Biomedical subjects
J Martin
Publications and source records attributed to J Martin.
Switzerland's participation in MONICA.
Switzerland is currently participating in the multicenter study "Monitoring of Trends and Determinants in Cardiovascular Disease - MONICA". Incidence of acute myocardial infarction will be studied over a period of ten years in a target population. The results will be compared with changes in medical care and the spread of known risk factors for cardiovascular disease in the population. This paper describes how the different data will be registered in Switzerland and how far the work has progressed up to now.
[Implementation of prevention: imperatives of multiple collaboration and action within the community].
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[School counselors: from the prevention of drug abuse to a larger role].
Since 1977, a programme has been launched in the Canton of Vaud (pop. 530,000), Switzerland, for the training and use of teachers as mediators in the school setting at various levels, to help tackling problems related to the use of drugs and other risk situations. They follow and in service training (14 afternoons) and are granted, from their working time, about two hours per week to dedicate to this function. Their main role is to be available for reference and empathic listening to children and teacher colleagues, as well as to headmasters, parents, etc. Experience has shown that, in general, mediators are consulted more often for unspecific risk situations, such as difficulties at school and in the family, or "blues". A survey among 51 mediators in function was carried out in 1984 by interviews. It showed a general satisfaction of the ombudsmen with their role. At this time, the student population each deals with is around 600 children. Most of them say they have seen 10 to 20 new cases a year, and follow them up for two weeks to one year usually. Their relationships with various concerned partners are good. They have developed both case work type activities and health educational ones (but there is no systematic drug related information). Some other Swiss cantons and European countries have embarked on similar programs. Such mediators appear to make a useful contribution, complementary to efforts by other interested professionals and institutions.
[Attitudes and practices of Vaud women concerning the self examination of breasts].
A survey by personal interviews on this subject was carried out in 1984 with a representative sample of 499 women living in the Canton of Vaud. The response rate was 76.6%. Among the respondents, 61.3% practice BSE, but only 27% do so regularly. A complementary inquiry of a group of women who refused the interviews shows a lower practice rate. Women aged 40-49 years, who have benefited more than other groups from related information through their physicians, are those who do BSE most. Our results indicate that such personalized information from a doctor is strongly and positively associated with BSE practice (p less than .001), when compared with "extra-medical" information (mainly from the mass media). There are some negative reactions (fear, reluctance) when the question of BSE is taken up, but they are not major ones and do not influence the interest of the majority of the women (63.3%) in wanting to be better informed on the subject.
[Teaching social and preventive medicine to pharmacy students].
The new Swiss reglementation for the final examination of students in pharmaceutics make social and preventive medicine a mandatory part of the curriculum. The number of hours attributed to the new subject differ markedly between the various schools of pharmacy. They are influenced by the attitude of the institutes and faculties (schools), professional societies but also by the students involved. The experiences of the first year are briefly discussed. Most important is to use the opportunity to improve the collaboration between the different partners in health care.
Clinical evaluation of left ventricular function using the cardiac helical fiber model: an echocardiographic study.
The cardiac helical fiber concept was introduced in 1969 and was shown mathematically to provide better approximations of normal ejection fractions compared with the conventional circumferential fiber model. The clinical applicability of this concept was evaluated noninvasively by M-mode and two-dimensional echocardiography in 55 subjects: 10 with aortic insufficiency, 10 with congestive cardiomyopathy, eight with hypertension, eight who were long-distance runners, 12 who were active and seven who were sedentary normals. Comparison of myocardial shortening by the circumferential and helical fiber models showed that the former discriminated only two groups of subjects, while endocardial and epicardial helical shortening discriminated three and four groups, respectively. Regression analyses suggest that more than 90% (r2 = 0.92) of variation in ejection fraction may be accounted for by variation in endocardial shortening, and that more than 75% (r2 = 0.77) of variation in observed endocardial shortening may be accounted for by variation in epicardial contraction. The study demonstrates that the helical fiber length concept may be useful for the noninvasive evaluation of left ventricular function in man.
[Conception of a program for the treatment and statistical interrogation of data, LOGIST].
This paper presents a general program which cannot only be used for the treatment and the statistical interrogations, but also for basic operations, such as the validity check and the preparation of data which is often necessary for other programs. Its use of language is simple, suitable and accessible to non-specialists. The program is sufficiently complete so that it can treat some complex problems without requiring complementary programs. It can treat several problems simultaneously. This allows one to gain data-reading time and the program is therefore economical. Its domain of use is large: epidemiological studies, psychological and sociological investigations, biological studies, clinical research, chronological follow-up, examinations of faculties, . . . . The program is written in FORTRAN IV and thus transferable. It contains more than 25 000 instructions but needs limited place in the core memory (less than 64 000 words). Its structure allows further evolution and addition of new procedures or new methods. A transformation into a conversational form is considered.
Community-based primary prevention of cardiovascular disease in Switzerland: methods and results of the National Research Program (NRP 1A).
The National Research Program 1A on Primary Prevention of Cardiovascular Disease in Switzerland was designed to determine whether community health education can reduce cardiovascular risk factors in whole population groups. Two towns (12,000 inhabitants each) in the French-speaking and two (16,000 inhabitants each) in the German-speaking part of the country were selected for either intervention or comparison. Following baseline screening in 1977 (stratified random samples) and the community intervention program (1978-1980), a final assessment on the initial participants was made at the end of 1980. In intervention towns, 26.2% of the regular smokers quit during this period compared with 18.1% in the reference towns. In addition, a significant net increase in the proportion of hypertensive patients under effective control was observed. A reduction in cholesterol levels was noted in both the intervention and the reference towns, with no difference between them. However, cholesterol levels in a subgroup of women participating in program activities as compared with those not participating were significantly reduced. The program, with extensive involvement of a diversity of community groups, has enjoyed continued support, even after the end of the research experience, thus demonstrating the viability and acceptability of community-oriented preventive action.
The prevalence of attention deficit disorders in a rural midwestern community sample of nine-year-old children.
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Multiple granulation tissue lesions occurring in isotretinoin treatment of acne vulgaris--successful response to topical corticosteroid therapy.
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The spectrum of diseases associated with necrotizing glomerulonephritis and its prognosis.
Necrotizing glomerulonephritis (NGN) represents small-vessel vasculitis in the kidney. To assess the diseases associated with necrotizing glomerular changes and their prognosis we studied all 32 patients who had this histologic finding on kidney biopsy from 1969 to 1982 and compared them to those patients who had crescentic, diffuse, or focal and segmental glomerulonephritis without necrosis (n = 29). The diseases associated with NGN were systemic lupus erythematosus (n = 6/15), Henoch-Schönlein purpura (n = 3/4) Goodpasture's syndrome (n = 4/7), Wegener's granulomatosis (n = 6/6), polyarteritis (n = 4/5), infective endocarditis (n = 2/3), and idiopathic rapidly progressive glomerulonephritis (n = 7/21). Necrotizing glomerulonephritis occurred significantly more often in the vasculitides than in all the other disorders put together. The most difficult diagnosis problem occurred in patients with renal disease and pulmonary hemorrhage (n = 9), in three of whom diagnosis was uncertain even after autopsy (two autopsies done within one month and one within three months of presentation). A fourth patient had a linear staining for IgG along the glomerular basement membrane (GBM) on kidney biopsy but was subsequently diagnosed as having Wegener's granulomatosis. Comparison of patients with without NGN revealed no difference in outcome (death or dialysis) one year after biopsy (38% v 43%) or in serum creatinine levels one year later (4.6 v 4.8 mg/dL). The prognostic effect of NGN was not obscured by unequal distribution of other adverse prognostic factors in the two groups. The most important prognostic characteristics we identified for outcome were serum creatinine at biopsy (chi 2 = 24.0, P less than .0004) and the sum of activity and chronicity indexes on biopsy (chi 2 = 12.7, P = .0004). These variables were similarly distributed in patients with and without necrosis, mean serum creatinine levels at biopsy being 4.3 v 4.2 mg/dL and sum of indexes 7.8 v 8.0. Other factors such as clinical diagnosis and therapy were not important prognostically and therefore could not explain our results. We conclude that NGN in patients with active proliferative glomerulonephritis has multiple causes. Diagnostic difficulties occurred in those with anti-GBM-negative pulmonary hemorrhage. The appearances of small-vessel vasculitis in the kidney did not appear to have prognostic significance.
[Improved early diagnosis of intrauterine pregnancy using an ultrasonic vaginal sonde].
The presented vaginal sonde can be brought up to the investigated tissue at minimal distance and the patient can be sonographed without special preparation (e.g. the uncomfortable and time consuming filling of the bladder). Besides the more feasible organization for the physician the method allows early diagnosis of intrauterine pregnancy and therefore the exclusion of ectopic pregnancy in patients suffering from sterility.
Compliance and policy issues and recommendations related to revision of the National Interim Primary Drinking Water Regulations for Radionuclides.
This paper summarizes the deliberations and conclusions of the Compliance and Policy Committee of the National Workshop for Radioactivity in Drinking Water. Prior to and during the workshop the committee considered a total of 32 possible compliance and policy issues and determined that 22 were valid. The committee developed positions on seven of these and these positions are presented herein. The remaining 25 issues are also listed with the committee's evaluation of each.
Behavior therapy for panic disorder.
Eleven patients who met DSM-III criteria for panic disorder were treated with behavior therapy techniques. Seven patients had mixed phobic avoidance and none were agoraphobic; three had no phobic symptoms. Mean duration of symptoms was 3.4 years. Treatment lasted a mean of 14 weeks and consisted of 1) education about physiology and management of panic symptoms; 2) relaxation, abdominal breathing, and cognitive anxiety management skills; and 3) imaginal and in vivo exposure. Upon termination of treatment, 10 of 11 patients were panic-free and six of seven mixed phobics showed complete remission or significant improvement of phobias. Follow-up data revealed excellent stability of remission. Clinical implications for the use of behavior therapy for panic disorder and directions for future research are discussed.
Improved perinatal knowledge in community hospitals through a self-instructional program.
The Perinatal Continuing Education Program (PCEP) was conducted throughout South Carolina. The program was well received and greatly valued; however, participants requested more information covering obstetrics. To meet this need, we developed the Perinatal Education Program for Community Hospitals (PEPCH), patterned after and similar to PCEP, and tested it in South Carolina and southern California. In the South Carolina trial, the posttest was found reliable (Kuder-Richardson index = .77). In the California trial, the pretest/posttest reliability was confirmed. Learning for nurses was documented (pretest = 30.8 +/- 5.3, posttest = 36.8 +/- 5.5, P less than .001). Completion rate for this voluntary program was 84%. We conclude that a self-study program based in the community hospital can improve knowledge of perinatal professionals.
The HLA-DR antigen frequency in Northern Ireland compared to the frequency in Bristol, Edinburgh and Eire.
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