Developing and testing a consensus-based core set of outcome measures for rehabilitation in musculoskeletal diseases.

OBJECTIVES: Rehabilitation is important for people with musculoskeletal diseases (MSDs), and evaluating the effect of rehabilitation on both an individual and group level is advocated. A consensus concerning use of outcome measures will improve collaboration between healthcare providers, and increase the possibility of conducting meta-analyses in future research. The aim of this study was to develop a consensus-based core set of outcome measures for rehabilitation in MSDs, and to test the feasibility and responsiveness of the set. METHOD: The core set was developed through a stepwise process comprising a Delphi consensus procedure, systematic literature searches, and a pilot study, including 386 patients, to test the feasibility and responsiveness of the set. RESULTS: The following aspects and outcome measures were selected: pain [numeric rating scale (NRS)], fatigue (NRS), physical fitness (the 30-second Sit to Stand test), mental health (Hopkins Symptom Checklist 5), daily activities (Hannover Functional Questionnaire), goal attainment (Patient-Specific Functional Scale including motivation score for baseline assessment), quality of life (5-level EuroQol 5 Dimensions), social participation (the social participation item from COOP/WONCA) and coping (Effective Musculoskeletal Consumer Scale-17). All tested outcome measures were found to be feasible, with high completion rates and acceptable score distribution. Standard response means varied from 0.3 to 0.9. CONCLUSIONS: A consensus-based core set of patient reported outcome measures is presented for evaluating rehabilitation in MSDs. The core set is feasible and responsive for use in Norway, but needs further testing in other countries.

Day care centers and respiratory health.

OBJECTIVE: To estimate the effects of the type of day care on respiratory health in preschool children. METHODS: A population-based cross-sectional study of Oslo children born in 1992 was conducted at the end of 1996. A self-administered questionnaire inquired about day care arrangements, children's health, environmental conditions, and family characteristics (n = 3853; response rate, 79%). RESULTS: In logistic regression controlling for confounding, children in day care centers had more often nightly cough (adjusted odds ratio, 1.89; 95% confidence interval, 1.34-2. 67), and blocked or runny nose without common cold (1.55; 1.07-1.61) during the past 12 months compared with children in home care. Poisson regression analysis showed an increased risk of the common cold (incidence rate ratio, 1.21; 1.12-1.30) and otitis media (1.48; 1.22-1.80), and the attributable proportion was 17.4% (95% confidence interval, 10.7-23.1) for the common cold and 32.4% (18. 0-44.4) for otitis media. Early starting age in the day care center increased the risk of developing recurrent otitis media. Also the lifetime risk of doctor-diagnosed asthma was higher in children who started day care center attendance during the first 2 years of life. CONCLUSIONS: Attendance to day care centers increases the risk of upper respiratory symptoms and infections in 3- to 5-year-old children. The starting age seems to be an important determinant of recurrent otitis media as well as asthma. The effect of day care center attendance on asthma is limited to age up to 2 years. This effect is most likely mediated via early respiratory tract infections that are substantially more common in children in day care centers compared with children in home care.

Residential exposure to plasticizers and its possible role in the pathogenesis of asthma.

The plasticizer di(2-ethylhexyl) phthalate (DEHP) is widely used in building materials. DEHP is identified as the major plasticizer exposure in dwellings. We provide evidence that inhalation exposure to DEHP as aerosols adsorbed to particulate matter is as important, or more important, than vapor phase exposure. The particulate inhalation exposure to DEHP is considered to be significant due to its low clearance and extensive penetration into the pulmonary region. DEHP is capable of creating high local concentrations in the airways at the deposition site with subsequent local effects. The proposed mechanism of effect states that mono(2-ethylhexyl) phthalate (MEHP), the primary hydrolysis product of DEHP, mimics the inducing prostaglandins (PG) PGD(2), 9alpha,11betaPGF2, and PGF2alpha, and thromboxanes in the lungs, thereby increasing the risk of inducing inflammation in the airways, which is a characteristic of asthma.

Exposure to nitrogen dioxide and the occurrence of bronchial obstruction in children below 2 years.

BACKGROUND: The objective of the investigation was to test the hypothesis that exposure to nitrogen dioxide (NO2) has a causal influence on the occurrence of bronchial obstruction in children below 2 years of age. METHODS: A nested case-control study with 153 one-to-one matched pairs was conducted within a cohort of 3754 children born in Oslo in 1992/93. Cases were children who developed > or = 2 episodes of bronchial obstruction or one episode lasting >4 weeks. Controls were matched for date of birth. Exposure measurements were performed in the same 14-day period within matched pairs. The NO2 exposure was measured with personal samplers carried close to each child and by stationary samplers outdoors and indoors. RESULTS: Few children (4.6%) were exposed to levels of NO2 > or = 30 microg/m3 (average concentration during a 14-day period). In the 153 matched pairs, the mean level of NO2 was 15.65 microg/m3 (+/-0.60, SE) among cases and 15.37 (+/-0.54) among controls (paired t = 0.38, P = 0.71). CONCLUSIONS: The results suggest that NO2 exposure at levels observed in this study has no detectable effect on the risk of developing bronchial obstruction in children below 2 years of age.

Interior surface materials in the home and the development of bronchial obstruction in young children in Oslo, Norway.

OBJECTIVES: This study assessed the role of polyvinyl chloride (PVC) plastics and textile materials in the home in the development of bronchial obstruction during the first 2 years of life. METHODS: The study was a matched pair case-control study based on a cohort of 3754 newborns in Oslo in 1992 and 1993 who were followed up for 2 years. The case group consisted of 251 children with bronchial obstruction; the control group was matched one-to-one for date of birth. RESULTS: In conditional logistic regression analysis, the risk of bronchial obstruction was related to the presence of PVC flooring (adjusted odds ratio [OR] = 1.89; 95% confidence interval [CI] = 1.14, 3.14) and textile wall materials (adjusted OR = 1.58; 95% CI = 0.98, 2.54). The reference category was wood or parquet flooring and painted walls and ceiling. Further analysis revealed an exposure-response relationship between the assessed amount of PVC and other plasticizer-containing surface materials and the risk of bronchial obstruction. CONCLUSIONS: This study provides new evidence of the role of PVC and textile wall materials in the development of bronchial obstruction in young children.

Ventilation in homes and bronchial obstruction in young children.

We assessed the role of ventilation rate in homes in the development of bronchial obstruction during the first 2 years of life. We conducted a matched case-control study based on a cohort of 3,754 newborns in Oslo in 1992-93 that was followed for 2 years. The case series comprised 172 children with bronchial obstruction, and the control series was one-to-one matched for date of birth. Ventilation rate and other building characteristics were measured/collected in home visits, and questionnaires were used to obtain additional information. We found that the risk of bronchial obstruction was not directly associated with the ventilation rate in liters per second and per person (ventilation rate quartiles: 6.9, 11.5 and 17.6 l/s,p [liter/second and person]) in the homes (odds ratio; OR 0.98, 95% confidence interval (CI) 0.96-1.01). The odds ratios of bronchial obstruction were higher in the low air change group (air change rate < or =0.5 h(-1)) than in the high air change group owing to exposure to environmental tobacco smoke (low 1.8; 95% CI: 0.35-9.66; high 1.5; 95% CI: 0.74-3.20), dampness problems (low 9.6; 95% CI: 1.05-87.4; high 2.3; 95% CI: 0.83-6.39), and the presence of textile wall paper (low 3.7; 95% CI: 0.62-21.5; high 1.7; 95% CI 0.72-3.94) and plasticizer-containing surfaces (low 12.6; 95% CI: 1.00-159; high 2.6; 95% CI: 1.02-6.58). Our results are consistent with the hypothesis that low ventilation rates strengthen the effects of indoor air pollutants.

Residential dampness problems and symptoms and signs of bronchial obstruction in young Norwegian children.

To assess the role of dampness problems and house dust mite exposure in the development of bronchial obstruction in early life, a cohort of 3,754 children born in Oslo during 1992 and 1993 was followed for 2 yr. Bronchial obstruction was defined as two or more episodes with symptoms and signs of obstruction or one lasting 1 mo or more. A matched case-control study was carried out in 251 cases of bronchial obstruction (response rate: 98%) and their 251 paired controls. Information on home dampness problem(s), house dust mite exposure, and potential confounders was collected during home visits and by questionnaires. Dampness problems were confirmed in the homes of 27% of the cases and 14% of the controls, while a concentration of Dermatophagoides pteronyssinus allergens > 2 microg/g dust was found in the beds of 11 (4.5%) cases and three (1.2%) controls. In conditional logistic regression analysis controlling for potential confounders, confirmed dampness problems increased the risk of bronchial obstruction (adjusted odds ratio: 3.8; 95% confidence interval: 2.0-7.2). Exposure to D. pteronyssinus allergens > 2 microg/g dust increased the risk of bronchial obstruction (adjusted odds ratio: 2.8; 95% confidence interval: 0.7-11.7). Residential dampness problems in Oslo dwellings seem to increase symptoms and signs of bronchial obstruction in young children, apparently without increasing their exposure to house dust mites.