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Biomedical subjects

A Rougemont

Publications and source records attributed to A Rougemont.

At least 37 records · Page 2Linked to original sources
PubMed1996

Switching Swiss enrollees from indemnity health insurance to managed care: the effect on health status and stisfaction with care.

OBJECTIVES: In 1992, most members of a Swiss indemnity health insurance plan were automatically transferred into a newly created managed care organization. This study examined whether this semivoluntary change affected enrollees' health status and satisfaction with care. METHODS: Three groups of enrollees were compared: 332 plan members who accepted the switch (managed care joiners); 186 plan members who opted to maintain indemnity coverage (non-joiners); and 296 persons continuosly enrolled in another indemnity plan (indemnity plan members). Health status, health related behaviors, and satisfaction with care received in the previous year were surveyed at baseline and 1 year later. RESULTS: Health status remained unchanged in all three groups. Smoking prevalence decreased among managed care joiners but remained constant in the other groups. Satisfaction with insurance coverage increased between baseline and follow-up in managed care joiners, but decreased in nonjoiners and indemnity plan members. The latter groups had higher satisfaction with health care, particularly with continuity of care. CONCLUSIONS: A semivoluntary switch from indemnity health insurance to managed care reduced satisfaction with health care but increased satisfaction with insurance coverage. There were no changes in self-perceived health status.

Adult↗
PubMed1995

From humanitarian action to international health.

Currently, three main perspectives are considered in international relations in the field of health: humanitarian action in cases of emergency, development cooperation, and "international health". Usually, these situations are described as separate fields, managed by different types of organizations, with specific aims and problems. The main questions raised by these perspectives are first discussed, then elements of convergence between them are described, and finally, some practical ways to reach the objectives of a global model in which humanitarian action and development cooperation are both situated within the broader methodological context of international health are explored.

Emergencies↗
PubMed1995

Malnutrition of children in Sikasso (Mali): prevalence and socio-economic determinants.

BACKGROUND: Malnutrition of children is a major public health problem in many African countries. Despite a relatively favourable geographical situation, the prevalence of malnutrition is high in the Sikasso region (Mali). METHODS: Survey repeated annually during 5 years, to a sample of 491 families living in Sikasso. The determinants of wasting and stunting were analysed using logistic regression. RESULTS: The prevalence of stunting was about 25%. Prevalence of wasting was about 12%, which is very high, and had been increasing in the past years. No strong associations with socio-economic factors were observed for wasting. Stunting was strongly associated with the education level of both parents, and with the family assets.

Child Nutrition Disorders↗
PubMed1995

Proteinuria screening using sulfosalicylic acid: advantages of the method for the monitoring of prenatal consultations in West Africa.

Screening for proteinuria is widely recommended in the monitoring of pregnancy in order to detect preeclampsia. The method often used in primary health care centers (urine heated with acetic acid) has often attained results of over 50% positive cases. This result indicates a considerable lack of specificity outside highly endemic, for urinary schistosomiasis areas. The sulfosalicylic acid test (SSA) represents a simple, reliable and inexpensive alternative. In order to validade this procedure in the conditions of a primary mother and child health (MCH) center, results of the SSA method were compared with standard commercial strip tests a. in a well equipped Swiss laboratory, b. in a school setting in Northern Cameroon. The proportion of agreement between the two methods was 82% (CI 66-98) and 90% (CI 83-96) respectively. The relatively easy implementation of the SSA test in a MCH center in an urban area in Southern Mali lead to results more compatible with what was expected epidemiologically (less than 5% from positive to highly positive results). This experiment confirms that the SSA technique is a simple method, easy to demonstrate and implement, as well as inexpensive. Consequences for monitoring of pregnancies in such conditions are finally discussed.

Allied Health Personnel↗
PubMed1995

Validation of a French-language version of the MOS 36-Item Short Form Health Survey (SF-36) in young healthy adults.

The MOS 36-Item Short Form Health Survey (SF-36) is designed to measure 8 dimensions of health in clinical and general population settings. The main aim of this paper was to examine the reliability and validity of this instrument in young adults. A secondary aim was to document the results of a rapid translation procedure of the instrument, to be compared later to the more thorough official French adaptation. The translated survey was answered in 1992 by 1007 residents of Geneva, Switzerland, 18-44 years old, identified from health insurance rolls (82% response rate). Completion rate for all 8 dimensions of health was 95.5%. The instrument demonstrated excellent covergent (100%) and discriminant (98%) validity against pre-set criteria. Interval scaling of responses could be verified in some, but not all, items. Cronbach alpha (reliability) coefficients ranged from 0.76 to 0.92. Factorial analysis yielded 2 principal components, corresponding to mental and physical health. Thirteen of 16 correlations between health dimensions and principal components were within a pre-established range. Validation by independent clinical variables was also, with few exceptions, consistent with theory. Thus the SF-36 retained excellent psychometric properties even when used in a generally very healthy group. The careful but rapid translation procedure used in this study may be an effective alternative to full-scale cultural adaptations when resources are limited.

Adult↗
PubMed1995

Mental health and choice between managed care and indemnity health insurance.

OBJECTIVE: Populations enrolled in various health insurance plans may differ in their health care needs. Whether mental health affects choice among competing health plans is not clear. This study examined self-selection by participants in a Swiss indemnity insurance plan that was transformed into a managed care organization that controlled access to specialists through gatekeeping and restricted coverage for psychiatric treatments. METHOD: Information regarding past use of health services and health status was provided by 421 persons who joined the new managed care organization and 222 nonjoiners. The mental health and somatic health characteristics of these two groups were compared. RESULTS: In the year preceding the creation of the managed care organization, the nonjoiners had made on average 2.3 more visits to psychiatrists than the joiners but 0.0 to 0.6 more visits to other physicians. The nonjoiners were more likely to have used psychoactive medications but not other medications. The rates of treatment for depression were similar in the two groups. The joiners reported significantly lower mental health status, but not somatic health status, than the nonjoiners. CONCLUSIONS: Both mental health status and past use of mental health services strongly affected choice of health insurance plan. The effects of somatic health and use of somatic health services on selection were consistently weaker. People who join managed care organizations may have substantial uncovered needs for psychiatric care. Minimum mandatory benefits for mental health care may be an effective countermeasure to unequitable self-selection.

Adolescent↗
PubMed1994

[Vaccination coverage of 2-year-old children in Geneva].

OBJECTIVE: To measure the immunization uptake among 2 year-old children living in Geneva. METHODS: Review of the vaccination cards, systematically checked because of the compulsory vaccination against diphtheria, during the year in 1991. RESULTS: 3937 immunization cards were reviewed, ie. 93.6% of the children in the given age group. Immunization uptake rates were, for diphtheria and tetanus (3 doses) 96.8%; pertussis (3 doses) 96.1%; poliomyelitis (3 doses) 96.6%. For measles, mumps and rubella vaccine (MMR) (1 dose), 78.4%. For the Haemophilus influenzae b vaccine, recently introduced: 68.5%. The uptake rate for MMR was lower among children of swiss origin (75.5%) than among children of other nationalities (84.6%, p < 0.0001). The highest rates were found among children coming from southern Europe and Latin America. CONCLUSIONS: From the point of view of the community risk, immunization uptake rates for diphtheria, tetanus, pertussis and poliomyelitis can be considered satisfactory. For MMR vaccine, the rate was higher than 2 years earlier, but still insufficient, compared to the level which could block the transmission of the target diseases in the population. The persistence of such a low rate of immunization uptake will not prevent the occurrence of epidemics in the population.

Child, Preschool↗
PubMed1993

Randomized trial of use of a monetary incentive and a reminder card to increase the response rate to a mailed health survey.

Insufficient response rates are a frequent problem in mailed epidemiologic health surveys. As part of a health survey of 1,235 young adults conducted from November 1992 through January 1993 in Geneva, Switzerland, a randomized factorial trial was carried out to assess the contributions of two tactics to increase response rates. The first incentive was the promise of sending 10 Swiss francs (7 US dollars) to respondents; the second was a red postcard, mailed 2 days after the questionnaire, which reminded potential participants to complete the questionnaire. The most effective strategy according to interim analysis was to be selected for follow-up mailings. Two weeks after the first mailing, response rates were 65% for those who had received both incentives, 57% for those who had been offered the money reward only, 54% for recipients of the reminder card, and 48% for those who had received neither incentive (p based on chi 2 (3 df) test < 0.001). The relative hazards of responding were 1.34 (95% confidence interval 1.15-1.55) for the money reward and 1.22 (95% confidence interval 1.05-1.41) for the reminder card. Follow-up mailings to all nonrespondents included both incentives. At the end of data collection, 1,007 persons (82%) had returned the questionnaire. The final response rates were 83, 84, 82, and 78% in the four groups, respectively (p = 0.29). Both the promise of a monetary reward and a reminder postcard considerably improved early response rates. The use of both incentives in follow-up mailings brought final response rates above 80%, except for those who had received no initial incentive. Testing various combinations of incentives in the early stages of a mailed health survey may be a generally useful strategy.

Adult↗
PubMed1992

A descriptive analysis of articles in the journal of Social and Preventive Medicine (Soz Präventivmed): 1980-1990.

This study provides a descriptive image of the work published in Soz Präventivmed between 1980 and 1990, and analyses certain trends. All articles of this period were categorized and recorded in a data base for: language of publication, city of location and affiliation of first author, sponsor (funding body), citation in Medline, regions and population concerned, type of article and subject matter. Over the decade, we note a reduction in the number of articles with a corresponding increase in their page length, and a progressive increase in the number of articles in English when compared with the two principal languages, German (1/2) and French (1/3). A majority of authors have university affiliations. Studies with original results comprise on average 44.6% of all publications, a tendency which gradually decreases over time. The proportion of epidemiological studies, a majority of which are descriptive studies, has increased progressively since 1980. Among the twelve categories of subject matter chosen as indicators some, such as health services research and research on elderly persons, appear more frequently during the first half of the decade, and others, such as heart disease, cancer epidemiology and AIDS, appear during the second half.

Epidemiologic Methods↗
PubMed1992

[Prevalence of smoking in hospital personnel and future teachers].

We have surveyed the prevalence of smoking habits and the opinions about it's regulation among 192 students in two different schools (a teachers' and a nursing school) and among 320 employees of the University Hospital of Geneva. Smoking prevalence varies depending on the profession and sex, and remains high considering the level of education of the surveyed population. Among the future school teachers 23% are smokers. In the hospital, the smoking prevalence is 25% in the health professionals and 32% in the administrative and technical staff. As many as 46% of the future nurses are smoking. Obviously much still needs to be done in order to decrease the number of smokers among the health professionals. The majority of the employees questioned, both smokers and non-smokers, were in favor of regulating smoking in the workplace. 91% of the hospital staff, and 86% of the smokers among them, favored a smoke free hospital policy. Restriction of tobacco use in the workplace should be implemented particularly when it is the wish of a majority of employees.

Female↗
PubMed1991

Epidemiological basis for clinical diagnosis of childhood malaria in endemic zone in West Africa.

It is difficult to distinguish childhood malaria from other common febrile disorders by parasite count alone, because of the wide variation in tolerance of parasitaemia among individuals. We postulated that the proportion of febrile episodes among young children that can be attributed to parasitaemia varies according to simple clinical criteria. We studied 1114 children aged 2-9 years, who attended a dispensary in the Republic of Niger, with a case-control approach; each of 557 febrile children was matched with a non-febrile control by sex, age, ethnic group, and day of presentation. Febrile episodes were classified according to three clinical criteria: the presence of a likely non-malarial cause; the duration (less than 3 or more than 3 days before presentation); and the intensity (below 39 degrees C or 39 degrees C and above). There was no evidence for an association between febrile episodes and parasite count during the dry, low-transmission, season. During the rainy, high-transmission, season, by contrast, there was a highly significant relation (p less than 0.0001) between the likelihood of fever and the parasite count; each clinical criterion strengthened the association. There was no association between parasitaemia and low intensity fevers, with an obvious cause, that started 3 or more days before presentation, even in the rainy season; however, the relative risk of a fever that met all three criteria developing in those with vs those without parasitaemia was 27.5. The proportion of febrile cases attributable to detectable parasitaemia (population attributable risk) ranged from 0 to 0.92. Our results suggest that simple clinical criteria may be valuable in the selection of febrile patients for antimalarial treatment. In this geographic area, high fever of short duration and with no other obvious cause that occurs during the rainy season is most likely to be malaria.

Animals↗
PubMed1991

The construction of a 'topic tree': a way of familiarizing a teaching staff to problem-oriented learning in a master's programme in public health.

At the planning stage of a community-oriented and problem-based learning master's programme in public health it is indispensable to build a network of teachers, experts in specific fields, willing to guide the students in acquiring new competencies and ready to facilitate the experimental learning process. We discuss in this paper the construction and the utilisation of the 'topic tree'. In addition we show how the teaching staff get acquainted with that educational methodology by experimenting with it themselves (prior to the students). About 10 experts, each one a specialist in a given field, have conceptualized their approach in building a topic tree (concept tree); such a tree makes it possible to schematize the topics to be understood in order to solve a given problem and the relationship existing between actions to be undertaken. The experiment, meant to initiate the teaching staff in experimental learning procedures, was appreciated by all the experts, who considered it a creative and stimulating method. It also permitted the construction of a bibliography including key documents concerning each identified priority health problem. We discuss the utility and the relevance of our approach in the perspective of initiating teachers in experiential learning based on problem-solving.

Algorithms↗
PubMed1990

Development of a haptoglobin ELISA. Its use as an indicator for malaria.

Hypo- or ahaptoglobinemia, a common phenomenon in tropical countries, is mainly due to malaria induced hemolysis. We have recently shown that the prevalence of hypohaptoglobinemia is a useful epidemiologic indicator in malaria endemic areas. The main limitation to the practical utilisation of this indicator is the available methodologies. Here we describe a sandwich ELISA for the determination of haptoglobin concentrations which is easy to perform, sensitive and requires a minimal amount of equipment. With this test system it is possible to detect haptoglobin in serum at a lower limit of 100 micrograms/ml for 10(-4) dilutions and of less than 1 micrograms/ml for 10(-2) dilutions. This represents at least 200 fold increase in sensitivity as compared to radial immunodiffusion.

Enzyme-Linked Immunosorbent Assay↗