Search PubMed⌕ Search

Biomedical subjects

B Burnand

Publications and source records attributed to B Burnand.

At least 109 records · Page 6Linked to original sources
PubMed1993

Dental disease among alcoholic individuals: a comparative study of hospitalized patients.

OBJECTIVE: To measure the presence and severity of dental disease, as assessed by physicians, among consecutively hospitalized alcoholic and nonalcoholic medical patients. DESIGN: Descriptive cross-sectional study. Patients who had Michigan Alcoholism Screening Test (MAST) scores > or = 8 were identified as being alcoholic. Nonalcoholic patients were defined as individuals with MAST scores < or = 4. These patients were matched with alcoholic patients for gender and age (+/- 5 years). The decayed, missing, and filled teeth (DMF) score and its components were used as a measure of dental disease. SETTING: General wards of internal medicine of a 1,000-bed urban teaching hospital in Lausanne, Switzerland. RESULTS: Among patients aged 20-75 years, the mean DMF score was higher among alcoholic patients than among nonalcoholic patients (26 vs 23, respectively; p < 0.001). This difference was greater among patients aged 20-39 years (20 vs 14, respectively) than among those aged 60-75 years (29 vs 27, respectively). The positive association between alcoholism and dental disease (crude odds ratio, 2.24; 95% CI, 1.15-4.31) remained after sequential stratification for several confounding factors. CONCLUSION: The study suggests that dental disease is frequent and severe in hospitalized medical patients and that alcoholism is an independent predictor of its severity. Routine assessment of dental disease by the physician is important for medical inpatients, especially among those who are alcoholic.

Adult↗
PubMed1993

[Blood lipids in the Swiss population: MONICA study 1988-89].

The second population survey of the Swiss MONICA project took place in 1988-89 in the cantons of Vaud, Fribourg and Ticino. Blood lipids (total, LDL, and HDL cholesterol as well as apolipoproteins A-I and B) were measured in 3341 individuals aged 25-74 years belonging to a representative sample of the three cantons' population. Total and LDL cholesterol values were high on average, especially among patients aged 45 and over: total cholesterol was > 6.5 mmol/l in 27% (age 25-34) to 58% (age 45-54) and in 15% (age 25-34) to 64% (age 65-74) of men and women, respectively. HDL cholesterol values were relatively stable with age, at a higher level in women (median 1.5 mmol/l) than in men (median 1.2 mmol/l). To summarize, about 1 out of 5 people had cholesterol values placing them at low risk for the development of coronary heart disease, whereas 1 out of 4 were at increased risk. Apolipoprotein B, a component of LDL cholesterol, and apolipoprotein A-I, a component of HDL cholesterol, were measured for the first time in a large representative sample of the Swiss population. The distribution of both apolipoproteins was, in the aggregate, very similar to the distribution of the corresponding LDL and HDL cholesterol. A comparison of cholesterol values measured in 1988-89 with values previously measured in the same population (MONICA population survey 1984-85) did not show any reduction with time.

Adult↗
PubMed1992

[Identification of alcoholism and therapeutic proposals: a study in a general hospital].

Alcoholism is a frequent condition in patients admitted to general hospitals. The rate of identification of patients suspected to be alcoholic, the therapeutic measures proposed to such patients and their destination at hospital discharge were among the issues studied in the general wards of a department of internal medicine of an hospital in the French-speaking region of Switzerland. The Michigan Alcoholism Screening Test (MAST) was utilized systematically among all patients aged 20-75 years who where admitted consecutively to the department. Two cohorts matched for age and sex were thus formed: 102 alcoholics (MAST greater than or equal to 8) and 102 non-alcoholics (MAST less than or equal to 4). A diagnosis of alcoholism or of a syndrome of alcohol dependence was found in only 50% of all exit reports of the alcoholic cohort, whereas alcohol-related problems were identified on a verbal basis by the attending physician in 89% of cases. Therapeutic measures were proposed to 69% of female alcoholics and to 43% of male alcoholics, more frequently among patients with the highest MAST scores. In addition, at hospital discharge, alcoholic patients were more likely to be sent to a destination other than their place of residence than were the non-alcoholic patients. This study illustrates the low rate of identification and subsequent treatment of alcoholism among hospitalized patients. It also suggests that hospital stays should be used more frequently to increase the systematic identification of alcohol problems, increase awareness of alcoholism and provide information to both patients and those caring for them.

Adult↗
PubMed1992

The role of diagnostic inconsistency in changing rates of occurrence for coronary heart disease.

The ante-mortem (in vivo) and post-mortem diagnoses of coronary heart disease (CHD) were compared in necropsies at a university hospital for 1965, 1975, and 1985. The secular trends showed gradually rising proportions in both true positive and false negative ante-mortem diagnoses. Both types of change in diagnostic error would progressively lower the counted numbers of CHD in official vital statistics. With suitable statistical corrections, the occurrence rates of CHD in Connecticut became much higher and showed less dramatic trends in secular decline. The results indicate that major improvements in accuracy are needed before vital statistics data are accepted at face value and analyzed for biologic explanations of the changing numbers.

Adult↗
PubMed1992

Serum 25-hydroxyvitamin D: distribution and determinants in the Swiss population.

The serum 25-hydroxyvitamin D [25(OH)D] concentration was measured in a representative sample of the general adult population in Switzerland (n = 3276). The median concentration was 46 nmol/L and no significant difference was found between men and women. Between the ages of 25 and 74 y, 25(OH)D was not significantly correlated with age (r2 = 0.01). Six percent of the population was vitamin D deficient [ie, 25(OH)D less than or equal to 20 nmol/L] and between 34% and 95% had a relatively low concentration of vitamin D (ie, less than 38 or less than 95 nmol/L, respectively). Among the determinants of low 25(OH)D were indicators of little sunshine exposure, such as the winter season [odds ratio (OR) 2.4, 1.5-3.7 (95% confidence interval)] and less than 30 min of time spent outdoors daily by individuals greater than 65 y of age (OR 5.6, 1.5-21.2), as well as indicators of low nutritional intake of vitamin D, such as the absence of regular intake of butter or margarine (OR 2.0, 1.3-3.1) and the consumption of few dairy products (OR 1.7, 1.2-2.4).

25-Hydroxyvitamin D 2↗
PubMed1992

[Screening for cardiovascular disease risk factors among employees of a hospital].

A health promotion and screening program for the detection of the major risk factors for ischemic heart disease was carried out in 1990 among the employees (n = 4,521; 70% female) of the Centre Hospitalier Universitaire Vaudois (CHUV). The prevalence of risk factors among the 1,425 employees (73% female) who took part in the study (participation rate: males 29%, females 33%) was compared with the prevalence of risk factors within three other populations: 1) new CHUV employees, who are systematically screened (n = 424: 71% female); 2) a representative sample of the general population; and 3) a group of employees from 44 companies located in the same region. Smoking was the most common of the three main risk factors; its prevalence was lowest among CHUV employees and highest among employees of the 44 firms. The prevalence of hypercholesterolemia and high blood pressure was variable among the different populations. These variations could partly be due to differences in methodologies and measurement conditions, but could not totally be explained in this way.

Adult↗
PubMed1991

Relationship of fasting serum insulin concentrations with blood pressure in a representative sample of the adult population of the Seychelles.

Several studies have been performed to determine if plasma insulin concentration bears a relationship with blood pressure and may be a causative factor in the genesis of hypertension. The results reported were discrepant between studies: insulin was observed to be independently correlated with blood pressure in some studies, whereas no such relationship was observed in others. Serum insulin, whole blood glucose, weight, height, and diastolic and systolic blood pressure of 839 fasting individuals, randomly selected from the adult population of Mahé Island, The Seychelles, were recorded; this population has a high hypertension prevalence rate. The proportion of hypertension was higher in subgroups of individuals with diabetes mellitus (52.4 percent) and with overweight (34.5 percent) than in the general population. Subgroups of individuals with diabetes, excessive weight or high blood pressure had higher mean fasting plasma insulin (13.6 +/- (s.d.) 7.9, 14.0 +/- 8.0, 11.1 +/- 9.7 respectively) than individuals not affected with these conditions (8.1 +/- 4.6 microU/ml). Both systolic and diastolic blood pressure were positively correlated with age, body mass index and fasting blood glucose in a multivariate model. No correlation with insulin was observed. In contrast, in a subgroup of 223 overweight individuals, age, blood glucose and plasma insulin were each positively correlated with blood pressure. It is concluded that, in this cross-sectional study, insulin was not independently correlated with blood pressure except for overweight individuals.

Adult↗
PubMed1991

[The epidemiology of osteoporosis].

Osteoporosis is characterized by low bone mass, micro architectural impairment of bone tissue, and a subsequent in crease in fracture risk. Fractures or the vertebrae and distal forearm, as well as the proximal femur, or hip fracture, are included. Hip fracture is associated with high mortality, morbidity and medical expenses. There is a dramatic increase in the incidence of hip fracture with age. Hip fracture incidence is 350 times higher in women aged 85 years and over comparatively to women between 35 and 44 years of age. In recent studies in Switzerland, it was observed that the annual age adjusted incidence rate of hip fracture was comparable with similar rates for white population in industrialized countries, although in men the rates were relatively high. Among the major risk factors for osteoporosis are age, female gender, white and Asian race, and menopause. Postmenopausal estrogen replacement therapy reduces bone resorption. Family history of osteoporosis, frail constitution, as well as excessive alcohol intake, cigarette smoking, chronic insufficient nutritional calcium intake and physical inactivity are other risk factors. A cardinal element is the peak bone mass reached in the third or fourth decade of life. Independently of osteoporosis, falls are a key agent in fractures; several medical conditions and drugs increase the risk of falling. There is an enormous social and financial cost of osteoporosis; the annual cost of medical treatment only for hip fracture is close to Fr. 200 million in Switzerland. The burden of osteoporosis is likely to increase in the future because of the demographic aging of the population unless large scale preventive interventions are undertaken.

Adult↗
PubMed1990

Indexes and boundaries for "quantitative significance" in statistical decisions.

Boundaries for delta, representing a "quantitatively significant" or "substantively impressive" distinction, have not been established, analogous to the boundary of alpha, usually set at 0.05, for the stochastic or probabilistic component of "statistical significance". To determine what boundaries are being used for the "quantitative" decisions, we reviewed pertinent articles in three general medical journals. For each contrast of two means, contrast of two rates, or correlation coefficient, we noted the investigators' decisions about stochastic significance, stated in P values or confidence intervals, and about quantitative significance, indicated by interpretive comments. The boundaries between impressive and unimpressive distinctions were best formed by a ratio of greater than or equal to 1.2 for the smaller to the larger mean in 546 comparisons, by a standardized increment of greater than or equal to 0.28 and odds ratio of greater than or equal to 2.2 in 392 comparisons of two rates; and by an r value of greater than or equal to 0.32 in 154 correlation coefficients. Additional boundaries were also identified for "substantially" and "highly" significant quantitative distinctions. Although the proposed boundaries should be kept flexible, indexes and boundaries for decisions about "quantitative significance" are particularly useful when a value of delta must be chosen for calculating sample size before the research is done, and when the "statistical significance" of completed research is appraised for its quantitative as well as stochastic components.

Confidence Intervals↗
PubMed1990

[Alcoholism and the practicing physician].

Alcoholism is a major public health problem in Switzerland as in most Western industrialized countries. The general practitioner should be a key person in screening for alcohol abuse and dependency. Yet, the general practitioner should provide information and counselling upon the consequences of excessive alcohol consumption. In a strategy of routine screening by general practitioners, asking the patient about the quantity and the frequency of alcohol consumption, clinical examination and laboratory testing are less effective than a standardized questionnaire. Examples of questionnaires include the Michigan Alcoholism Screening Test (MAST) and the CAGE questionnaire. The rationale for systematic screening is that early pathological injuries due to excessive alcohol consumption are reversible. Yet, the prognosis seems to be more favourable where therapy begins early and the amount of psychosocial problems is limited. An early therapeutic intervention could be started as a multidisciplinary approach, targeting the patient and emphasizing the role of the patient's physician.

Alcohol Drinking↗
PubMed1990

[Hypercholesterolemia in general practice--2 representative surveys in Switzerland].

Two representative surveys of general practitioners in 1987 and 1989 showed, that cigarette smoking and high blood pressure are considered the most important risk factors for coronary heart disease. Elevated blood cholesterol level rank third. Between the two surveys no significant changes took place. The blood cholesterol level is usually measured at a check-up visit or in presence of another risk factor. Routine measurement is not common. At what level do Swiss physicians initiate a therapy? The median range in 1989 for a diet therapy was 6.2-6.7 mmol/l (240-260 mg%) for a 30 years old person, and 6.7-7.2 mmol/l for a 60 years old person. Lipid-lowering drugs are used at about 1 mmol/l (40 mg%) higher levels and there is less agreement between the physicians. Within two years the levels of initiating therapy decreased significantly. Differences between the three Swiss language regions (german/french/italian) in initiating therapy can be seen. 90% of the physicians mentioned compliance problems with a diet therapy. In 1989 half of the surveyed doctors experienced insufficient results in both diet and drug treatment. Further, compliance problems and side effects of drug treatment are mentioned. Half of the physicians reported having tested their own cholesterol level in the last 12 months. Older physicians are considerably more conscious of high cholesterol levels than younger.

Adult↗
PubMed1988

[Clinical epidemiology: definitions, uses and reasons for development in Switzerland].

Clinical epidemiology is the most currently used name for a comparatively new branch of medicine covering a certain number of activities related to the practice of clinical medicine, but using epidemiological techniques and methods. Clinical epidemiology has only just begun to be known in Europe, whereas units are being increasingly developed and expanded in North America, particularly within the clinical departments of hospitals. The methods it offers are valid for both practicing physicians and hospital doctors (or those being trained in hospitals) and serve the purpose of promoting a better quality medical service, especially where a more adequate evaluation of the effectiveness of diagnostic methods, therapy and prognosis in medicine is concerned. Clinical epidemiology proposes a methodology of medical reasoning and of decision-making, as well as techniques intended to facilitate the indispensable task of keeping up with advances in medical knowledge.

Clinical Protocols↗
PubMed1988

[Total plasma cholesterol and HDL in a Swiss population: what attitude and norms should be adopted?].

The reports on the effectiveness of blood lipid lowering in the primary prevention of ischaemic heart disease have promoted the development of statements and strategies for decreasing plasma cholesterol levels. As the risk of ischaemic heart disease gradually increases with the serum cholesterol level, a shift of the whole cholesterol distribution curve towards lower cholesterol values not exceeding 5.2 mmol/l is found to be desirable. The population survey conducted in the cantons of Vaud and Fribourg, as part of the MONICA-project, has yielded the data about the distribution of serum total and HDL-cholesterol for a representative sample of the population. 34% of men and 30% of women aged 25 to 74 have a blood cholesterol value exceeding 6.7 mmol/l, the percentage of people with high cholesterol levels increasing with age, especially in women. HDL-cholesterol levels, higher in women than in men, remain fairly constant according to the particular age group concerned. On application of the norms proposed by the US Consensus Conference on blood cholesterol, one finds that 32% of women and 37% of men have to be considered as 'high risk' and 18% of both sexes at 'moderate risk' concerning the development of coronary heart disease. The consequences of the application of such norms in Switzerland, as well as the current cholesterol values of the Swiss population as compared to those obtained earlier on in Switzerland and the USA have to be considered on a large scale in order to draw up a global strategy for health promotion and the prevention of cardiovascular disease.

Adult↗
PubMed1988

Combining repeated blood pressure measurements to obtain prevalences of high blood pressure.

Blood pressure (BP) levels may be classified as normal, borderline, or high with respect to the World Health Organization (WHO) criteria, but most studies like the MONICA project require at least two BP measurements and must tackle the problem of combining the results of the different readings into a single value for classification. The Swiss MONICA project measured the blood pressure of 1872 individuals in the areas of Vaud and Fribourg. Second BP readings were, on average, lower than the first by 3.2 mmHg for systolic and 1.1 mmHg for diastolic BP. These differences, while trivial at the individual level, nevertheless generate significant effects on prevalences of high BP. The first reading, the second, the mean, and the lowest yield prevalences of 14%, 10%, 11% and 9% respectively. Therefore, any published prevalence of high blood pressure should specify the method of measurement, the number of readings taken, and the way results were combined.

Adult↗
PubMed1986

[AIDS: information as a means to prevention].

Objective information for the groups exposed to the disease and the public in general is the only step that is currently possible in the prevention of AIDS. A certain number of information and support actions have been developed as a consequence of the appearance of AIDS in Switzerland. The AIDS information hot-line at the CHUV is one of these actions with the aim of orienting the information according to demand and examining the utility of this means, we made a prospective evaluation of the calls (between 23 October 1985-inception of the line and 31 March 1986). Out of a total of 535 calls, 317 requests for appointments (tests, consultation) or written documentation, and 218 (41%) were transferred to the doctor; 39% of the calls came from people who were directly concerned (ill, with a positive test, exposed groups), 11% from health professionals, and 47% from the general public. 56% of the calls were concerned with transmission of the disease (sexual, blood, indirect), 22% with the meaning of the detection test, 22% referred to the symptoms of the disease. According to the doctor's estimate, although the standard of knowledge is satisfactory in 55% of the cases, a considerable number of false ideas, that generate irrational fear, still persist. This hot-line thus provides a sympathetic ear and individual support, particularly for the exposed groups, rather than information about the disease. The existence of this action, therefore, appears justified, but must be integrated into a global strategy of information promotion.

Acquired Immunodeficiency Syndrome↗