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

Projet qualité hôpitaux universitaires de Genève - Hospices cantonaux: évaluation comparative de quatre questionnaires de satisfaction des patients hospitalisés

[Table des matières] 1. Contexte suisse. 2. Méthode. 2.1. Description comparative des instruments disponibles. 2.2. Comparaison de quatre questionnaires de satisfaction. 2.3. Population. 2.4. Taille de l'échantillon. 2.5. Variables mesurées. 2.6. Informations concernant l'envoi par courrier. 2.7. Saisie des données. 2.8. Analyse. 3. Résultats. 3.1. Enquête comparative. 3.2. Participation à l'étude comparative. 4. Commentaires et recommandations. 4.1. Recommandations. 4.2. Choix du questionnaire. 5.1. Questionnaire d'évaluation des questionnaires de satisfaction. 5.2. Détail des proportions de réponses à valeur supérieure (plafond) des échelles de masure. 5. 3. Glossaire de la terminologie psychométrique. 5.4. Questionnaires Hospices, Picker, SEQUS, PJS-24

Quality of care and survival of haemodialysed patients in western Switzerland

Background. Many factors affect survival in haemodialysis (HD) patients. Our aim was to study whether quality of clinical care may affect survival in this population, when adjusted for demographic characteristics and co-morbidities. Methods. We studied survival in 553 patients treated by chronic HD during March 2001 in 21 dialysis facilities in western Switzerland. Indicators of quality of care were established for anaemia control, calcium and phosphate product, serum albumin, pre-dialysis blood pressure (BP), type of vascular access and dialysis adequacy (spKt/V) and their baseline values were related to 3-year survival. The modified Charlson co-morbidity index (including age) and transplantation status were also considered as a predictor of survival. Results. Three-year survival was obtained for 96% of the patients; 39% (211/541) of these patients had died. The 3-year survival was 50, 62 and 69%, respectively, in patients who had 0-2, 3 and ≥4 fulfilled indicators of quality of care (test for linear trend, P < 0.001). In a Cox multivariate analysis model, the absence of transplantation, a higher modified Charlson's score, decreased fulfilment of indicators of good clinical care and low pre-dialysis systolic BP were independent predictors of death. Conclusion. Good clinical care improves survival in HD patients, even after adjustment for availability of transplantation and co-morbiditie

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

Variability in quality of care among dialysis units in western Switzerland

Background. Quality indicators for dialysis care vary across countries and regions, but regional variability across centres has received little attention. We analysed variations in quality indicators among dialysis facilities in western Switzerland to identify opportunities for improving care for patients with end-stage kidney disease. Methods. A cross-sectional study of 617 dialysis patients treated at 19 facilities examined the distribution of indicators of quality of care addressing: adequacy of dialysis (Kt/V ≥1.2 for haemodialysis, Kt/V ≥2 for peritoneal dialysis), anaemia control (haemoglobin ≥110 g/l), calcium and phosphate control (product ≤4.4 mmol2/l2), adequate nutrition (serum albumin >35 g/l), hypertension control (pre-dialysis blood pressure 40 patients better fulfilled quality targets than university-based centres. Adjustment for patient characteristics did not modify these results. Conclusions. Substantial variations in quality indicators existed between dialysis centres in western Switzerland, which could not be attributed to different centre policies, or to differences in available measures of patient case mix. These findings indicate opportunities for improvement in dialysis practice which may translate into improved clinical outcome

The Quality of Primary Care in a Country with Universal Health Care Coverage

BACKGROUND: Standard indicators of quality of care have been developed in the United States. Limited information exists about quality of care in countries with universal health care coverage. OBJECTIVE: To assess the quality of preventive care and care for cardiovascular risk factors in a country with universal health care coverage. DESIGN AND PARTICIPANTS: Retrospective cohort of a random sample of 1,002 patients aged 50-80years followed for 2years from all Swiss university primary care settings. MAIN MEASURES: We used indicators derived from RAND's Quality Assessment Tools. Each indicator was scored by dividing the number of episodes when recommended care was delivered by the number of times patients were eligible for indicators. Aggregate scores were calculated by taking into account the number of eligible patients for each indicator. KEY RESULTS: Overall, patients (44% women) received 69% of recommended preventive care, but rates differed by indicators. Indicators assessing annual blood pressure and weight measurements (both 95%) were more likely to be met than indicators assessing smoking cessation counseling (72%), breast (40%) and colon cancer screening (35%; all p 75% for hypertension, dyslipidemia and diabetes. However, foot examination was performed only in 50% of patients with diabetes. Prevention indicators were more likely to be met in men (72.2% vs 65.3% in women, p < 0.001) and patients <65years (70.1% vs 68.0% in those ≥65years, p = 0.047). CONCLUSIONS: Using standardized tools, these adults received 69% of recommended preventive care and 83% of care for cardiovascular risk factors in Switzerland, a country with universal coverage. Prevention indicator rates were lower for women and the elderly, and for cancer screening. Our study helps pave the way for targeted quality improvement initiatives and broader assessment of health care in Continental Europ

A randomized trial of four patient satisfaction questionnaires

BACKGROUND: Patient satisfaction surveys are increasingly used by hospitals. Many questionnaires are available, but little evidence exists to guide the choice of the most suitable instrument. OBJECTIVE: To compare the acceptability and patient perceptions of 4 patient satisfaction questionnaires. RESEARCH DESIGN: Randomized trial of 4 satisfaction questionnaires: Picker, Patient Judgment System (PJS), Sequs, and a locally developed Lausanne questionnaire. SUBJECTS: Patients discharged from 2 Swiss teaching hospitals (n = 2850). MEASURES: Response rates, missing data, completion time, and patient ratings of the questionnaire (5-point agree-disagree scale). RESULTS: Response rates were similar across instruments (Picker: 70%, PJS: 71%, Sequs: 68%, Lausanne: 73%; P= 0.27). The Picker questionnaire had the most missing responses (mean per item: Picker: 3.1%, PJS: 1.9%, Sequs: 1.6%, Lausanne: 1.1%; P&lt;0.001) and took the longest to complete (minutes: Picker: 19.3, PJS: 12.5, Sequs: 13.4, Lausanne: 13.1; P&lt;0.001), but the fewest patients indicated that the questionnaire failed to address at least 1 important aspect of the hospital stay (Picker: 28.2%, PJS: 38.8%, Sequs: 39.1%, Lausanne: 28.9%; P&lt;0.001). Patient evaluations of the questionnaires were generally similar; the most favorable assessment was chosen by approximately half of the respondents (average of 10 items: Picker: 46.5%, PJS: 46.2%, Sequs: 47.4%, Lausanne: 48.2%; P= 0.60). Key survey results differed considerably by questionnaire. CONCLUSIONS: No questionnaire emerged as uniformly better than the others in terms of acceptability and patient evaluations. All 4 could be used for patient satisfaction surveys. [authors]]]> Health Care Surveys ; Hospital-Patient Relations ; Hospitals, Teaching ; Patient Satisfaction ; Questionnaires oai:serval.unil.ch:BIB_7098773934E2 2022-05-07T01:20:13Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_7098773934E2 Induction of apoptosis in human corneal and HeLa cells by mutated BIGH3 info:doi:10.1167/iovs.02-0661 info:eu-repo/semantics/altIdentifier/doi/10.1167/iovs.02-0661 info:eu-repo/semantics/altIdentifier/pmid/12824240 Morand, S. Buchillier, V. Maurer, F. Bonny, C. Arsenijevic, Y. Munier, F. L. Schorderet, D. F. info:eu-repo/semantics/article article 2003-07 Investigative Ophthalmology and Visual Science, vol. 44, no. 7, pp. 2973-9 info:eu-repo/semantics/altIdentifier/pissn/0146-0404 <![CDATA[PURPOSE: To determine the effects of overexpression of mutated BIGH3 in HeLa and human corneal epithelial (HCE) cells. METHODS: Six mutations known to be responsible for autosomal dominant corneal dystrophies linked to chromosome 5 were generated in a BIGH3 expression vector and transfected in HeLa and HCE cells. The expression and secretion of the various BIGH3-EGFP fusion proteins were measured by Western blot analysis. Apoptotic cells were identified by Hoechst/propidium iodide and annexin V staining. Lactate dehydrogenase (LDH) activity was measured in the medium of transfected cells. Truncated BIGH3 protein and site-specific mutations were generated to determine the exact region that mediated apoptosis. RESULT: The overexpressed BIGH3 fusion protein was secreted regardless of its mutation status and was clearly observed in the culture medium. Overexpression of mutated BIGH3 induced apoptosis in both cell lines through activation of caspase-3. Although all the disease-causing mutations tested in this experiment induced apoptosis, the strongest effect was observed with the R124C and R555W mutations. Overexpression of a carboxyl-truncated BIGH3 protein did not induce apoptosis, suggesting that a region located in the C-terminal domain was necessary to mediate cell death. In addition, mutation of the Pro-Asp-Ile (PDI) site at 616-618 was sufficient to prevent induction of apoptosis. CONCLUSIONS: Overexpression of mutated BIGH3 induces apoptosis in HeLa and HCE cells through activation of a pathway that uses the PDI domain of the fourth internal Fas domain and activation of caspase-3. Because DI is a known site of interaction with alpha 3 beta 1 integrins, it suggests that integrins play a role in mediating apoptosis in the system used in the current study. This work suggests that apoptosis is a key element in the pathophysiology of BIGH3-related corneal dystrophies

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

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