Overweight and obesity in a Swiss city: 10-year trends

Abstract Background Increased rates of overweight/obesity have been reported in recent years in developed countries. This population study of healthy subjects evaluated the changes in overweight/obesity prevalence in 2003, compared with 1993, and determined the association of age, sex and leisure-time activity with body mass index (BMI), fat-free mass index (FFMI) and fat mass index (FMI). Design Two transversal samples of convenience. Participants Healthy volunteers (1993, n=802; 2003, n=1631). Methods Fat-free mass was determined using the bioelectrical impedance multiple regression equation. Multivariable linear regression, including confounding variables (age, sex, leisure-time activity), was used to model the body composition evolution between the 1993 and the 2003 subjects. Results BMI and FMI were higher in 2003 than in 1993, P<0.001. FFMI was not higher in 2003 than in 1993, P=0.38. More subjects were overweight/obese in 2003 than in 1993 (27.5 versus 17.2%, chi-square P<0.001), and had a high FFMI (30.2 versus 21.8%, chi-square P<0.001) and high FMI (28.0 versus 20.3%, chi-square P<0.001). Multivariate linear regressions showed that leisure-time activity was negatively, and sex, age and inclusion year were positively associated with BMI, FFMI and FMI (the exception was a negative association with sex) (P<0.001). Conclusion Overweight prevalence increased between 1993 and 2003 in a Swiss city, and was associated with a higher fat mass. This observation remained statistically significant after adjustment for age, sex and leisure-time activit

Age and quality of in-hospital care of patients with heart failure

Background: Elderly patients may be at risk of suboptimal care. Thus, the relationship between age and quality of care for patients hospitalized for heart failure was examined. Methods: A cross-sectional study based on retrospective chart review was performed among a random sample of patients hospitalized between 1996 and 1998 in the general internal medicine wards, with a principal diagnosis of congestive heart failure, and discharged alive. Explicit criteria of quality of care, grouped into three scores, were used: admission work-up (admission score); evaluation and treatment during the stay (evaluation and treatment score); and readiness for discharge (discharge score). The associations between age and quality of care scores were analysed using linear regression models. Results: Charts of 371 patients were reviewed. Mean age was 75.7 (±11.1) years and 52% were men. There was no relationship between age and admission or readiness for discharge scores. The evaluation and treatment score decreased with age: compared with patients less than 70 years old, the score was lower by −2.6% (95% CI: −7.1 to 1.9) for patients aged 70 to 79, by −8.7% (95% CI: −13.0 to −4.3) for patients aged 80 to 89, and by −19.0% (95% CI: −26.6 to −11.5) for patients aged 90 and over. After adjustment for possible confounders, this relationship was not significantly modified. Conclusions: In patients hospitalized for congestive heart failure, older age was not associated with lower quality of care scores except for evaluation and treatment. Whether this is detrimental to elderly patients remains to be evaluate

A predictive score to identify hospitalized patients' risk of discharge to a post-acute care facility

<p>Abstract</p> <p>Background</p> <p>Early identification of patients who need post-acute care (PAC) may improve discharge planning. The purposes of the study were to develop and validate a score predicting discharge to a post-acute care (PAC) facility and to determine its best assessment time.</p> <p>Methods</p> <p>We conducted a prospective study including 349 (derivation cohort) and 161 (validation cohort) consecutive patients in a general internal medicine service of a teaching hospital. We developed logistic regression models predicting discharge to a PAC facility, based on patient variables measured on admission (day 1) and on day 3. The value of each model was assessed by its area under the receiver operating characteristics curve (AUC). A simple numerical score was derived from the best model, and was validated in a separate cohort.</p> <p>Results</p> <p>Prediction of discharge to a PAC facility was as accurate on day 1 (AUC: 0.81) as on day 3 (AUC: 0.82). The day-3 model was more parsimonious, with 5 variables: patient's partner inability to provide home help (4 pts); inability to self-manage drug regimen (4 pts); number of active medical problems on admission (1 pt per problem); dependency in bathing (4 pts) and in transfers from bed to chair (4 pts) on day 3. A score ≥ 8 points predicted discharge to a PAC facility with a sensitivity of 87% and a specificity of 63%, and was significantly associated with inappropriate hospital days due to discharge delays. Internal and external validations confirmed these results.</p> <p>Conclusion</p> <p>A simple score computed on the 3rd hospital day predicted discharge to a PAC facility with good accuracy. A score > 8 points should prompt early discharge planning.</p

Reduction of missed appointments at an urban primary care clinic: a randomised controlled study

<p>Abstract</p> <p>Background</p> <p>Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments.</p> <p>Methods</p> <p>We conducted a randomised controlled study in an urban primary care clinic at the Geneva University Hospitals serving a majority of vulnerable patients. All patients booked in a primary care or HIV clinic at the Geneva University Hospitals were sent a reminder 48 hrs prior to their appointment according to the following sequential intervention: 1. Phone call (fixed or mobile) reminder; 2. If no phone response: a Short Message Service (SMS) reminder; 3. If no available mobile phone number: a postal reminder. The rate of missed appointment, the cost of the intervention, and the profile of patients missing their appointment were recorded.</p> <p>Results</p> <p>2123 patients were included: 1052 in the intervention group, 1071 in the control group. Only 61.7% patients had a mobile phone recorded at the clinic. The sequential intervention significantly reduced the rate of missed appointments: 11.4% (n = 122) in the control group and 7.8% (n = 82) in the intervention group (p < 0.005), and allowed to reallocate 28% of cancelled appointments. It also proved to be cost effective in providing a total net benefit of 1846. - EUR/3 months. A satisfaction survey conducted with 241 patients showed that 93% of them were not bothered by the reminders and 78% considered them to be useful. By multivariate analysis, the following characteristics were significant predictors of missed appointments: younger age (OR per additional decade 0.82; CI 0.71-0.94), male gender (OR 1.72; CI 1.18-2.50), follow-up appointment >1year (OR 2.2; CI: 1.15-4.2), substance abuse (2.09, CI 1.21-3.61), and being an asylum seeker (OR 2.73: CI 1.22-6.09).</p> <p>Conclusion</p> <p>A practical reminder system can significantly increase patient attendance at medical outpatient clinics. An intervention focused on specific patient characteristics could further increase the effectiveness of appointment reminders.</p

Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure

International audienc

Evaluation of quality improvement interventions to reduce inappropriate hospital use

Objectives. To assess the impact of process analyses and modifications on inappropriate hospital use. Design. Pre-post comparison of inappropriate hospital use after process modifications. Setting. The Department of Internal Medicine of the Geneva University Hospitals, Switzerland. Participants. A random sample of 498 patients. Interventions. Two processes of care (i.e. non-urgent admissions and transfer to a rehabilitation hospital), which influenced inappropriate hospital use, were identified and modified. The impact of these modifications was then assessed. Main outcome measures. The proportion of inappropriate hospital admissions and inappropriate hospital days. Results. As a baseline assessment before quality improvement interventions, the appropriateness of hospital use (admissions and hospital days) was evaluated using the Appropriateness Evaluation Protocol (AEP) in a sample of 500 patients (5665 days). After modification of the two processes through a quality improvement program, inappropriate hospital use was reassessed in a sample of 498 patients (6095 days). Inappropriate hospital admissions decreased from 15 to 9% (P = 0.002) and inappropriate hospital days from 28 to 25% (P = 0.12). Conclusion. Using the AEP as a criterion, the quality improvement interventions significantly reduced inappropriate hospital use due to the process of non-urgent admissions, but the reduction of inappropriate hospital days specifically attributed to the transfer to the rehabilitation hospital did not reach statistical significanc

C-reactive protein implications in new-onset hypertension in a healthy population initially aged 65 years: the Proof study

Background Because inflammation is known to be related with several cardiovascular diseases, we sought to determine whether C-reactive protein (CRP) might precede the onset of hypertension. Methods The study population was selected from the Proof study cohort including 1011 individuals initially aged 65 years at baseline and followed for 7 years. CRP, ambulatory blood pressure measurement (ABPM) and casual blood pressure were repeatedly measured during examination. Normotensive individuals were selected according to different measurements of blood pressure, self-reported history of hypertension and use of anti hypertensive treatment. Results Among 335 individuals, considered normotensive at baseline with ABPM (threshold 135/85 mmHg), with no history of hypertension and no use of anti hypertensive treatment, the incidence of hypertension was 9.9% 2 years later. The 2-year risk for new-onset hypertension was 18% greater for 1 mg/l increment of CRP (odds ratio, 1.18; 95% confidence interval, 1.01 - 1.39). This relationship remained after adjustment for low-density lipoprotein cholesterol, BMI and change in CRP between the two examinations but not after adjustment for 24-h systolic ABPM. Among the 160 individuals considered normotensive at baseline with an additional criterion (casual blood pressure below 140/90 mmHg), the incidence of hypertension was 26.9% 2 years later. The 2-year risk for new-onset hypertension was 52% greater for 1 mg/l increment of CRP (odds ratio, 1.52; 95% confidence interval, 1.17 - 1.96) after adjustment for systolic ABPM, change in CRP and BMI. Conclusion An elevated baseline CRP value precedes new-onset hypertension at an early stage among an elderly healthy population. Whether CRP measurement can ease the detection of patients likely to develop clinical hypertension remains to be determined. J Hypertens ;27:736-743 (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins