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Biomedical subjects

G McIntosh

Publications and source records attributed to G McIntosh.

At least 19 recordsLinked to original sources
PubMed2000

Prognostic factors for time receiving workers' compensation benefits in a cohort of patients with low back pain.

STUDY DESIGN: Prospective inception cohort study. OBJECTIVE: To develop a prognostic model that predicts time receiving workers' compensation benefits for low back pain claimants. SUMMARY OF BACKGROUND DATA: As the cost and difficulty of managing low back pain escalate, any predictor of outcome is advantageous. METHODS: To obtain the outcome and predictor variables, patient data from two separate databases were linked: a clinical database and an administrative (Ontario workers' compensation) database. Claimants injured between January 1 and December 31, 1994, were included and observed for 1 year from the date of accident. The outcome variable was cumulative number of calendar days receiving benefits. RESULTS: Multivariable Cox proportional hazards regression (forward stepwise) showed eight significant predictors; five were associated with increased time receiving benefits compared with their reference groups: 1) working in the construction industry, 2) older age, 3) lag time from injury to treatment, 4) pain referred into the leg, and 5) three or more positive Waddell nonorganic signs. Three predictors were associated with reduced time receiving benefits: 1) higher values of questionnaire score, 2) intermittent pain, and 3) a previous episode of back pain. A predictive score was calculated to categorize claimants as at high or low risk for chronicity. When an arbitrary cutoff point was set at the 75th percentile of predictive score, negative predictive value was 94%. CONCLUSION: This research identified eight factors for time receiving workers' compensation benefits among claimants with low back pain. This model discriminates between high- and low-risk claimants. Few low-risk claimants continued to receive benefits for more than 3 months.

Adult↗
PubMed2000

Graduated driver licensing in Wisconsin: a new law for teens and parents.

The final components of Wisconsin's graduated driver licensing (GDL) statute [Biennial state budget act 1999 Wisconsin Act 9] went into effect on September 1, 2000. The GDL system seeks to reduce the number of teen motor vehicle collisions and fatalities by gradually introducing young drivers to all driving situations, beginning with the easiest and progressing to the more difficult. The stages of licensing are defined by the degree of risk involved. When teen drivers demonstrate the ability to drive safely in a restricted setting with high levels of supervision, they "graduate" to the next licensing level with fewer restrictions. Numerous factors are associated with the high rate of teen motor vehicle crashes and fatalities. Such factors include driver inexperience and easy distractibility, alcohol use and lack of seat belt use. The GDL addresses all of these risk factors. This article reviews the injury prevention strategies incorporated in the GDL and outlines the basic components of Wisconsin's law.

Accidents, Traffic↗
PubMed2000

Fatal injuries in adolescents.

Injuries are a major cause of morbidity and mortality among adolescents. Adolescents routinely experiment with high-risk behaviors, increasing their risk of injury. Major modes of injury in adolescents include motor vehicle collisions, drowning, suicide and homicide. This article reviews the risk factors for fatal injuries in adolescents and discusses current prevention strategies. Previous research identifies many risk factors associated with adolescent injuries. Practitioners can help prevent teen injuries by screening all adolescent patients and identifying those at high risk of injury. Patients at high risk need preventive counseling and evaluation for possible referral to other services. Current strategies are useful in preventing many injuries; however, further research is needed to evaluate these strategies and to design new prevention programs.

Accidents, Traffic↗
PubMed1999

Intertester reliability of a low back pain classification system.

STUDY DESIGN: This prospective study of intertester reliability examined pairs of therapists' ability to agree independently on a patient's low back pain diagnosis. OBJECTIVE: To determine the intertester reliability of a low back pain classification system among experienced and novice clinicians. BACKGROUND: Many of the disparate categorization schemes for patients with low back pain are purely nominal, assigning designations based on the presumptive source of the problem without providing any practical guide for rehabilitation. A useful classification scheme reliably groups patients into treatment-directing categories. METHODS: The study included 204 patients with low back pain referred to 10 clinics across Canada. Paired physiotherapists performed separate physical examinations on each patient. Both examiners then completed a simple ballot choosing one of five pain patterns. RESULTS: Agreement on patient classification by independent examiners was 78.9% (kappa = 0.61). CONCLUSION: This clinically relevant and clearly defined pain pattern system uses key elements of the history and examination to classify patients with low back pain. The pattern provides a framework for initiating active rehabilitation strategy. Using this approach, clinicians agreed on the categorization of 78.9% of mechanical low back pain cases.

Adolescent↗
PubMed1998

Spontaneous onset of back pain.

OBJECTIVES: To assess the frequency with which patients attribute low back pain to spontaneous onset. DESIGN: A consecutive sample of two distinct groups of patients seeking treatment for back pain: those without need to identify cause (study group, n = 4,689) and those required to report a specific event to qualify for benefits paid for by a third party (compensated group, n = 6,687). SETTING: Active exercise-based back pain rehabilitation clinics. SUMMARY OF BACKGROUND DATA: Research on the natural history of back pain has revealed frequent reports of spontaneous recovery, usually within 8-12 weeks after onset. There is little comparable literature pertaining to the report of spontaneous onset. METHODS: Data were collected for two groups of consecutive patients who attended for initial assessments of their back pain at 16 Canadian Back Institute locations, between May 1, 1994 and February 28, 1995. Patient responses were collected using a standardized, professionally administered questionnaire. RESULTS: In the group without need to identify cause, 66.7% of patients could not identify an event producing their symptoms. For those required to report a specific event, only 9.8% of patients failed to attribute cause. Multivariate logistic regression revealed that the required-to-report group was approximately 15 times more likely to report an event (odds ratio = 14.95; 95% confidence interval = 13.44, 16.65) than the study group; those pursuing litigation were more than 2.5 times more likely to report a causative event (odds ratio = 2.68; 95% confidence interval = 2.09, 3.49). CONCLUSIONS: Back pain occurred spontaneously in approximately 67% of patients seeking treatment in the study group. The authors consider spontaneous onset to be part of the natural history of back pain for this group.

Adult↗
PubMed1998

The incidence of spinal surgery in Canada.

OBJECTIVE: To estimate the incidence of spinal surgery in 5 Canadian provinces over a 12-month period. DESIGN: Cumulative incidence study. SETTING: Five provinces (63% of Canada's population). PARTICIPANTS: All patients who underwent spinal surgery between July 1, 1992, and June 30, 1993, in British Columbia, Alberta, Ontario, New Brunswick and Newfoundland. MAIN OUTCOME MEASURE: Overall spinal surgery rates per province and by age and sex. RESULTS: In the 5 provinces over the allotted 12-month period, 12,329 spinal surgical procedures were performed. The overall rate of spinal surgery for the 5 provinces was 80 per 100,000 population. Ontario had the lowest rate of 61 per 100,000; British Columbia had the highest at 89 per 100,000. Men aged 40 to 49 years in Newfoundland had the highest overall rate at 210 per 100,000. Calculation of relative risks determined that Newfoundland's under-20 age groups for both sexes were almost 3 times as likely to undergo spinal surgery as the same age groups in Ontario (male relative risk = 2.73, female relative risk = 2.84). Males in British Columbia and Alberta had a statistically significant increased risk of surgery across all age groups except for those under 20 years old, and females in British Columbia showed a statistically significant increased risk of surgery across all age groups compared with those in Ontario. Males underwent 57.7% of all spine operations. CONCLUSIONS: The incidence of spinal surgery is not uniform across Canada. Overall, the per capita rate is lower than in the United States. The explanation for this divergence remains unclear.

Adult↗
PubMed1997

The relationship between nonorganic signs and centralization of symptoms in the prediction of return to work for patients with low back pain.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the relationship between the nonorganic signs (Waddell scores) of patients with low back pain, their response to repetitive end-range lumbar spine test movements (centralization of symptoms), and the rate of return to work at a 6-month follow-up. SUBJECTS: Patients were assessed at five locations of the Canadian Back Institute. A consecutive sample of 126 patients with low back pain, with or without referred leg pain, was selected and reviewed. METHODS: Physical therapists assessed patients' responses to repetitive test movements (centralization), as described by McKenzie, and tested the patients for nonorganic signs (Waddell scores). Therapists completed a data sheet that classified patients as either those who centralize their symptoms or those who do not centralize their symptoms and recorded their Waddell scores. Although the patients were classified at assessment, they remained in treatment. All patients followed a structured Canadian Back Institute protocol of active exercise, regardless of centralization status or Waddell score. RESULTS: The inability to centralize symptoms indicated a decreased likelihood of returning to work, regardless of the Waddell score. A high Waddell score predicted a poor chance of returning to work, regardless of the patients' ability to centralize symptoms. CONCLUSION AND DISCUSSION: A high Waddell score appears to be the best predictor of outcome, as indicated by return to work.

Adult↗
PubMed1997

Outcomes of surgeons who have undergone spine surgery.

The objective of this study was to examine the prevalence, characteristics, and outcomes of spine surgery among a membership of American orthopaedic surgeons with a particular interest in spine care [North American Spine Society (NASS)] and a general membership of Canadian orthopaedic surgeons [Canadian Orthopaedic Association (COA)]. A 25-item multiple choice questionnaire was developed and mailed to both memberships. The COA response rate was 45.9%; the NASS response rate was 45.8%. Of those who replied, 17.2% had undergone spinal surgery, and the results differed significantly between the COA at 12.9% and NASS at 21.9%. As a percentage of the total mailing, 7.7% had undergone spinal surgery. These results differed significantly between the COA at 5.9% and NASS at 9.7%. Although the surgery rate for NASS respondents was more than 1.5 times that of COA respondents, they had strikingly similar outcomes. They are a highly motivated, self-employed group who missed little work before and after having surgery.

Back Pain↗
PubMed1996

Effect of high-amylose starch and oat bran on metabolic variables and bowel function in subjects with hypertriglyceridemia.

We compared the effects of a diet in which approximately 25% of the carbohydrate was replaced by high-amylose starch with those of a similar diet high in oat bran or low-amylose starch in 23 hypertriglyceridemic subjects who were overweight mostly because of abdominal adiposity. Each diet was consumed for 4 wk in random order and in a crossover fashion. Overall, the diets were high in carbohydrate (> 55% of energy) and low in fat (< 30% of energy); the amount of resistant starch in the foods containing high-amylose starch was 17 g in women and 25 g in men. The metabolic effects of specific starches on plasma lipids, fasting and postprandial glucose and insulin profiles, and bowel function were assessed at the end of each intervention. Plasma triacylglycerols (triglycerides) were significantly lower after the oat bran diet than after the other two diets (P < 0.02). No other effects on fasting plasma lipids, glucose, or insulin were noted. However, when the high-amylose starch comprised 33% of the carbohydrate content in a test meal, there was a significant but biologically small reduction in the overall postprandial plasma insulin concentration by 17% relative to the low-amylose diet (P < 0.01). Both the oat bran and the high-amylose diet resulted in an increased frequency of bowel actions and lower fecal pH (P < 0.02) relative to the low-amylose diet. However, unlike the oat bran diet, the high-amylose diet increased short-chain fatty acid concentrations in fecal water by 32% (P < 0.001).

Adult↗
PubMed1995

A test to measure lift capacity of physically impaired adults. Part 1--Development and reliability testing.

STUDY DESIGN: Two laboratory studies and one field study evaluated the safety and test-retest reliability of a new test of lift capacity. The first two studies were conducted in a carefully controlled laboratory setting. The first study investigated the safety and intra-rater reliability of the EPIC Lift Capacity test protocol with healthy adult subjects. The second study assessed the safety and inter-rater reliability of the test with disabled subjects. The third study was conducted in the field with 65 evaluators and investigated the safety and intra-rater reliability of the test with healthy adult subjects. OBJECTIVE: To assess the safety and reliability of a new test of lift capacity. SUMMARY OF BACKGROUND DATA: A new test of lift capacity has been developed. Test development occurred within the context of ergonomic standards and guide-lines of the major professional associations and public agencies that govern test development in the United States. METHODS: In study no. 1, 26 healthy subjects participated. In study no. 2, 14 disabled subjects participated. In study no. 3, 318 healthy subjects participated. After subjects underwent basic screening and warm-up, the EPIC Lift Capacity test was administered. One to 2 weeks later, the test was administered again. Correlations between the times of testing were calculated. RESULTS: No subjects were injured. Hamstring soreness the next day that resolved without complication was reported by some healthy subjects. None of the disabled subjects reported new symptoms. CONCLUSION: The safety and reliability of the EPIC Lift Capacity test was adequately demonstrated in a laboratory setting and across multiple field sites with evaluators who have varying types and degrees of professional preparation.

Adult↗
PubMed1994

Effect of discharge recommendations on outcome.

STUDY DESIGN: The incidence of two common discharge recommendations, return to work unrestricted (RTWU) and restricted (RTWR) suggested that most restrictions were applied on the basis of patients' subjective reports of pain or therapists' unfounded fears that return to full duty would result in physical harm. OBJECTIVES: This prospective study compares the therapist's return to work recommendation to the patient's actual work status and analyzes the effect of that recommendation on outcome. METHODS: There were 1438 consecutive patients reviewed by structured telephone interviews during the two halves of the study: the control group when pain was accepted as a reason for restriction and the study group when it was not. SUMMARY OF BACKGROUND DATA: In the control group, 44% of the patients were recommended to RTWU; for the study group, 81% received this recommendation. Compliance was 84% for the control subjects and 78% for the study group. RESULTS: The absolute number of patients who returned to unrestricted work doubled in the study group. CONCLUSIONS: The probability of a successful return to normal duty increased with a recommendation of RTWU (P = 0.0001), whereas the probability of failure increased when restrictions were imposed (P = 0.0001).

Adult↗
PubMed1994

The effect of the Persian Gulf Crisis on the psychiatric hospitalization of Navy children and adolescents.

The effect of the Persian Gulf Crisis on Navy families was studied through admission rates of children to a private psychiatric hospital, marital status and diagnostic categories. During that time there was a statistical increase in admission of young boys under age twelve and all children from remarried families. Almost one-half of these patients were diagnosed with Dysthymia whereas this diagnosis was given only once during the time period before or after the crisis.

Anxiety, Separation↗
PubMed1994

Effect of dietary lipids and endocrine changes on polyunsaturated fatty acids in phospholipids of pancreas and brown adipose tissue of obese and lean rats.

Obese (fa/fa) rats fed on control diet have lower proportions of linoleic acid (18:2n-6) and/or arachidonic acid (20:4n6) in IBAT and pancreas phospholipids compared with lean (Fa/-) rats. Lower stearic acid (18:0) to oleic acid (18:1n-9) mean ratios in fa/fa compared with Fa/- suggest enhanced delta 9-desaturase activity in the former. 18:2/20:4 mean ratios in pancreas, but not IBAT, are indicative of a reduced delta 6-desaturase activity in fa/fa rats. Absolute amounts of phospholipids (mg/unit tissue wt) were 2-fold greater in IBAT of fa/fa compared with Fa/- rats, irrespective of their diet. This was reflected in greater absolute amounts of 18:2n-6 and 20:4n-6 only in HSO and HTO fa/fa groups, but not in the control group. Adrenalectomy (Adx) or T3 treatment also modified phospholipid fatty acid composition of IBAT and pancreas phospholipids in animals fed on the control diet with fa/fa rats more sensitive to endocrine induced changes. In fa/fa rats T3 treatment increased docosahexaenoic acid (22:6n-3) in IBAT of both phenotypes compared with the control, but this effect was evident only in fa/fa and not Fa/- pancreas. T3 treatment also increased docosapentaenoic acid (22:5n-3) in IBAT from, both phenotypes, but no 22:5n-3 was evident in the pancreatic tissue of these animals. ADX also increased 22:6n-3 in the IBAT of fa/fa (Fa/- values were less than 1%) but not in the pancreas of fa/fa or Fa/-. ADX modified the relative proportions of 18:0 to 18:1 and 18:2 to 20:4 in IBAT and pancreas of fa/fa in a way that indicated decreased delta 9-desaturase and increased delta 6-desaturase activities; these effects tended toward normal again in pancreas of fa/fa rats on corticosterone replacement (CST).

Adipose Tissue, Brown↗
PubMed1994

Implementing CQI: measuring levels of service quality at physiotherapy clinics.

The purpose of this study was to provide a profile of patient perceptions of the service quality delivered by a back pain rehabilitation clinic. Data were gathered and analyzed at the clinic level in twelve different locations across Canada. Measurement techniques were based on validated survey methods and developed from a growing stream of social science research. Results provided clinic managers with a profile of perceived service quality in terms of three key aspects: administrative support, quality of therapy received, and satisfaction with the results. The results also provided each clinic with benchmarks so that on-going service quality measurements can be incorporated into a system of continuous quality improvement. This process can assist rehabilitation clinics (and other health care providers) in improving service as well as ultimately reducing the costs of providing treatments involving physiotherapy.

Back Pain↗
PubMed1992

The role of inositol lipids in the activation of monocytes by interleukin-1 and bacterial endotoxin.

The effect of interleukin-1 (IL-1) and bacterial endotoxin (lipopolysaccharide, LPS) on the activation of phosphoinositidase C (PIC) and on prostaglandin E2 release was studied in monocytes (M phi). Both IL-1 alpha and IL-1 beta increased the release of PGE2 in a concentration-dependent manner, with EC50s of 0.48 nM and 0.12 nM, respectively. Intact M phi were prelabelled with [3H]inositol and the formation of inositol phosphates (IPs) was estimated by ion exchange chromatography. PIC activity was estimated directly by measuring the conversion of [3H]phosphatidylinositol-4,5-bisphosphate to aqueous soluble radioactivity by M phi homogenates. IL-1 alpha (5.8 nM) increased the accumulation of IPs within 1-4 minutes and increases in IP3 and IP4 occurred before the increase in IP1+2 whereas LPS only increased the IPs level after at least 30 min. IL-1 alpha increased PIC activity in M phi homogenates within 15 min with an EC50 of 0.58 nM and IL-1 beta (0.1 nM) also increased activity. Neither IL-1 alpha nor IL-1 beta affected the PIC activity of membrane or cytosolic fractions. LPS decreased activity in all fractions. These data indicate that IL-1, but not LPS, can directly lead to an increased activity of PIC which may be involved in eicosanoid formation in M phi.

Animals↗
PubMed1991

Regulation of polyunsaturated fatty acid metabolism in tissue phospholipids of obese (fa/fa) and lean (Fa/-) Zucker rats. 1. Effect of dietary lipids on cardiac tissue.

The present investigation addressed three questions: (i) Does the obese syndrome alter the fatty acid composition of cardiac tissue and membrane phospholipids in obese (fa/fa) rats? (ii) Are changes, if they occur, similar to those reported for tissues of the genetically obese (ob/ob) mouse? (iii) Can cardiac tissue phospholipids and their component fatty acids be modified by dietary lipids and if so does this occur to the same extent in both fa/fa and lean (Fa/-) rats? Proportions of polyunsaturated fatty acids (PUFA) in cardiac total phospholipids of fa/fa rats differed significantly from those of Fa/- rats and from those reported for ob/ob mice. Increased 18:2n-6 and decreased 20:4n-6 and 22:6n-3 in fa/fa rats indicated impaired PUFA metabolism, possibly reduced delta 6 and/or delta 5 desaturase activity, compared with Fa/- rats. No differences in hepatic delta 6 and delta 5 desaturase activity between fa/fa and Fa/- were found but enhanced activity of delta 9 desaturase activity in fa/fa as compared to Fa/- was evident. Inclusion of sunflower oil (SO) or triolein (TO) at 5% and 20% by weight in the diet elicited marked changes in the fatty acyl composition of cardiac phospholipids in both fa/fa and Fa/- rats when compared with animals fed the control Oxoid diet alone. Supplementation with triolein was most effective, reducing 18:2n-6 and increasing 20:4n-6 proportions in fa/fa rats so that they resembled those in Fa/- rats fed the control Oxoid diet. The type of fat rather than the amount of its dietary intake appears to be the main determinant of the observed changes in phospholipid composition.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗