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Biomedical subjects

C E Minder

Publications and source records attributed to C E Minder.

At least 19 recordsLinked to original sources
PubMed1995

The prognostic significance of protein-energy malnutrition in geriatric patients.

Although it has been shown that protein-energy malnutrition is a predictor of adverse outcome in geriatric patients, it is unclear whether this is due to underlying disease or disability, or whether malnutrition is an independent outcome predictor. To clarify the predictive role of malnutrition, we analysed the 4.5-year mortality and living location follow-ups of 219 geriatric patients admitted to a geriatric assessment unit. Prevalence of anthropometric and serological malnutrition indicators were between 13.7% and 39.8% at hospital admission. In bivariate models, prealbumin, subnormal arm muscle area, and subnormal body weight were predictors of mortality and survival at home. On the other hand, albumin, transferrin, and triceps skin-fold thickness did not predict these outcomes. In multivariate models the hazard ratio (HR) of 4.5-year mortality remained significant with an HR of 1.8 (95% CI 1.3-2.6) for subnormal arm muscle area, and 1.6 (95% CI 1.0-2.6) for subnormal body weight. Prealbumin was the strongest serological outcome predictor (multivariate mortality HR 1.9, 95% CI, 1.3-2.8). In these models, subnormal cognitive function, impaired physical function, and creatinine clearance < 30 ml/min were also associated with increased mortality. Malnutrition did not predict hospital discharge location, but among patients discharged home, those with initial malnutrition had a decreased length of survival at home. Our findings indicate that certain protein-energy malnutrition indicators are independent risk factors predicting decreased length of overall survival and survival at home in geriatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1995

[Introduction to the statistical aspects of planning clinical oncologic phase III studies].

A phase III clinical trial is a comparative study in which one assesses the relative efficacy of a treatment or treatments. It generally has one of the following objectives: 1. To determine the effectiveness of a new treatment relative to the natural history of the disease, for example when comparing a new treatment to not treatment or to placebo in an adjuvant setting. 2. To determine if a new treatment is more effective than the best current standard therapy (at the risk of increasing the toxicity). 3. To determine if a new treatment is as effective as the best current standard therapy but is associated with less severe toxicity or a better quality of life (equivalence trial). Clinical trials must be properly designed in order to answer such questions with a high degree of certainty. The purpose of this paper is to present several concepts which must be taken into account during the process of designing a clinical trial.

Aged↗
PubMed1994

A mortality study of lung cancer among swiss professional drivers: accounting for the smoking related fraction by a multivariate approach.

The mortality due to lung cancer among 'chauffeurs', who have a presumably long-term exposure to diesel exhaust fumes, was analysed. As controls, men in industrial occupations of similar socio-economic status were selected. Cases were drawn from the Swiss mortality register for the years 1979-1983. Person-years were obtained using data from the 1980 census records. These two data files were combined by occupation, age class and socio-economic status. Age adjusted incidence rates were calculated applying Poisson regression. To control for tobacco related lung cancer mortality an indirect adjustment was undertaken. Using information about the smoking habits of the people in the occupations under study, smoking-attributable lung cancer mortality was accounted for by incorporating Axelson's technique into multivariate regression modeling. The mortality ratio for lung cancer for chauffeurs with respect to the controls was 2.27, which is significantly in excess of 1:95% CI (1.99, 2.58). Other tobacco related diagnoses such as bladder cancer, esophageal cancer and ischemic heart diseases showed excess risks as well. After accounting for smoking, a slight but significant increase in lung cancer mortality remained among chauffeurs (mortality ratio 1.48, 95% CI: 1.30, 1.68). In summary, the present results do support the hypothesis that diesel exhaust is a significant cause of lung cancer.

Adult↗
PubMed1992

Oral, pharyngeal and laryngeal cancer as a cause of death among Swiss cooks.

In an analysis of Swiss mortality data (1979-1987) excess mortality due to oral, pharyngeal and laryngeal cancer was found among cooks, and the rate was very high in the age group < 55 years. The peak number of cases was observed among cooks in the age category 45-49 years. In the standard population the highest number of such deaths was observed between 65 and 69 years of age. The numbers of alcohol-related causes of death were also elevated among the cooks, while the numbers of smoking-related deaths were not. Although the dominant role of combined alcohol and tobacco consumption for the development of oral, pharyngeal and laryngeal cancer has been confirmed by many studies, other factors (eg, volatile carcinogenic compounds formed during the cooking process) may contribute to the excess mortality from oral, pharyngeal and laryngeal cancer among cooks. The question of the relevance of such factors will have to be answered by further studies.

Age Factors↗
PubMed1992

Cancer mortality of Swiss men by occupation, 1979-1982.

Results of a study of male cancer mortality are presented by occupation. The data base consisted of the 1979-1982 mortality register and 1980 census data from Switzerland. In a novel approach, a linked subset of death certificates and census records was used to correct the numerator-denominator bias of standardized mortality ratios and their confidence intervals. Agricultural occupations exhibited low cancer mortality (exception: stomach cancer). Electricians suffered excess mortality from cancer of several sites. Foundry and chemical workers had elevated mortality risks for digestive tract cancers. Other metal workers suffered from high mortality from cancers of the respiratory organs. Construction workers were subject to high mortality from cancers of the upper digestive tract and lungs. Innkeepers, cooks, and owners or managers of guest houses had high rates of cancers of the digestive system. Occupations using combustion-powered equipment suffered from excess lung cancer mortality. In general the results of the study agree with those of several other studies.

Abstracting and Indexing↗
PubMed1991

[The periodontal status of the population of 12 cantons in Switzerland].

An epidemiological survey in 12 cantons of Switzerland yielded a high percentage of all the sites examined with signs of gingivitis. Nevertheless, only 4% of all the sites showed periodontal breakdown of 7 mm or more; however, those sites were distributed in larger proportions of the population sample. Further frequency analysis revealed that more than 75% of the persons examined yielded no or only few sites with periodontal breakdown. The results of this study indicate that despite the high percentage of inflamed gingival units in the population, periodontal breakdown is less frequent than commonly estimated.

Age Factors↗
PubMed1990

[Mortality analysis: when is single evaluation of the basic cause of death allowable, when should multi-causality be assessed?].

Data quality is often a critical point in mortality studies. The purpose of the present report is to present criteria for assessing the value of death-certificate-based mortality studies. For this purpose all 57,454 Swiss death certificates of the year 1979 were analysed. Reliability of the diagnosis listed on the death certificate was investigated by comparing for each case of a linked sample of 12,478 deaths the cause of death with medical information available from the hospital record. Retrieval rates (percentage of cases for which the given diagnosis appears in both registries) were calculated for the primary diagnoses named in each data set. These can be considered as measures of reliability of diagnoses. The graphs given indicate a high reliability for cancers and accidents. Reliability was lower for other causes of death such as cardiovascular diseases, diabetes mellitus, rheumatic diseases. Restriction to the primary cause of death can be accepted for most cancers, accidents and violent deaths. For other causes of death, decisions must be made individually and multicausal analysis may be indicated. In addition, knowledge of the reliability of the diagnoses of interest is necessary for the interpretation of results derived from death certificate-based mortality studies.

Cause of Death↗
PubMed1990

Health and social inequities in Switzerland.

Despite standards of living and life expectancy amongst the highest in Europe, Switzerland exhibits fairly substantial social inequities in health. As regards male mortality by socio-economic group, these differentials are both marked and independent of cause of death. There is a wealth of information on morbidity and disability supporting the hypothesis that people in lower socio-economic groups tend to age faster and suffer more at younger ages. It is similarly evident that infants of low class mothers, particularly those unwed, underprivileged immigrant, are at excess risk. The Swiss results are of political and scientific interest in that they suggest that the average wealth of a community does not determine health differentials.

Adolescent↗
PubMed1990

Changes in subgingival microbiota during puberty. A 4-year longitudinal study.

It was the purpose of the present investigation to monitor the composition of the subgingival microbiota at selected sites in individuals passing through puberty and to correlate observed changes with the development of pubertal maturation. Between the ages of 11 and 14 years, pubertal and skeletal maturation was monitored annually in 22 boys and 20 girls. During this time, subgingival microbial samples were taken every 4th to 5th month (10 times in 4 years) mesially of the upper first molars. High values in total bacterial counts were reached after the onset of puberty, followed by a decrease towards the end of the observation period. The frequency of detection of Actinomyces odontolyticus and of Capnocytophaga sp. increased with time. The frequencies of other selected species, specifically of black pigmenting Bacteriodes sp. were not found to increase when tested by linear and quadratic models of time trend. However, a statistically significant rise in the frequency of detecting B. intermedius and B. melaninogenicus was noted in the initial pubertal phase identified by the onset of testicular growth in boys (p = 0.05). A significant relationship also existed between testes growth and increase of A. odontolyticus (p less than 0.01). In girls, a similar increase was obtained for A. odontolyticus when studied in relation to the Tanner scores for breast development (p less than 0.01). The changes observed in the subgingival microbiota during puberty may be related to the development of gingivitis, which was demonstrated by a higher tendency for gingival bleeding during the course of the pubertal maturation process.

Actinomyces↗
PubMed1990

Comparison of clinical periodontal parameters with the Community Periodontal Index for Treatment Needs (CPITN) data.

The purpose of this analysis was to assess the ability of the CPITN system to rate severity and prevalence of periodontal diseases in a population, in comparison with full mouth scorings using conventional clinical parameters (Plaque Index, Gingival Index, Retention Index, Pocket Probing Depth and Loss of Attachment). These parameters were collected in a randomly selected sample in Switzerland. The data were then transformed to fit the definitions of the CPITN. Furthermore, a comparison of the data set from Switzerland with data obtained from the Oral Global Data Bank of the WHO was made. By conversion of the Swiss data into the CPITN format, many details were lost, which were considered to be relevant to assess severity, prevalence and localization of periodontal diseases within a population. In addition, the transformed data generally overestimated the prevalence of periodontal destruction when compared with data from surveys in other industrialized countries in which the CPITN was used to evaluate the periodontal status. The comparison of the data before transformation into the CPITN, however, corroborated results from epidemiological studies in which conventional periodontal index systems were used. This indicates that data obtained to determine defined treatment needs (CPITN) may be of questionable value for the assessment of the true prevalence and severity of periodontal disease in a population.

Dental Health Services↗
PubMed1989

[Effects of air pollutants on the respiratory system in young children].

A one year study on a random sample of 1225 Swiss children aged 0-5 years was conducted in four different areas (two urban, one suburban and one rural) of Switzerland to investigate the relationship between air pollution and respiratory symptoms. For each child daily symptoms over a six week period were recorded by their parents in the form of a standard diary and air pollution was assessed by personal NO2-samplers. 20% of the diaries were validated by comparison with the attending pediatrician's case-notes and showed good agreement (87%). The frequency of respiratory symptoms per child per day was found to increase with increasing levels of NO2 measured outdoors, but not with NO2 concentration indoors (when other indoor sources for NO2 where present). Possible other factors were accounted for by multiple regression analysis and the variables "season" and "child's susceptibility to colds" also showed a significant association with respiratory symptoms. But the relationship between NO2 outdoors and respiratory symptoms per child per day remained statistically significant. The multiple regression model explains 7% of the total variability. The result indicates that air pollution is a contributory factor in the development of respiratory symptoms in children.

Air Pollutants↗
PubMed1989

[A mortality databank for international comparison and background information].

This article describes the structure and utilization of a computerized databank system for WHO mortality data. This system makes available "at finger-tips" data which previously were published by WHO in its blue volumes. The data can be handled much more flexible. At the moment the system provides information on age-standardized rates (direct standardization), total number of cases, as well as cover per age-group and year for about a hundred countries. The time period covered is 1950-1985, with exceptions for data which are not available to WHO.

Humans↗
PubMed1989

[Physical occupational activity and colonic carcinoma mortality in Swiss men 1979-1982].

Colorectal cancers are the second most frequent cause of cancer death among men. To our knowledge, approximately six studies have been able to show an inverse relationship between occupational physical activity and colon cancer mortality. Information drawn from the mortality statistics for the years 1979-1982 was used to study this hypothetical association among Swiss men aged 15-79. At-risk-populations were calculated based on 1980 national census data on occupation of all Swiss men. Estimates of occupational physical activity (OPA) were based on job titles of death certificates and were "blindly" classified into three groups of low, moderate and high OPA by three independent experts. Among the cohort of 1.86 million men, 1995 deaths of colon cancer and 1066 deaths of rectal cancer occurred during the four study years. The standardized mortality ratio showed a significant, graded and inverse relationship between OPA and mortality from colon cancer but not from rectal cancer. The estimated relative risk for colon cancer of the physically inactive, as compared to those active, was 1.3 to 1.4, slightly influenced by minor differences in the way of classification of OPA. For several reasons this estimate of excess risk is probably on the low side. The subgroup of men with jobs with very high OPA showed no further reduction in risk of colon cancer, which suggests that other etiologic factors, such as diet, may play an important role. As sedentary lifestyle and colon cancer are both frequent in central Europe the hypothesized protective effect of habitual physical activity against colon cancer would seem important, especially from the public health point of view.

Adolescent↗
PubMed1989

Reproducibility of microscopic and cultural data in repeated subgingival plaque samples.

In association studies, micro-organisms can only be recognized as suspects for playing a major rôle in the development of a pathological environment, if their destructive action goes along with a marked proportional increase of their numbers or if their first detection can be related to the clinical onset of the disease. Limitations in the reproducibility of repeated samples have to be taken into account, when changes of the microbial composition of subgingival environments are to be studied, and when local clinical changes are to be related to shifts in the composition of the pertaining microbiological compartment. To study reproducibility, a total of 109 sites was sampled repeatedly with sterile paperpoints at an interval of 7 to 10 days in 24 patients suffering from periodontal disease and 12 edentulous patients wearing successful and failing osseointegrated titanium implants. Using continuous anaerobic techniques, the samples were cultured on nonselective and selective media and were studied by darkfield microscopy. Both the intertest-agreements of frequencies of detection (kappa-statistics) as well as the discrepancies of proportions of bacterial groups and selected bacterial species were determined. The standard deviation of proportional differences between first and second samples ranged between 6.4% (fusiform organisms) and 17.2% (coccoid cells) for darkfield parameters, between 4.3% (B. melaninogenicus on ETSA/Kana.) and 14.0% (B. gingivalis on ETSA/Kana.) for selected bacterial species and between 6.9% (gram-negative anaerobic cocci) and 24.0% (gram-positive facultative cocci) for bacterial groups classified according to gram stain characteristics and atmospheric growth conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗
PubMed1988

Smoking, alcohol consumption, and endurance capacity: an analysis of 6,500 19-year-old conscripts and 4,100 joggers.

Using data from two Swiss studies, a 20% random sample (n = 6,592) of all 19-year-old army conscripts and all male participants in a 16-km popular race (n = 4,358), we studied the relationships among smoking, alcohol consumption, and endurance capacity using univariate and multivariate analyses. Alcohol was significantly correlated with endurance capacity among joggers in univariate analysis, but lost its significance in multivariate analysis. Among army conscripts, the distance covered in a 12-min endurance run was inversely related to daily cigarette consumption and years of smoking (P less than 0.001). This association was apparent even among light smokers who had been smoking for less than 2 years when they were compared with nonsmokers. Among joggers, even when the lower training activity of the smokers was controlled for, smoking retained a negative, independent association with endurance capacity, as measured by 16-km race time. In multiple regression analysis of endurance capacity, the standardized regression coefficient for smoking was -0.14 for distance covered in the 12-min run and 0.10 for 16-km running time, the latter despite the low prevalence (6.9%) of regular cigarette smokers among the joggers. Seventy percent of the 16-km race participants who smoked around the time they took up jogging quit smoking as joggers. Within the limits of this cross-sectional study design, these results suggest that smoking exerts a direct, biologically mediated, deleterious effect on endurance capacity. The lower levels of exercise of the smokers did not entirely explain the difference in endurance between smokers and nonsmokers. This observation of a short-term negative association between even light smoking and endurance capacity may have implications for health education and promotion efforts.

Adult↗
PubMed1988

Relationship of training and life-style to 16-km running time of 4000 joggers. The '84 Berne "Grand-Prix" Study.

To investigate running activity, life-style, and endurance capacity of joggers, all competitors of a popular 16-km race were surveyed by questionnaire. The response rate was 83.6%, yielding a study population of 4358 male runners over age 16. In univariate analysis, there were significant associations between 16-km running time and weekly training distance (average of 1 year), weekly training frequency, body mass index (BMI), age, cigarette smoking, years of regular running, and frequency of alcohol cosumption. A multiple regression analysis provided six significant, independent predictors of 16-km time, explaining 47% of its variance: weekly training distance (standardized regression coefficient = -0.46), age (0.37), BMI (0.23), years of regular running (-0.19), weekly training frequency (-0.11), and cigarette smoking (0.10). Based on laboratory treadmill testing of a subsample of runners, 16-km running times were transformed into maximum aerobic capacities (VO2 max equivalents) for all competitors. In comparison with the general population, even the slowest 5% of the runners showed a higher endurance capacity than the age-specific population mean. Application of the multivariate regression model for an estimation of the overall impact of training and life-style on endurance capacity showed that the great difference in mean endurance levels between joggers and the general population could entirely be attributed to differences in running activity, BMI, and smoking. We conclude that the joggers investigated were, on average, not selected concerning biological predisposition and genetic endowment since their behavior alone explained their high average endurance capacity.

Adolescent↗