, however, can be a challenge. Only two community-based randomized trials to reduce postpartum weight retention have been conducted [7], in which the drop-out rates were 27% [8] and 40% [9], respectively. Participation in such interventions may be complicated by factors unique to this period, including difficulty and lack of time to attend structured activities while caring for infants [10]. However, data collected directly from postpartum women are lacking.Through semi-structured, in-depth personal interviews, we explored barriers faced by women who refused partic
Alternative models for academic family practices
J Michener, Trulsstbye, Victoria S Kaprielian, Katrina M Krause, Kimberly SH Yarnall, Susan D Yaggy, Margaret Gradison
BMC Health Services Research , 2006, DOI: 10.1186/1472-6963-6-38
Abstract: The basis of comparison is a traditional academic family medicine center. Apart of the faculty practice plan, our center consistently operated at a deficit despite high productivity. A number of different practice types and alternative models of service delivery were therefore developed and tested. They ranged from a multi-specialty office arrangement, to a community clinic operated as part of a federally-qualified health center, to a team of providers based in and providing care for residents of an elderly public housing project. Financial comparisons using consistent accounting across models are provided.Academic family practices can, at least in some settings, operate without subsidy while providing continuity of care to a broad segment of the community. The prerequisites are that the clinicians must see patients efficiently, and be able to bill appropriately for their payer mix.Experimenting within academic practice structure and organization is worthwhile, and can result in economically viable alternatives to traditional models.The Future of Family Medicine Report [1] calls for a fundamental redesign of the American family physician workplace. This change will require additional time, effort, and financial investment [2], at a time when academic family practices are under heavy economic pressure. Departments of family medicine are caught between an increasingly uninsured patient population, high costs of resident education, and practice plan cost structures based on high-margin subspecialty practices [3,4].Most departments have given up hope of operating self-sustaining practices, and seek support from their specialty colleagues in return for referrals and revenue generated by ancillary services. Such relationships are possible, as each dollar of revenue generated in the family practice can be linked to $8 of revenue within a health system [5]. Still, the process of seeking and defending this support is politically tiresome, and may compromise the ideals of fam
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