Truls Oestbye
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gmsto@nus.edu.sg
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Publication Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery(2013-12) Wu, L.C.; Malhotra, R.; Allen Jr., J.C.; Lie, D.; Tan, T.C.; Østbye, T.; DUKE-NUS GRADUATE MEDICAL SCHOOL S'POREPurpose: In Singapore, a developed Asian nation, a relatively high proportion of women undergo episiotomy. We assess risk factors and midwife-reported reasons for episiotomy among women undergoing normal vaginal deliveries (NVDs) conducted by midwives and ascertain the association between episiotomy and degree of perineal tear. Methods: Participants included 77 midwives from a high-volume delivery unit in Singapore. The study had three sequential phases: (1) medical record review of women undergoing NVDs conducted by midwives over a 1-month period to document the proportion with episiotomy; (2) focus group discussions with midwives to form a checklist of reasons for episiotomy; (3) checklist-based documentation of midwife-reported reasons for episiotomy and data collection on maternal, neonatal, practice and midwife factors, and degree of perineal tear among women undergoing NVDs conducted by midwives over a 2-month period. Risk factors for episiotomy were assessed through logistic regression. Results: Primiparity, advanced maternal age, Indian ethnicity, higher birth weight and older midwife age were associated with episiotomy. The most common midwife-reported reason for episiotomy among primiparous women was primiparity (55.1 %), and among multiparous women was fetal distress (20.0 %) and poor maternal effort (20.0 %). All women with episiotomy sustained at least a second-degree perineal tear versus 27.1 % among women without episiotomy. Conclusion: Most midwife-reported reasons for episiotomy were not congruent with international practice guidelines. Women without episiotomy have lesser tears than those with episiotomy. Practice protocols and educational programs are needed to change episiotomy practice. © 2013 Springer-Verlag Berlin Heidelberg.Publication Association of preterm birth with long-term survival, reproduction, and next-generation preterm birth(2008-03-26) Swamy, G.K.; Østbye, T.; Skjærven, R.; DUKE-NUS GRADUATE MEDICAL SCHOOL S'POREContext: Preterm birth is a major cause of infant morbidity and mortality. Less is known about long-term health among persons born preterm. Objective: To determine the long-term effects of preterm birth on survival, reproduction, and next-generation preterm birth. Design, Setting, and Participants: Population-based, observational, longitudinal study using registry data from 1 167 506 singleton births in the Medical Birth Registry of Norway in 1967-1988. The cohort was followed up through 2002 for survival. The cohort was truncated to births from 1967-1976 for assessment of educational achievement and reproductive outcomes through 2004. Main Outcome Measures: In relation to sex and gestational age at birth, absolute mortality, risk of fetal, infant, child, and adolescent mortality, and incidence and risk of reproduction and next-generation preterm birth. Singleton term (37-42 weeks) fetal deaths and live births, stratified by sex, served as the reference group for all analyses. Results: The percentage who were born preterm was higher among boys (5.6%) than among girls (4.7%). Preterm participants had an increased risk of mortality throughout childhood. For boys born at 22 to 27 weeks, mortality rates were 1.33% and 1.01% for early and late childhood death, with relative risks (RRs) of 5.3 (95% confidence interval [CI], 2.0-14.2) and 7.0 (95% CI, 2.3-22.0), respectively. The mortality rate for girls born at 22 to 27 weeks was 1.71% for early childhood death, with an RR of 9.7 (95% CI, 4.0-23.7); there were no late childhood deaths. For 28 to 32 weeks, the early and late childhood mortality rates among boys were 0.73% and 0.37%, with RRs of 2.5 (95% CI, 1.6-3.7) and 2.3 (95% CI, 1.3-4.1), respectively. Girls born at 28 to 32 weeks did not have a significantly increased risk of childhood mortality. Reproduction was diminished for index participants born preterm. For men and women born at 22 to 27 weeks, absolute reproduction was 13.9% and 25%, with RRs of 0.24 (95% CI, 0.17-0.32) and 0.33 (95% CI, 0.26-0.42), respectively. For 28 to 32 weeks, absolute reproduction was 38.6% and 59.2% for men and women, with RRs of 0.7 (95% CI, 0.66-0.74) and 0.81 (95% CI, 0.78-0.85), respectively. Preterm women but not men were at increased risk of having preterm offspring. Conclusion: In persons born in Norway in 1967-1988, preterm birth was associated with diminished long-term survival and reproduction. ©2008 American Medical Association. All rights reserved.Publication Unsuspected dengue and acute febrile illness in rural and semi-urban southern Sri Lanka(2012) Reller, M.E; Bodinayake, C; Nagahawatte, A; Devasiri, V; Kodikara-Arachichi, W; Strouse, J.J; Broadwater, A; Østbye, T; de Silva, A; Woods, C.W; DUKE-NUS MEDICAL SCHOOLDengue virus (DENV), a globally emerging cause of undifferentiated fever, has been documented in the heavily urbanized western coast of Sri Lanka since the 1960s. New areas of Sri Lanka are now being affected, and the reported number and severity of cases have increased. To study emerging DENV in southern Sri Lanka, we obtained epidemiologic and clinical data and acuteand convalescent-phase serum samples from patients ?2 years old with febrile illness. We tested paired serum samples for DENV IgG and IgM and serotyped virus by using isolation and reverse transcription PCR. We identified acute DENV infection (serotypes 2, 3, and 4) in 54 (6.3%) of 859 patients. Only 14% of patients had clinically suspected dengue; however, 54% had serologically confirmed acute or past DENV infection. DENV is a major and largely unrecognized cause of fever in southern Sri Lanka, especially in young adults.Publication 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(BioMed Central Ltd., 2003) Ostbye T.; Taylor D.H.; Lee A.M.M.; Greenberg G.; Van Scoyoc L.; DUKE-NUS MEDICAL SCHOOLPublication Variation in and correlates of body mass status of older Singaporean men and women: Results from a national survey(2013-01) Østbye, T.; Malhotra, R.; Chan, A.; DUKE-NUS GRADUATE MEDICAL SCHOOL S'POREThis study describes the body mass status of older (≥60 years) Singaporeans, using the international and Asian body mass index (BMI) classifications, assesses sociodemographic correlates of BMI, underweight, obesity, and "high-risk" BMI (≥27.5 kg/m2), and ascertains the relationship between body mass and important health outcomes. Prevalence of underweight, obesity, and high-risk BMI among 4371 older Singaporeans was 6.8%, 7.4%, and 18.6%, respectively. Women (vs men) and Malays and Indians (vs Chinese) were more likely to have obesity or high-risk BMI. Increasing education decreased the odds of obesity and high-risk BMI only among women. Prevalence and odds of various health conditions was similar in corresponding categories of the two BMI classifications. Whereas the prevalence of obesity is lower among elderly in Singapore than in many other countries, the prevalence of high-risk BMI is considerable. It is important to address high-risk BMI among them, with elderly of minority ethnic groups, especially females, being a priority. © 2013 APJPH.Publication The association between history of diabetic foot ulcer, perceived health and psychological distress: The Nord-Trøndelag Health Study(BioMed Central Ltd., 2009) Iversen M.M.; Midthjell K.; Tell G.S.; Moum T.; Østbye T.; Nortvedt M.W.; Uhlving S.; Hanestad B.R.; DUKE-NUS MEDICAL SCHOOLPublication Under reporting of road traffic injuries in the district of Kandy, Sri Lanka(BMJ Publishing Group, 2013) Periyasamy N.; Lynch C.A.; Dharmaratne S.D.; Nugegoda D.B.; Ostbye T.; DUKE-NUS MEDICAL SCHOOLPublication Introducing PACS to the late majority. a longitudinal study(2010-02) Hurlen, P.; Østbye, T.; Borthne, A.; Gulbrandsen, P.; DUKE-NUS GRADUATE MEDICAL SCHOOL S'POREThe purpose of this study was to study whether the benefits from introducing a picture archiving and communication systems (PACS) reported by innovators and early adopters also can be achieved by a hospital belonging to the "late majority" and to see whether such benefits are sustained, using report turnaround time (RTAT) as an indicator. Activity-related data was retrieved from the radiology information system (RIS) over a 2-year period. The median RTAT for preliminary reports was initially reduced from 12 to 2 h then increased to 3 h. For final reports, the median RTAT was initially reduced from 23 to 13 h then gradually reverted back to 22 h. Innovators and early adopters demonstrate not only that positive results can be achieved but also the importance of involving key personnel. We believe that such involvement and the focus on wider organizational concerns are important when introducing PACS to the late majority, both for achieving and sustaining positive results. © 2008 Society for Imaging Informatics in Medicine.Publication Multiparity is Associated With High Motivation to Change Diet Among Overweight and Obese Postpartum Women(2010-03) Bastian, L.A.; Pathiraja, V.C.; Krause, K.; Namenek Brouwer, R.J.; Swamy, G.K.; Lovelady, C.A.; Østbye, T.; DUKE-NUS GRADUATE MEDICAL SCHOOL S'POREBackground: Pregnancy is associated with weight gain and obesity. The aim of this study was to identify the effect of parity and other factors on motivation to change diet to lose weight in a cohort of overweight and obese postpartum women. Study Design: Active Mothers Postpartum is a randomized, controlled trial aimed at postpartum weight reduction. At baseline, we measured motivation to change diet to lose weight among 491 overweight/obese postpartum women. Logistic regression was used to model the effect of parity on motivation to change diet at baseline while adjusting for potential confounders including age, race, education, body mass index category, and breastfeeding status. Results: Approximately two thirds (68%) of participants were highly motivated to change their diet to lose weight. In the multivariable model, women with three or more children had 2.5 times the odds of high motivation compared with primigravid women, and women not breastfeeding had 1.6 times the odds of high motivation compared with any breastfeeding. Conclusion: Although risk for obesity is incurred starting with a woman's first pregnancy, women in this study were more motivated to change their diet to lose weight after their third pregnancy. Further research is needed to understand how to best capitalize on the high motivation in women with several children as well as how to improve motivation for primigravid women and women who are breastfeeding. © 2010 Jacobs Institute of Women's Health.Publication Predictors of weight loss communication in primary care encounters(2011-12) Pollak, K.I.; Coffman, C.J.; Alexander, S.C.; Manusov, J.R.E.; Østbye, T.; Tulsky, J.A.; Lyna, P.; Esoimeme, I.; Brouwer, R.J.N.; Dolor, R.J.; DUKE-NUS GRADUATE MEDICAL SCHOOL S'POREObjective: Evidence suggests that physicians' use of motivational interviewing (MI) techniques helps patients lose weight. We assessed patient, physician, relationship, and systems predictors of length of weight-loss discussions and whether physicians' used MI techniques. Methods: Forty primary care physicians and 461 of their overweight or obese patients were audio recorded and surveyed. Results: Weight-related topics were commonly discussed (nutrition 78%, physical activity 82%, and BMI/weight 72%). Use of MI techniques was low. A multivariable linear mixed model was fit to time spent discussing weight, adjusting for patient clustering within physician. More time was spent with obese patients (p= .0002), by African American physicians (p= .03), family physicians (p= .02), and physicians who believed patients were embarrassed to discuss weight (p= .05). Female physicians were more likely to use MI techniques (p= .02); African American physicians were more likely to use MI-inconsistent techniques (p< .001). Conclusion: Primary care physicians routinely counsel about weight and are likely to spend more time with obese than with overweight patients. Internists spend less time on weight. Patient and systems factors do not seem to influence physicians' use MI techniques. Practice implications: All physicians, particularly, male and African American physicians, could increase their use of MI techniques to promote more weight loss among patients. © 2011 Elsevier Ireland Ltd.