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Papers by Robert Tate

American Journal of Epidemiology, Nov 13, 2017

Journal of Pediatrics, Perinatology and Child Health, 2021

Healthy Aging Research, 2015

Background: In light of evidence from previous work, we identified the overlaps and gaps between ... more Background: In light of evidence from previous work, we identified the overlaps and gaps between six prominent theoretical frameworks of successful aging and lay conceptualizations of the same. It has formerly been suggested that considering complex phenomena from the bottom up and from the top down allows one to get to the root of an issue that warrants inquiry; namely the discrepancy between researcher-generated theories and lay conceptualizations of successful aging. Methods: In the present study we approached this issue from the bottom up and top down, using the saturated Manitoba Follow-up Study coding system (the 'MFUS-SA-CM v.1') as a template. Results: The overlaps we found depicted aspects of successful aging that were well represented by theories in the field. The gaps highlighted aspects of successful aging that were underrepresented by the theories. The gaps were particularly important, since they flagged theoretical areas that could be expanded upon via lay conceptualizations. Conclusions: By broadening the existing theoretical 'take' on successful aging to include aspects of lay definitions that have thus far been downplayed, we aim to provide the research community with a much-needed tool with which to consistently inform their successful aging research.

BMJ Open

ObjectiveIn studies of trajectories of physical functioning among older people, the data cannot b... more ObjectiveIn studies of trajectories of physical functioning among older people, the data cannot be measured continuously, but only at certain time points in prespecified cycles. We examine how data collection cycles can affect the estimation of trajectories and their associations with survival.Study design and settingLongitudinal data from the Manitoba Follow-Up Study (MFUS), with 12 measurements collected annually from 2004 to 2015, are analysed using a summary measures of physical functioning from the Short Form-36 questionnaire. Based on the joint models of the functioning trajectories and risk of death, we compare the estimations among models using different frequency of data collection (annually, biennially and triennially).ResultsOur 2004 baseline includes 964 men who were survivors from the original MFUS cohort with mean age of 84 years and range between 75 and 94 years. Results from analysis of annual data indicate that the mean physical functioning is significantly decreasi...

Rural and Remote Health, 2021

Introduction: Understanding rural-urban differences, and understanding levels of life satisfactio... more Introduction: Understanding rural-urban differences, and understanding levels of life satisfaction in rural populations, is important in planning social and healthcare services for rural populations. The objectives of this study were to determine patterns of life satisfaction in Canadian rural populations aged 45-85 years, to determine rural-urban differences in life satisfaction across a rural-urban continuum after accounting for potential confounding factors and to determine if related social and health factors of life satisfaction differ in rural and urban populations. Methods: A secondary analysis was conducted using data from an ongoing population-based cohort study, the Canadian Longitudinal Study on Aging. A cross-sectional sample from the baseline wave of the tracking cohort was used, which was intended to be as generalizable as possible to the Canadian population. Four geographic areas were compared on a rural-urban continuum: rural, mixed (indicating some rural, but could also include some peri-urban areas), peri-urban, and urban. Life satisfaction was measured using the Satisfaction with Life Scale and dichotomized as satisfied versus dissatisfied. Other factors considered were province of residence, age, sex, education, marital status, living arrangement, household income, and chronic conditions. These factors were self-reported. Bivariate analyses using χ tests were conducted for categorical variables. Logistic regression models were constructed with the outcome of life satisfaction, after which a series of models were constructed, adjusting for province of residence, age, and sex, for sociodemographic factors, and for health-related factors. To report on differences in the factors associated with life satisfaction in the different areas, logistic regression models were constructed, including main effects for the variable of interest, for the variable rurality, and for the interaction term between these two variables. Results: Individuals living in rural areas were more satisfied with life than their urban counterparts (odds ratio (OR)=1.23; 95% confidence interval (CI): 1.13-1.35), even after accounting for the effect of confounding sociodemographic and health-related factors (OR=1.32, 95%CI: 1.19-1.45). Those living in mixed (OR=1.30, 95%CI: 1.14-1.49) and peri-urban (OR=1.21, 95%CI: 1.07-1.36) areas also reported being more satisfied than those living in urban areas. In addition, a positive association was found between life satisfaction and age, as well as between life satisfaction and being female. A strong graded association was noted between income and life satisfaction. Most chronic conditions were associated with lower life satisfaction. Finally, no major interaction was noted between rurality and each of the previously mentioned different factors associated with life satisfaction. Conclusion: Rural-urban differences in life satisfaction were found, with higher levels of life satisfaction in rural populations compared to urban populations. Preventing and treating common chronic illness, and also reducing inequalities in income, may prove useful to improving life satisfaction in both rural and urban areas. Studies of life satisfaction should consider rurality as a potential confounding factor in analyses of life satisfaction within and across societies.

Innovation in Aging, 2019

The Manitoba Follow-up Study is in its 71st year of continuous operation. Since 1948, 3,983 aircr... more The Manitoba Follow-up Study is in its 71st year of continuous operation. Since 1948, 3,983 aircrew recruits to the Royal Canadian Air Force during the Second World War have submitted routine medical examinations and completed questionnaires. On May 1, 2006, 1001 of these men (25%) were alive mean age of 86 years. The effects of 7 chronic diseases (CDs) diagnosed before 2006 were modeled with multinomial logistic regression to predict the pattern of decline of living and dying through an 11 year window to 2017. By 2017, 11% were still alive, 10% died very early in the window, 44% experienced a slow decline of a least three years to death, 17% experienced a step decline to death, and 18% experienced a terminal drop, death within six months of decline in functioning. Only 30% were free of CD in 2006; 36% had 1 CD, and 34% had more than 1 CD. As the number of CDs increased, the probability of remaining alive by 2017 decreased: 18% alive if no CD, 10% if 1 CD, 8% if 2 CDs, and 3% of &gt...

Innovation in Aging, 2017

The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2004

The population of alternate level care (ALC) patients utilizing acute-care hospital resources ina... more The population of alternate level care (ALC) patients utilizing acute-care hospital resources inappropriate to their needs is growing. The purpose of this study was to explore how the care of ALC patients was managed at 4 acute-care facilities in the Canadian province of British Columbia and to examine how this care impacts on outcomes of staff injury. Interviews were conducted to identify and characterize the different models of ALC. Injury outcomes for all caregivers were obtained (n = 2,854) and logistic regression conducted to compare staff injuries across ALC models. Injured workers were surveyed regarding their perceptions of injury risk and ALC. Five ALC models were identified: low-mix, high-mix, dedicated ALC units, extended care units, and geriatric assessment units. The risk for caregiver injuries was lowest on dedicated ALC units. These findings suggest that acute-care facilities faced with a growing ALC population should consider creating dedicated ALC units.

Stroke, 1978

Little attention has been given to assessing risk factors for cerebrovascular disease (CBVD) and ... more Little attention has been given to assessing risk factors for cerebrovascular disease (CBVD) and less has been given to relating long term changes in blood pressure (BP) to CBVD occurrence. In the Manitoba Study 811 a cohort of 3,983 North American men (predominantly between 25-34 years of age at entry in 1948), measured 5 times during the 26 year observation period from 1948 to 1974, was related to the incidence of CBVD. Used were measurements of age, systolic (SBP) and diastolic (DBP) blood pressure and Body Mass Index-weight/height 2 determined at entry and at examination closest to July 1, 1954, 1959, 1964 and 1969. Change was calculated as the difference in these variables between examinations. In order to adjust for age and BP as CBVD risk factors, as well as for the effect both may have on the rate of BP change, the data were analyzed using multivariate as well as univariate methods. After adjusting for age and SBP, change in SBP was significantly associated with subsequent CBVD, primarily in men middle aged or older. When considering SBP after entry, changes from a measurement 5 years earlier were more important than SBP changes over longer intervals. Thus, in evaluating SBP as a risk factor for CBVD, the rate of change in SBP is also an important factor in the identification of the stroke prone individual.

Circulation, 1982

The objective of this investigation was to determine the relationship of blood pressure (BP) in y... more The objective of this investigation was to determine the relationship of blood pressure (BP) in young men, ages 20-39 years, to their subsequent BP from the perspective of BP tracking, position in BP distribution and later evidence of hypertensive BP values. Since 1948, the Manitoba Study group has followed 3983 men, 90% of whom were 20-39 years old at entry. BP in persons not prescribed antihypertensive medications was examined at 5-year intervals during the 30-year observation period to 1978. To adjust for age, BP was examined within 5-year age groups at entry. The correlations between entry and subsequent BP at the same length of follow-up were greater for systolic than diastolic BP and increased with older ages. The correlation decreased wtih every 5-year examination after entry for all ages. Men whose BP was below the mean at entry were less likely to have a BP greater than 1 standard deviation (SD) above the mean at any of the examinations. Men with an entry BP greater than 1 ...

Canadian Journal of Public Health, 2015

OBJECTIVE: The aim of the study was to explore the variations in body mass index (BMI) trajectori... more OBJECTIVE: The aim of the study was to explore the variations in body mass index (BMI) trajectories during the 20 years before diagnosis of type 2 diabetes mellitus (T2DM) over four decades between 1968 and 2007. METHODS: Longitudinal measurements of BMI from 437 men, all with a diagnosis of T2DM, were used in the analysis. A mixed method approach was used to fit individual patterns of BMI measurements during the 20 years before diagnosis of T2DM. RESULTS: The mean BMI at diagnosis was 26.7 kg/m 2 (95% confidence interval, 26.4-27.1). Compared with men whose condition was diagnosed between 1968 and 1977, for men with a diagnosis between 1978 and 2007 the mean BMI about 10 years before diagnosis significantly increased by 0.92 to 1.54 BMI units. Decades also varied in how long there was a persistent increase in BMI during the 20 years before diagnosis. The rate of change in mean BMI among men whose T2DM was diagnosed in the most recent two decades increased by 8.8% to 22.6% during the 10-year interval before diagnosis, but there was no significant difference among men given a diagnosis between 1978 and 1987. The quadratic trend of BMI prior to diagnosis was also significantly affected by age at diagnosis. CONCLUSION: The BMI trajectories during the 20 years leading up to T2DM varied by decade of diagnosis. The increase in BMI persisted for much longer among relatively younger men with a diagnosis in more recent decades. Strategies to prevent T2DM, informed by the pattern of BMI trajectories, should be customized to consider a potential age-period effect.

Canadian Journal of Occupational Therapy, Oct 1, 2001

The Canadian Occupational Performance Measure (COPM) is receiving international attention as an i... more The Canadian Occupational Performance Measure (COPM) is receiving international attention as an important assessment for directing occupational therapy interventions and measuring client-centred outcomes. The COPM measures individuals' perceptions of disability by identifying those tasks that are important to them and difficult to perform. The Health Assessment Questionnaire (HAQ) has been used extensively with persons with arthritis and measures individuals' perceived difficulty in performing predetermined tasks of daily living. The HAQ has been shown to correlate with actual performance and has reported concurrent validity with a number of similar scales. In this study, 13 participants diagnosed with rheumatoid arthritis were assessed with the COPM and the disability dimension of the HAQ. Participants scored performance limitations on both the COPM and the HAQ; the correlation coefficient between the scores was not statistically significant. However, when the COPM and the HAQ scores for similar activities were compared, a statistically significant correlation was found. These findings support the use of the COPM as a valid measure of self-reported performance.

Community Dentistry and Oral Epidemiology, Oct 1, 1993

– Nursing caries is a specific form of rampant dental caries affecting the majority of preschool ... more – Nursing caries is a specific form of rampant dental caries affecting the majority of preschool aboriginal children who live in the Province of Manitoba, Canada. Since the majority of these individuals live in remote regions of the province access to denial treatment is difficult, resulting in long delays in the provision of treatment and, most likely, significant morbidity associated with dental pain and oral infection. Travel to distant centres for treatment under general anesthesia by pediatric dentists has become the usual method by which treatment is provided to the majority of affected children. We believed that this was an expensive method of providing these necessary services and our purpose was to document all costs associated with the treatment of nursing caries in this population. We analyzed the records of 884 children who were treated for nursing caries between 1980 and 1988 in Manitoba and collected data for costs in the following categories: travel, lodging, medical, dental, hospital and nursing. Our results show that the remote band groups had significantly higher costs (P < 0.001) than groups which were located closer to treatment centres. The costs which accounted primarily for this significant difference were travel and medical costs associated with hospitalization and the administration of general anesthesia. Our results support the need for the redeployment of resources on the basis of regional need and the development of community‐based preventive programs and treatment programs which will significantly reduce the incidence of nursing caries in preschool Canadian aboriginal children.

Journal of Urban Health-bulletin of The New York Academy of Medicine, Dec 1, 2003

It is increasingly acknowledged that the process of community involvement is critical to the succ... more It is increasingly acknowledged that the process of community involvement is critical to the successful implementation of community-based health interventions. Between 1995 and 1999, a multisectoral intervention called Plan Cayo Hueso was launched in the inner-city community of Cayo Hueso in Havana, Cuba, to address a variety of health determinants. To provide a better understanding of the political structures and processes involved, the Cuban context is described briefly. The interventions included improvements in housing, municipal infrastructure, and social and cultural activities. A qualitative study, consisting of interviews of key informants as well as community members, was conducted to evaluate the community participatory process. Questions from an extensive household survey pre-and postintervention that had been conducted in Cayo Hueso and a comparison community to assess the effectiveness of the intervention also informed the analysis of community participation, as did three community workshops held to choose indicators for evaluating effectiveness and to discuss findings. It was found that formal leaders led the interventions, providing the institutional driving force behind the plan. However, extensive community involvement occurred as the project took advantage of the existing community-based organizations, which played an active role in mobilizing community members and enhanced linkage systems critical to the project's success. Women played fairly traditional roles in interventions outside their households, but had equivalent roles to men in interventions within their household units. Most impressive about this project was the extent of mobilization to participate and the multidimensional ecosystem approach adopted. Indeed, Plan Cayo Hueso involved a massive mobilization of international, national, and community resources to address the needs of this community. This, as well as the involvement of community residents in the evaluation process, was seen as resulting in improved social interactions and community well-being and enhanced capacity for future action. While Cuba is unique in many respects, the lessons learned about enhancing community participation in urban health intervention projects, as well as in their evaluation, are applicable worldwide.

American Journal of Industrial Medicine, Jun 17, 2003

Background This study is an extension of a previously published analysis of cancer mortality in a... more Background This study is an extension of a previously published analysis of cancer mortality in a transformer manufacturing plant where there had been extensive use of mineral oil transformer fluid. The objectives of the present study were to update the mortality analysis and include deaths for the past 6 years as well as to do an analysis of cancer incidence of the cohort. Methods A cohort of 2,222 males working at a transformer manufacturing plant between 1946 and 1975 was constructed. Using a classical historical cohort study design, cancer incidence and mortality were determined through record linkage with Canadian provincial and national registries. The rates of cancer incidence and mortality experienced by this cohort were compared to that of the Canadian male population. Results A statistically significant increased risk of developing and dying of pancreatic cancer was found but not an increase in overall cancer mortality. This was consistent with the previous report from this group. Interestingly, the cohort demonstrated a statistically significant risk of overall cancer incidence and specific increased incidence of gallbladder cancer. Conclusions This study contributes further evidence to the growing body of literature indicating the carcinogenic properties of mineral oils used in occupational settings, in particular those used prior to 1970s.

American Journal of Cardiology, Aug 1, 1994

These data suggest that PTCA for patients aged 290 years incurs an increased risk of in-hospital ... more These data suggest that PTCA for patients aged 290 years incurs an increased risk of in-hospital complications and limited clinical benefit. Acknowledgmenk The authors thank Lori Helmen, BS, for statistical analysis and Denise Evans for assistance in preparation of this manuscript.

PubMed, Apr 3, 2001

Background: Reported prevalence rates of asthma vary within and between countries around the worl... more Background: Reported prevalence rates of asthma vary within and between countries around the world. These differences suggest environmental factors in addition to genetic factors in the cause of the disease and may provide clues for preventive strategies. We examined the variability of asthma-related symptoms and medication use among adults in 6 sites across Canada (Vancouver, Winnipeg, Hamilton, Montreal, Halifax and Prince Edward Island) and compared our findings with those from sites that had participated in a recent European survey. Methods: We used the same sampling strategy and standardized questionnaire as those used in the European Community Respiratory Health Survey (ECRHS). The 6 Canadian sites were selected to represent different environments with respect to climate, air pollution and occupational exposure. Community-based samples of 3000 to 4000 people aged 20-44 years were randomly selected in each site. Subjects were asked to complete the questionnaire by mail between March 1993 and November 1994. Prevalence rates (and 95% confidence intervals [CIs]) of asthma symptoms, self-reported asthma attacks and use of asthma medication were compared across the Canadian sites and with sites that had participated in the ECRHS. Results: The overall response rate of those selected to receive the questionnaire was 86.5% (range 74.5%-92.8%). The prevalence rates of most asthma symptoms varied significantly among the Canadian sites. For instance, 21.9% (Montreal) to 30.4% (Halifax) of the men and 24.0% (Vancouver) to 35.2% (Halifax) of the women reported wheezing in the year before the survey. Depending on the site, 4.4% to 6.3% of the men and 5.2% to 9.5% of the women reported an asthma attack in the last year, and 4.0% to 6.1% of the men and 4.9% to 9.7% of the women were currently using asthma medication. Prevalence rates of symptoms, asthma attacks and medication use did not change with age, but they were higher among women than among men. Compared with the results from the ECRHS sites, those from the Canadian sites were among the highest. Interpretation: Significant variation in the prevalence of asthma symptoms, asthma attacks and use of asthma medication between Canadian sites and international sites suggests environmental influences. Different combinations of factors in different sites may be responsible for the high prevalence rates and should be the subject of further research to guide clinical management and public health intervention.

Applied Ergonomics, Jun 1, 2001

Back injuries are a serious problem for nursing personnel who perform frequent patient-handling a... more Back injuries are a serious problem for nursing personnel who perform frequent patient-handling activities. Common prevention strategies include body mechanics education, technique training, and ergonomic interventions such as the introduction of assistive equipment. This investigation assessed and compared the e!ectiveness of two patient-handling approaches to reducing injury risk. One strategy involved using improved patient-handling technique with existing equipment, and the other approach aimed at eliminating manual patient handling through the use of additional mechanical and other assistive equipment. Both intervention arms received training in back care, patient assessment, and use of the equipment available on their particular wards. An analysis of compliance with interventions and the e!ects of patient-handling methods on both peak and cumulative spinal compression and shear during various tasks was conducted. Results showed greater compliance with interventions that incorporated new assistive patient-handling equipment, as opposed to those consisting of education and technique training alone. In several tasks, subjects who were untrained or non-compliant with interventions experienced signi"cantly higher peak spinal loading. However, patient-handling tasks conducted with the aid of assistive equipment took substantially longer than those performed manually. This, along with variations in techniques, led to increases in cumulative spinal loading with the use of patient-handling equipment on some tasks. Thus, the use of mechanical assistive devices may not always be the best approach to reducing back injuries in all situations. No single intervention can be recommended; instead all patient-handling tasks should be examined separately to determine which methods maximize reductions in both peak and cumulative lumbar forces during a manoeuver.

The American Journal of Medicine, May 1, 1995

Atrial fibrillation is a common arrhythmia associated with increased cardiovascular morbidity and... more Atrial fibrillation is a common arrhythmia associated with increased cardiovascular morbidity and mortality. T his study was undertaken to identify the natural history of this condition, including risk factors for its development, and outcome.