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Frei A, Strassmann A, Guler M, Carron T, Steurer-Stey C, Dalla Lana K, Giroud P, Peytremann-Bridevaux I, Puhan M. EVALUATION OF THE IMPLEMENTATION OF THE “LIVING WELL WITH COPD” SELF-MANAGEMENT PROGRAM IN SWITZERLAND. Chest 2020. [DOI: 10.1016/j.chest.2020.05.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gijs E, Zuercher E, Henry V, Morin D, Bize R, Peytremann-Bridevaux I. Diabetes care: Comparison of patients' and healthcare professionals' assessment using the PACIC instrument. J Eval Clin Pract 2017; 23:803-811. [PMID: 28251768 DOI: 10.1111/jep.12720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/14/2017] [Accepted: 01/16/2017] [Indexed: 12/07/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Whereas the Patient Assessment of Chronic Illness Care (PACIC) instrument measures the extent to which care received by patients is congruent with the Chronic Care Model, the 5As model emphasizes self-management and community resources, 2 key components of the Chronic Care Model. We aimed at comparing evaluation of diabetes care, as reported by patients with diabetes and healthcare professionals (HCPs), using these instruments. METHODS Two independent samples, patients with diabetes (n = 395) and HCPs (including primary and secondary care physicians and nurses; n = 287), responded to the 20-item PACIC and the six 5As model questions. The PACIC-5A (questions scored on a 5-point scale, 1 = never to 5 = always) was adapted for HCPs (modified-PACIC-5A). In both samples, means and standard deviations for each question as well as proportions of responses to each response modality were computed, and an overall score was calculated for the 20-item PACIC. RESULTS Patients' and HCPs' overall scores were 2.6 (SD 0.9) and 3.6 (SD 0.5), respectively, with HCPs reporting higher scores for all questions except 1. Patients' education and self-management, referral/follow-up and participation in community programs were rated as low by patients and HCPs. CONCLUSION Healthcare professionals, particularly diabetes specialists, tended to report better PACIC scores than patients, suggesting that care was not reported similarly when received or provided. Evaluation differences might be reduced by a closer collaboration between patients and HCPs, as well as the implementation of community-based interventions considering more patients' perspectives such as patients' education and self-management.
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Affiliation(s)
- E Gijs
- Lausanne University Hospital, Lausanne, Switzerland
| | - E Zuercher
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - V Henry
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - D Morin
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Faculty of Nursing Science, Laval University, Quebec, Canada
| | - R Bize
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - I Peytremann-Bridevaux
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
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Peytremann-Bridevaux I, Ebert ST, Senn N. Involvement of family physicians in structured programs for chronic diseases or multi-morbidity in Switzerland. Eur J Intern Med 2015; 26:150-1. [PMID: 25638287 DOI: 10.1016/j.ejim.2015.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 10/24/2022]
Affiliation(s)
- I Peytremann-Bridevaux
- Institute of Social and Preventive Medicine, CHUV, University of Lausanne, 10 route de la Corniche, 1010 Lausanne, Switzerland.
| | - S T Ebert
- Department of Ambulatory Care and Community Medicine, University of Lausanne, 44 rue du Bugnon, 1011 Lausanne, Switzerland
| | - N Senn
- Department of Ambulatory Care and Community Medicine, University of Lausanne, 44 rue du Bugnon, 1011 Lausanne, Switzerland
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Iglesias K, Burnand B, Peytremann-Bridevaux I. PACIC Instrument: disentangling dimensions using published validation models. Int J Qual Health Care 2014. [DOI: 10.1093/intqhc/mzu075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Iglesias K, Burnand B, Peytremann-Bridevaux I. PACIC Instrument: disentangling dimensions using published validation models. Int J Qual Health Care 2014; 26:250-60. [DOI: 10.1093/intqhc/mzu042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Peytremann-Bridevaux I, Taffe P, Burnand B, Bridevaux PO, Puhan MA. Mortality of patients with COPD participating in chronic disease management programmes: a happy end? Thorax 2014; 69:865-6. [DOI: 10.1136/thoraxjnl-2013-204983] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Collet TH, Taffe P, Bordet J, Burnand B, Peytremann-Bridevaux I. Reproducibility of diabetes quality of care indicators as reported by patients and physicians. Eur J Public Health 2014; 24:1004-9. [DOI: 10.1093/eurpub/cku011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lauvergeon S, Burnand B, Peytremann-Bridevaux I. [Implementation of a diabetes disease management program in Switzerland: patients' and healthcare professionals' point of view]. Rev Epidemiol Sante Publique 2013; 61:475-84. [PMID: 24035386 DOI: 10.1016/j.respe.2013.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 09/18/2012] [Accepted: 05/10/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND A reorganization of healthcare systems is required to meet the challenge of the increasing prevalence of chronic diseases, e.g. diabetes. In North-America and Europe, several countries have thus developed national or regional chronic disease management programs. In Switzerland, such initiatives have only emerged recently. In 2010, the canton of Vaud set up the "Diabetes Cantonal Program", within the framework of which we conducted a study designed to ascertain the opinions of both diabetic patients and healthcare professionals on the elements that could be integrated into this program, the barriers and facilitators to its development, and the incentives that could motivate these actors to participate. METHODS We organized eight focus-groups: one with diabetic patients and one with healthcare professionals in the four sanitary areas of the canton of Vaud. The discussions were recorded, transcribed and submitted to a thematic content analysis. RESULTS Patients and healthcare professionals were rather in favour of the implementation of a cantonal program, although patients were more cautious concerning its necessity. All participants envisioned a set of elements that could be integrated to this program. They also considered that the program could be developed more easily if it were adapted to patients' and professionals' needs and if it used existing structures and professionals. The difficulty to motivate both patients and professionals to participate was mentioned as a barrier to the development of this program however. Quality or financial incentives could therefore be created to overcome this potential problem. CONCLUSION The identification of the elements to consider, barriers, facilitators and incentives to participate to a chronic disease management program, obtained by exploring the opinions of patients and healthcare professionals, should favour its further development and implementation.
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Affiliation(s)
- S Lauvergeon
- Institut universitaire de médecine sociale et préventive (IUMSP), centre hospitalier universitaire Vaudois et université de Lausanne, Biopôle 2, route de la Corniche 10, 1010 Lausanne, Suisse
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Rège-Walther M, Mazzocato C, Peytremann-Bridevaux I. [Direct support measures reduce psychological stress in family caregivers]. Praxis (Bern 1994) 2012; 101:1383-1384. [PMID: 23074052 DOI: 10.1024/1661-8157/a001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- M Rège-Walther
- Institut universitaire de médecine sociale et préventive (CHUV et Université de Lausanne) et Cochrane Suisse.
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Rège-Walther M, Théry G, Thierrin L, Peytremann-Bridevaux I. [Should women in labor be allowed to eat and drink?]. Praxis (Bern 1994) 2012; 101:1119-1120. [PMID: 22915515 DOI: 10.1024/1661-8157/a001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- M Rège-Walther
- Institut universitaire de médecine sociale et préventive, CHUV et Université de Lausanne
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Peytremann-Bridevaux I, Lauvergeon S, Mettler D, Burnand B. Diabetes care: Opinions, needs and proposed solutions of Swiss patients and healthcare professionals: a qualitative study. Diabetes Res Clin Pract 2012; 97:242-50. [PMID: 22459986 DOI: 10.1016/j.diabres.2012.02.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 01/10/2012] [Accepted: 02/23/2012] [Indexed: 11/26/2022]
Abstract
AIMS To explore, both among patients with diabetes and healthcare professionals, opinions on current diabetes care and the development of the "Regional Diabetes Program". METHODS We employed qualitative methods (focus groups - FG) and used purposive sampling strategy to recruit patients with diabetes and healthcare professionals. We conducted one diabetic and one professional FG in each of the four health regions of the canton of Vaud/Switzerland. The eight FGs were audio-taped and transcribed verbatim. Thematic analysis was then undertaken. RESULTS Results showed variability in the perception of the quality of diabetes care, pointed to insufficient information regarding diabetes, and lack of collaboration. Participants also evoked patients' difficulties for self-management, as well as professionals' and patients' financial concerns. Proposed solutions included reinforcing existing structures, developing self-management education, and focusing on comprehensive and coordinated care, communication and teamwork. Patients and professionals were in favour of a "Regional Diabetes Program" tailored to the actors' needs, and viewed it as a means to reinforce existing care delivery. CONCLUSIONS Patients and professionals pointed out similar problems and solutions but explored them differently. Combined with coming quantitative data, these results should help to further develop, adapt and implement the "Regional Diabetes Program".
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Affiliation(s)
- I Peytremann-Bridevaux
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, 17 Rue du Bugnon, CH-1005 Lausanne, Switzerland.
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Griesser AC, Wasserfallen JB, Peytremann-Bridevaux I. [Do clinical pathways achieve the goal?]. Praxis (Bern 1994) 2012; 101:863-864. [PMID: 22715078 DOI: 10.1024/1661-8157/a000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Chappuis A, Meylan P, Peytremann-Bridevaux I. [Does zinc conquer the common cold?]. Praxis (Bern 1994) 2012; 101:601-602. [PMID: 22535456 DOI: 10.1024/1661-8157/a000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- A Chappuis
- Institut universitaire de médecine sociale et préventive, CHUV et Université de Lausanne
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Peytremann-Bridevaux I, Ruffieux C, Burnand B. Reply to the letter to the editor “Freedom of choice”. Swiss Med Wkly 2012. [DOI: 10.4414/smw.2012.13528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Camain JY, Wiesel PH, Peytremann-Bridevaux I. [Heartburn: in short-term treatment you have the choice!]. Praxis (Bern 1994) 2012; 101:331-332. [PMID: 22377981 DOI: 10.1024/1661-8157/a000875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- J-Y Camain
- Institut Universitaire de Médecine Sociale et Préventive, CHUV et Université de Lausanne
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Burnand B, Peytremann-Bridevaux I, von Elm E, Walther R. [Should respiratory physical therapy be prescribed in a case of pneumonia?]. Praxis (Bern 1994) 2011; 100:1499-1500. [PMID: 22124961 DOI: 10.1024/1661-8157/a000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- B Burnand
- Cochrane Suisse, Institut de médecine sociale et préventive CHUV et Université de Lausanne, Lausanne
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Chappuis A, Meylan P, Peytremann-Bridevaux I. [Zinc for a cold?]. Rev Med Suisse 2011; 7:2048. [PMID: 22073702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- A Chappuis
- Institut universitaire de médecine sociale et préventive, CHUV et Université de Lausanne, Bugnon 17, 1005 Lausanne
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Schiltz P, Cachat F, Rège Walther M, Peytremann-Bridevaux I. [What is the status of steroids in the treatment of infants with bronchiolitis?]. Praxis (Bern 1994) 2011; 100:1251-1252. [PMID: 21971620 DOI: 10.1024/1661-8157/a000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- P Schiltz
- Département de pédiatrie, Hôpital du Samaritain, Vevey
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Nanchen D, Mazzolai L, Peytremann-Bridevaux I. [Certain patients profit from self-management of oral anticoagulation]. Praxis (Bern 1994) 2011; 100:983-984. [PMID: 21833917 DOI: 10.1024/1661-8157/a000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- D Nanchen
- Institut de médecine sociale et préventive, CHUV et Université de Lausanne et Policlinique médicale universitaire, CHUV, Lausanne.
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Santschi V, Burnier M, Peytremann-Bridevaux I. [Do elderly hypertensive patients benefit from drug therapy?]. Praxis (Bern 1994) 2011; 100:731-732. [PMID: 21656501 DOI: 10.1024/1661-8157/a000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- V Santschi
- Institut de Médecine Sociale et Préventive, CHUV et Université de Lausanne
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Camain JY, Wiesel PH, Peytremann-Bridevaux I. [Heartburn: you can choose to support in the short term]. Rev Med Suisse 2011; 7:1169. [PMID: 21721208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- J-Y Camain
- Institut universitaire de médecine sociale et préventive, CHUV et Université de Lausanne, Lausanne
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Santschi V, Hullin R, Peytremann-Bridevaux I. [Can telemetry improve treatment of patients with heart failure? ]. Praxis (Bern 1994) 2011; 100:481-482. [PMID: 21484712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- V Santschi
- Institut de médecine sociale et préventive, CHUV et Université de Lausanne
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Rège-Walther M, Théry G, Thierrin L, Peytremann-Bridevaux I. [Should we allow women to eat or drink during labor?]. Rev Med Suisse 2010; 6:1984. [PMID: 21125732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Myriam Rège-Walther
- Institute universitaire de médecine sociale et préventive (CHUV et Université de Lausanne)
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Rossi I, Dacremont V, Peytremann-Bridevaux I. [Prevention of malaria in travellers: which antimalarial is best?]. Rev Med Suisse 2010; 6:1840. [PMID: 20964023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- I Rossi
- Institut universitaire de médecine sociale et préventive, Bugnon, Lausanne
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Peytremann-Bridevaux I, Kolly V, Perneger TV. The association between body mass index and patients' experiences with inpatient care. Int J Qual Health Care 2010; 22:140-4. [PMID: 20144942 DOI: 10.1093/intqhc/mzq005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To explore the association between patients' body mass index (BMI) and their experiences with inpatient care. DESIGN Cross-sectional. Mail survey. SETTING University Hospital of Geneva. PARTICIPANTS Questionnaires were mailed to 2385 eligible adult patients, 6 weeks after discharge (response rate = 69%). MAIN OUTCOME MEASURES Patients' experiences with care were measured using the Picker inpatient survey questionnaire. BMI was calculated using self-reported height and weight. Main dependent variables were the global Picker patient experience (PPE-15) score and nine dimension-specific problem scores, scored from 0 (no reported problems) to 1 (all items coded as problems). We used linear regressions, adjusting for age, gender, education, subjective health, smoking and hospitalization, to assess the association between patients' BMI and their experiences with inpatient care. RESULTS Of the patients, 4.8% were underweight, 50.8% had normal weight, 30.3% were overweight and 14.1% were obese. Adjusted analysis shows that compared with normal weight, obesity was significantly associated with fewer problematic items in the surgery-related information domain, and being underweight or overweight was associated with more problematic items in the involvement of family/friends domain. The global PPE-15 score was significantly higher (more problems) for underweight patients. CONCLUSIONS Underweight patients, but not obese patients, reported more problems during hospitalization.
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Affiliation(s)
- I Peytremann-Bridevaux
- Institute of Social and Preventive Medicine, Centre Hospitalier Vaudois and University of Lausanne, Switzerland.
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Peytremann-Bridevaux I, Hagon-Traub I, Cauderay M, Kuhne Y, Favrod-Coune C, Ruiz J, Burnand B, Stucki G. Chronic disease prevention and management program for diabetic patients in the canton of Vaud (Switzerland). Int J Integr Care 2009. [PMCID: PMC2807098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and problem statement Diabetes constitutes a major burden for communities in terms of morbidity, mortality and healthcare costs. The canton of Vaud plans to implement a prevention and chronic disease management program for diabetes. Methods Meetings gathering cantonal and academic specialists in prevention and public health, GPs and specialists in diabetology (private practices and hospitals), representatives of para-medical and hospital professionals, from patients' associations and insurance companies have allowed to define the aims and main action lines of the program. Results Four objectives were defined: 1) general population: increase knowledge on diabetes and risk factors, reduce the prevalence of glucose intolerance and undiagnosed diabetes; 2) diabetic patients: promote self-management education, and coordinated, integrated evidence-based care stratified according to disease severity and patients' needs; 3) healthcare professionals: reinforce information and education for better diabetic care; 4) authorities and partners: implement a surveillance system. Working groups determined provisional measures. Conclusions This preparatory work will enable the development and implementation of the diabetes program. This project, innovative for Switzerland, represents a tremendous opportunity for all healthcare stakeholders of the canton to work together towards a common goal: improving the state of health and healthcare of diabetic patients.
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Affiliation(s)
| | - I. Hagon-Traub
- Service de la Santé Ensemble Hospitalier de la Côte, Hôpital de Morges, Switzerland
| | | | - Y. Kuhne
- Association du Réseau de soins de la Broye et du Nord vaudois, Yverdon, Switzerland
| | | | - J. Ruiz
- Service de CHUV and University of Lausanne, Switzerland
| | | | - G. Stucki
- Service de la Santé Publique du canton de Vaud, Lausanne, Switzerland
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Juillerat P, Peytremann-Bridevaux I, Vader JP, Arditi C, Schusselé Filliettaz S, Dubois RW, Gonvers JJ, Froehlich F, Burnand B, Pittet V. Appropriateness of colonoscopy in Europe (EPAGE II). Presentation of methodology, general results, and analysis of complications. Endoscopy 2009; 41:240-6. [PMID: 19280536 DOI: 10.1055/s-0028-1119643] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS Appropriate use of colonoscopy is a key component of quality management in gastrointestinal endoscopy. In an update of a 1998 publication, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE II) defined appropriateness criteria for various colonoscopy indications. This introductory paper therefore deals with methodology, general appropriateness, and a review of colonoscopy complications. METHODS The RAND/UCLA Appropriateness Method was used to evaluate the appropriateness of various diagnostic colonoscopy indications, with 14 multidisciplinary experts using a scale from 1 (extremely inappropriate) to 9 (extremely appropriate). Evidence reported in a comprehensive updated literature review was used for these decisions. Consolidation of the ratings into three appropriateness categories (appropriate, uncertain, inappropriate) was based on the median and the heterogeneity of the votes. The experts then met to discuss areas of disagreement in the light of existing evidence, followed by a second rating round, with a subsequent third voting round on necessity criteria, using much more stringent criteria (i. e. colonoscopy is deemed mandatory). RESULTS Overall, 463 indications were rated, with 55 %, 16 % and 29 % of them being judged appropriate, uncertain and inappropriate, respectively. Perforation and hemorrhage rates, as reported in 39 studies, were in general < 0.1 % and < 0.3 %, respectively CONCLUSIONS The updated EPAGE II criteria constitute an aid to clinical decision-making but should in no way replace individual judgment. Detailed panel results are freely available on the internet (www.epage.ch) and will thus constitute a reference source of information for clinicians.
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Affiliation(s)
- P Juillerat
- Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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Arditi C, Peytremann-Bridevaux I, Burnand B, Eckardt VF, Bytzer P, Agréus L, Dubois RW, Vader JP, Froehlich F, Pittet V, Schusselé Filliettaz S, Juillerat P, Gonvers JJ. Appropriateness of colonoscopy in Europe (EPAGE II). Screening for colorectal cancer. Endoscopy 2009; 41:200-8. [PMID: 19280531 DOI: 10.1055/s-0028-1119626] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS To summarize the published literature on assessment of appropriateness of colonoscopy for screening for colorectal cancer (CRC) in asymptomatic individuals without personal history of CRC or polyps, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS A systematic search of guidelines, systematic reviews, and primary studies regarding colonoscopy for screening for colorectal cancer was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy in these circumstances. RESULTS Available evidence for CRC screening comes from small case-controlled studies, with heterogeneous results, and from indirect evidence from randomized controlled trials (RCTs) on fecal occult blood test (FOBT) screening and studies on flexible sigmoidoscopy screening. Most guidelines recommend screening colonoscopy every 10 years starting at age 50 in average-risk individuals. In individuals with a higher risk of CRC due to family history, there is a consensus that it is appropriate to offer screening colonoscopy at < 50 years. EPAGE II considered screening colonoscopy appropriate above 50 years in average-risk individuals. Panelists deemed screening colonoscopy appropriate for younger patients, with shorter surveillance intervals, where family or personal risk of colorectal cancer is higher. A positive FOBT or the discovery of adenomas at sigmoidoscopy are considered appropriate indications. CONCLUSIONS Despite the lack of evidence based on randomized controlled trials (RCTs), colonoscopy is recommended by most published guidelines and EPAGE II criteria available online (http://www.epage.ch), as a screening option for CRC in individuals at average risk of CRC, and undisputedly as the main screening tool for CRC in individuals at moderate and high risk of CRC.
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Affiliation(s)
- C Arditi
- Healthcare Evaluation Unit, Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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Schusselé Filliettaz S, Juillerat P, Burnand B, Arditi C, Windsor A, Beglinger C, Dubois RW, Peytremann-Bridevaux I, Pittet V, Gonvers JJ, Froehlich F, Vader JP. Appropriateness of colonoscopy in Europe (EPAGE II). Chronic diarrhea and known inflammatory bowel disease. Endoscopy 2009; 41:218-26. [PMID: 19280533 DOI: 10.1055/s-0028-1119627] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS To summarize the published literature on assessment of appropriateness of colonoscopy for investigation of chronic diarrhea, management of patients with known inflammatory bowel disease (IBD), and for colorectal cancer (CRC) surveillance in such patients, and to report report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS A systematic search of guidelines, systematic reviews, and primary studies regarding the evaluation of chronic diarrhea, the management of IBD, and colorectal cancer surveillance in IBD was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS According to the literature, colonoscopic evaluation may be justified for patients aged > 50 years with recent-onset chronic diarrhea or with alarm symptoms. Surveillance colonoscopy for CRC should be offered to all patients with extensive ulcerative colitis or colonic Crohn's disease of 8 years' duration, and to all patients with less extensive disease of 15 years' duration. Intervals for surveillance colonoscopy depend on duration of evolution, initial diagnosis, and histological findings. The EPAGE II criteria also confirmed the appropriateness of diagnostic colonoscopy for diarrhea of > 4 weeks' duration. They also suggest that, in addition to assessing extent of IBD by colonoscopy, further colonoscopic examination is appropriate in the face of persistent or worsening symptoms. Surveillance colonoscopy in IBD patients was generally appropriate after a lapse of 2 years. In the presence of dysplasia at previous colonoscopy, it was not only appropriate but necessary. CONCLUSIONS Despite or perhaps because of the limitations of the available published studies, the panel-based EPAGE II (http://www.epage.ch) criteria can help guide appropriate colonoscopy use in the absence of strong evidence from the literature.
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Affiliation(s)
- S Schusselé Filliettaz
- Healthcare Evaluation Unit, Institute of Social and Preventive Medicine, University of Lausanne and Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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30
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Peytremann-Bridevaux I, Arditi C, Froehlich F, O'Malley J, Fairclough P, Le Moine O, Dubois RW, Gonvers JJ, Schusselé Filliettaz S, Vader JP, Juillerat P, Pittet V, Burnand B. Appropriateness of colonoscopy in Europe (EPAGE II). Iron-deficiency anemia and hematochezia. Endoscopy 2009; 41:227-33. [PMID: 19280534 DOI: 10.1055/s-0028-1119644] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of iron-deficiency anemia (IDA) and hematochezia, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of IDA and hematochezia was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS IDA occurs in 2 %-5 % of adult men and postmenopausal women. Examination of both the upper and lower gastrointestinal tract is recommended in patients with iron deficiency. Colonoscopy for IDA yields one colorectal cancer (CRC) in every 9-13 colonoscopies. Hematochezia is a well-recognized alarm symptom and such patients are likely to be referred for colonoscopy. Colonoscopy is unanimously recommended in patients aged > or = 50. Diverticulosis, vascular ectasias, and ischemic colitis are common causes of acute lower gastrointestinal bleeding (LGIB); CRC is found in 0.2 %-11 % of the colonoscopies performed for LGIB. Most patients with scant hematochezia have an anorectal or a distal source of bleeding. The expert panel considered most clinical indications for colonoscopy as appropriate in the presence of IDA (58 %) or hematochezia (83 %). CONCLUSION Despite the limitations of the published studies, guidelines unanimously recommend colonoscopy for the investigation of IDA and hematochezia in patients aged > or = 50 years. These indications were also considered appropriate by EPAGE II, as were indications in patients at low risk for CRC with no obvious cause of bleeding found during adequate previous investigations.
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Affiliation(s)
- I Peytremann-Bridevaux
- Healthcare Evaluation Unit, Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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31
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Schusselé Filliettaz S, Gonvers JJ, Peytremann-Bridevaux I, Arditi C, Delvaux M, Numans ME, Lorenzo-Zúñiga V, Dubois RW, Juillerat P, Burnand B, Pittet V, Vader JP, Froehlich F. Appropriateness of colonoscopy in Europe (EPAGE II). Functional bowel disorders: pain, constipation and bloating. Endoscopy 2009; 41:234-9. [PMID: 19280535 DOI: 10.1055/s-0028-1119625] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS To summarize the published literature on assessment of appropriateness of colonoscopy for the investigation of functional bowel symptoms, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of functional bowel symptoms was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS Much of the evidence for use of colonoscopy in evaluation of chronic abdominal pain, and/or constipation and/or abdominal bloating is modest. Major limitations include small numbers of patients and lack of adequate characterization of these patients. Large community-based follow-up studies are needed to enable better definition of the natural history of patients with functional bowel disorders. Guidelines stress that alarm features ("red flags"), such as rectal bleeding, anemia, weight loss, nocturnal symptoms, family history of colon cancer, age of onset > 50 years, and recent onset of symptoms should all lead to careful evaluation before a diagnosis of functional bowel disorder is made. EPAGE II assessed these symptoms by means of 12 clinical scenarios, rating colonoscopy as appropriate, uncertain and inappropriate in 42 % (5/12), 25 % (3/12), and 33 % (4/12) of these, respectively. CONCLUSIONS Evidence to support the use of colonoscopy in the evaluation of patients with functional bowel disorders and no alarm features is lacking. These patients have no increased risk of colon cancer and thus advice on screening for this is not different from that for the general population. EPAGE II criteria, available online (http://www.epage.ch), consider colonoscopy appropriate in patients of > 50 years with chronic or new-onset bowel disturbances, but not in patients with isolated chronic abdominal pain.
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Affiliation(s)
- S Schusselé Filliettaz
- Healthcare Evaluation Unit, Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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Arditi C, Gonvers JJ, Burnand B, Minoli G, Oertli D, Lacaine F, Dubois RW, Vader JP, Schusselé Filliettaz S, Peytremann-Bridevaux I, Pittet V, Juillerat P, Froehlich F. Appropriateness of colonoscopy in Europe (EPAGE II). Surveillance after polypectomy and after resection of colorectal cancer. Endoscopy 2009; 41:209-17. [PMID: 19280532 DOI: 10.1055/s-0028-1119646] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS To summarize the published literature on assessment of appropriateness of colonoscopy for surveillance after polypectomy and after curative-intent resection of colorectal cancer (CRC), and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS A systematic search of guidelines, systematic reviews and primary studies regarding the evaluation and management of surveillance colonoscopy after polypectomy and after resection of CRC was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy for these conditions. RESULTS Most CRCs arise from adenomatous polyps. The characteristics of removed polyps, especially the distinction between low-risk adenomas (1 or 2, small [< 1 cm], tubular, no high-grade dysplasia) vs. high-risk adenomas (large [> or = 1 cm], multiple [> 3], high-grade dysplasia or villous features), have an impact on advanced adenoma recurrence. Most guidelines recommend a 3-year follow-up colonoscopy for high-risk adenomas and a 5-year colonoscopy for low-risk adenomas. Despite the lack of evidence to support or refute any survival benefit for follow-up colonoscopy after curative-intent CRC resection, surveillance colonoscopy is recommended by most guidelines. The timing of the first surveillance colonoscopy differs. The expert panel considered that 56 % of the clinical indications for colonoscopy for surveillance after polypectomy were appropriate. For surveillance after CRC resection, it considered colonoscopy appropriate 1 year after resection. CONCLUSIONS Colonoscopy is recommended as a first-choice procedure for surveillance after polypectomy by all published guidelines and by the EPAGE II criteria. Despite the limitations of the published studies, colonoscopy is also recommended by most of the guidelines and by EPAGE II criteria for surveillance after curative-intent CRC resection.
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Affiliation(s)
- C Arditi
- Healthcare Evaluation Unit, Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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Bize R, Lamy O, Peytremann-Bridevaux I. [Osteoporotic fracture in menopausal women: alendronate reduces the risk]. Rev Med Suisse 2008; 4:2703. [PMID: 19157286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- R Bize
- Institut universitaire de médecine sociale et préventive de l'Université de Lausanne et Réseau francophone Cochrane Bugnon 17, 1005 Lausanne
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Peytremann-Bridevaux I, Voellinger R, Santos-Eggimann B. Healthcare and preventive services utilization of elderly Europeans with depressive symptoms. J Affect Disord 2008; 105:247-52. [PMID: 17509695 DOI: 10.1016/j.jad.2007.04.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 04/13/2007] [Accepted: 04/16/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depressive symptoms are associated with increased healthcare utilization. However, it is unclear whether depressed individuals experience more or less frequent access to preventive services. Our goal was to investigate the association between depressive symptoms and both utilization of healthcare and preventive services. METHODS Baseline self-reported data (2004) from non-institutionalized individuals aged > or =50 years participating in the Survey of Health, Ageing, and Retirement in Europe (SHARE) were used. Of the 18,560 respondents to the baseline questionnaire, 13,580 answered the supplementary questionnaire, which included measures of preventive services. Healthcare utilization during the previous 12 months, including outpatient visits, medication, hospitalization, surgery, and home healthcare were assessed. Preventive service measures assessed the participation in influenza immunization and colorectal and breast cancer screening. Depression status was assessed with the EURO-D, a validated instrument for which a score >3 defines clinically significant depressive symptoms. Logistic regressions were performed adjusting for age, gender, socioeconomic status, behavioral risk, chronic disease, disability, and country of residence. RESULTS The estimated prevalence of depressive symptoms was 28.2%. Depressive symptoms were associated with significantly greater use of all healthcare domains but not preventive services, with the exception of colorectal cancer screening. Similar trends were found for each country of residence and for both genders. LIMITATIONS It was not known whether medical tests were used for screening or diagnostic purposes. CONCLUSIONS SHARE data suggest that patients with depressive symptoms are frequent users of healthcare but not preventive services. Low screening rates may reflect missed screening opportunities rather than a lack of screening opportunities.
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Affiliation(s)
- I Peytremann-Bridevaux
- Health Services Research Unit, Institute of Social and Preventive Medicine, University of Lausanne, Switzerland.
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Affiliation(s)
- A Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier, Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
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36
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Peytremann-Bridevaux I, Faeh D, Santos-Eggimann B. Prevalence of overweight and obesity in rural and urban settings of 10 European countries. Prev Med 2007; 44:442-6. [PMID: 17258803 DOI: 10.1016/j.ypmed.2006.11.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 09/14/2006] [Accepted: 11/11/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES First to explore differences in prevalence of overweight and obesity between rural and urban areas of 10 European countries, then to determine whether body mass index varies with the countries' gross domestic product. METHODS We used baseline data (2004) from countries participating in the Study of Health, Ageing and Retirement in Europe, which included 16,695 non-institutionalized individuals aged 50-79 years with body mass index > or =18.5 kg/m(2). Height and weight were self-reported and body mass index categorized as normal weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)) and obesity (> or =30 kg/m(2)). Weighted prevalences of overweight and obesity in rural and urban areas were estimated, and logistic regressions performed to investigate the association between rural residence and body mass index, adjusting for age, sex, household income and education. Spearman's correlation examined the relationship between body mass index and gross domestic product. RESULTS We found no differences in the prevalence of overweight and obesity between rural and urban areas. Separate analysis by gender, age, education or income level did not reveal additional rural-urban variations. Body mass index was slightly higher when gross domestic product was lower. CONCLUSIONS Programs aimed at preventing or managing overweight and obesity in the 50-79 years age range should be addressed to residents of both rural and urban areas, but tailored to their specific characteristics.
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Affiliation(s)
- I Peytremann-Bridevaux
- Health Services Research Unit, Institute for Social and Preventive Medicine, University of Lausanne, Switzerland.
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Peytremann-Bridevaux I, Santos-Eggimann B. Healthcare utilization of overweight and obese Europeans aged 50–79 years. J Public Health (Oxf) 2007. [DOI: 10.1007/s10389-007-0103-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Berna C, Junod AF, Peytremann-Bridevaux I, Calmy A. [The PROVE IT-TIMI-22 study or the biter being bit]. Rev Med Suisse 2005; 1:966-70. [PMID: 15898682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The importance of statins in secondary prevention is well established since the 4S, CARE and LIPID studies, their indications being now applied to even normocholesterolemic patients. To date, it is still unclear which statin to choose, and at what dose. A recent study entitled "PROVE IT-TIMI-22" has compared 80 mg of atorvastatin/day to 40 mg of pravastatin/day in early secondary prevention. It appears that the intensive treatment with atorvastatin has been more effective on the LDL-cholesterol levels and has had a more favourable effect on the clinical evolution based on a composite score. We herein propose a critical review of this study and recommend a somewhat cautious attitude before giving high doses of atorvastatin in the secondary prevention of all the patients with coronary heart disease.
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Affiliation(s)
- C Berna
- Service de Medecine Interne Générale, Département de Médecine Interne, HUG, 1211 Genève.
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