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Biomedical subjects

Philip D St John

Publications and source records attributed to Philip D St John.

4 recordsLinked to original sources
PubMed2006

Depressive symptoms among older adults in urban and rural areas.

OBJECTIVES: To determine if there are differences in depressive symptoms between residents of urban areas, small town zones, and predominantly rural regions and to determine factors associated with depressive symptoms among these groups of residents. METHOD: The study was set in the Canadian province of Manitoba amongst a community-dwelling population of older adults who were cognitively intact. The design of the study was a cross-sectional survey and measures included age, gender, education, living arrangements, number of persons providing companionship, perceived adequacy of income, functional impairment, self-rated health and the Center for Epidemiologic Studies-Depression (CES-D) scale. Urban/rural residence was measured by grouping Census sub-divisions according to 1991 Census population: urban (>19,999); small town (2500 to 19,999); or predominantly rural (<2500). RESULTS: In the total sample (n = 1382), 11.5% exhibited depressive symptoms: 11.6% in urban areas (n = 844); 14.0% in small town zones (n = 250); 9.0% in predominantly rural regions (n = 288) (p > 0.05, chi-square test). No rural-urban differences were seen in multivariate models. In predominantly rural regions, living alone, perceiving one's income as inadequate, and having functional impairment were associated with depressive symptoms. The only significant factor in small town zones was poorer self-rated health whereas in urban areas, poorer self-rated health, functional impairment, and fewer persons providing companionship were significantly related to depressive symptoms. CONCLUSIONS: We did not observe rural-urban differences. However, the factors associated with depressive symptoms varied among older adults living in predominantly rural regions, in small towns, and in urban areas.

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PubMed2003

Should meta-analysts search Embase in addition to Medline?

It is widely accepted that meta-analysts should search multiple databases. The selection of databases is ideally based on the potential contribution of each database to the project or on the potential for bias if a database is excluded, as supported by research evidence. We explore whether searching Embase yields additional trials that influence a meta-analysis. We identified meta-analyses that searched Medline and Embase. A random-effects weighted mean method was used to estimate the intervention effect in articles indexed only in Embase compared with those indexed elsewhere. On average, Embase-unique trials yielded significantly smaller estimates by 29% (ratio of odds ratio [ROR] 0.71, 95% confidence interval [CI] 0.56-0.90) but influenced the pooled estimate by an average of only 6% (ROR 0.94, 95% CI 0.88-0.99). Searching Medline but not Embase risks biasing a meta-analysis by finding studies that show larger estimates, but their prevalence seems low enough that the risk may be slight, provided the rest of the search is comprehensive.

Databases, Bibliographic↗
PubMed2002

Cognitive scores, even within the normal range, predict death and institutionalization.

BACKGROUND: Dementia is a predictor of death and institutionalization. It is less clear if variations in cognition within the normal range predict adverse outcomes. OBJECTIVE: To determine if variation at the high end of cognitive test scores predicts mortality or institutionalization, independent of the effect of potential confounders. DESIGN: Secondary analysis of the Canadian Study of Health and Aging, a population-based longitudinal study with an initial data collection in 1991 and follow-up five years later. SETTING: Community-dwelling seniors living in Canada. PARTICIPANTS: 9008 consenting seniors were sampled from representative population registries in Canada. MEASURES: Age, gender, marital status, the Mini-Mental State Examination, self-rated health, and activities of daily living. OUTCOMES: Death or institutionalization over the five years of follow-up. RESULTS: Mini-Mental State Examination scores predicted mortality and institutionalization. The unadjusted odds ratio of mortality was 0.85 (95% confidence interval 0.84, 0.86) per point on the Mini-Mental State Examination, and the adjusted odds ratio was 0.95 (95% confidence interval 0.93, 0.97). The unadjusted odds ratio for institutionalization was 0.83 (95% confidence interval 0.82, 0.85), and the adjusted odds ratio was 0.91 (95% confidence interval 0.90, 0.94). This effect was present even in analyses restricted to those within the normal range of Time 1 Mini-Mental State Examination scores. CONCLUSIONS: Low normal cognitive test scores predict adverse outcomes. Clinicians should consider close clinical follow-up of those with low normal cognitive test scores. Further research is needed to target seniors for follow-up and possible intervention to decrease mortality and institutionalization risk.

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