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T V Perneger

Publications and source records attributed to T V Perneger.

108 records · Page 6Linked to original sources
PubMed1995

Diagnosis of hypertensive end-stage renal disease: effect of patient's race.

The authors conducted a simulation study to examine whether the race of a patient with end-stage renal disease (ESRD) influences the diagnosis of underlying kidney disease made by the nephrologist. The hypothesis was that ESRD may be more readily ascribed to hypertension in blacks than in whites. Nephrologists practicing in Maryland during 1991 were sent written case histories based on the presentation of seven patients with ESRD. For each case history, the patient's race was randomly assigned to be "black" or "white." The nephrologist's diagnosis of underlying renal disease was recorded as "hypertensive" or "other." Analysis of 197 case histories from 58 physicians (81% of those eligible) was performed using logistic regression. The distribution of underlying causes of ESRD in the case histories was similar to national statistics: hypertensive ESRD, 34%; diabetic ESRD, 30%; glomerulonephritis, 11%; other, 16%; unknown, 10%. Case histories that identified the patient's race as black were more likely (odds ratio = 1.97; 95% confidence interval 1.05-3.68) to result in a diagnosis of hypertensive ESRD than case histories in which the patient's race was said to be white, after adjustment for case history. Analyses that accounted for the physicians' individual tendencies to diagnose hypertensive ESRD yielded similar results. These findings suggest that black ESRD patients may be more likely to be labeled as having hypertensive kidney disease than white ESRD patients with similar clinical histories. Using race as a criterion to establish diagnoses of kidney disease may obscure the interpretation of incidence statistics, affect the management of individual patients, and hinder epidemiologic studies of risk factors for kidney failure. Definition of clear diagnostic criteria for the underlying cause of kidney failure is highly desirable.

Adult↗
PubMed1995

Studying the causes of kidney disease in humans: a review of methodologic obstacles and possible solutions.

Until recently, epidemiology has contributed little to the understanding of kidney disease etiology. In the past, the immediate need for therapy eclipsed the longer-term need to develop preventive strategies. As a result, kidney disease epidemiology lacked sufficient institutional and financial support. These difficulties are being progressively (albeit yet incompletely) resolved. Other obstacles pertained to research methods. The need for large cohort studies to investigate a relatively uncommon outcome can be overcome by the use of alternative study designs, such as nonconcurrent prospective studies or case control studies. Unfortunately, other methodologic obstacles remain. These include (1) lack of sensitive markers of early renal insufficiency for use in general populations, (2) variations in access to end-stage renal disease therapy, (3) uncertainty regarding cause-of-death certification in persons with kidney diseases, (4) ambiguous criteria for diagnosing specific renal diseases, (5) lack of independence between risk factor assessments and kidney disease definition, (6) inconsistent risk factor assessments, and (7) inadequate conceptual models for causation of kidney failure. We suggest a global framework, including (1) defining rigorous diagnostic criteria for renal diseases, (2) conducting etiologic studies of "all-cause" end-stage renal disease, (3) systematically collecting data on risk factors for renal injury, and (5) distinguishing between initiators and promoters of renal insufficiency and between proximate and distal risk factors. These suggestions aim to foster a multidisciplinary debate on etiologic research on renal diseases. Identification of modifiable risk factors may provide a basis for effective preventive interventions.

Epidemiologic Methods↗
PubMed1995

Validation of a French-language version of the MOS 36-Item Short Form Health Survey (SF-36) in young healthy adults.

The MOS 36-Item Short Form Health Survey (SF-36) is designed to measure 8 dimensions of health in clinical and general population settings. The main aim of this paper was to examine the reliability and validity of this instrument in young adults. A secondary aim was to document the results of a rapid translation procedure of the instrument, to be compared later to the more thorough official French adaptation. The translated survey was answered in 1992 by 1007 residents of Geneva, Switzerland, 18-44 years old, identified from health insurance rolls (82% response rate). Completion rate for all 8 dimensions of health was 95.5%. The instrument demonstrated excellent covergent (100%) and discriminant (98%) validity against pre-set criteria. Interval scaling of responses could be verified in some, but not all, items. Cronbach alpha (reliability) coefficients ranged from 0.76 to 0.92. Factorial analysis yielded 2 principal components, corresponding to mental and physical health. Thirteen of 16 correlations between health dimensions and principal components were within a pre-established range. Validation by independent clinical variables was also, with few exceptions, consistent with theory. Thus the SF-36 retained excellent psychometric properties even when used in a generally very healthy group. The careful but rapid translation procedure used in this study may be an effective alternative to full-scale cultural adaptations when resources are limited.

Adult↗
PubMed1995

Race and socioeconomic status in hypertension and renal disease.

Publications within the past year have added to our understanding of the relationships between race, socioeconomic status, hypertension, and renal disease. The catalog of racial differences in hypertension and renal disease has been enriched on several accounts. Some of these differences can be explained by specific intervening variables, but others remain attributed to race itself. Unfortunately, what 'race' actually represents is still subject to debate. This debate should be encouraged, because the lack of a clear concept of race hinders research in this area. The main new finding of the year may be a confirmation by several studies that low socioeconomic status is an independent risk factor for end-stage renal disease, regardless of race. Research explaining the mechanisms by which poverty affects the risk of kidney failure is urgently needed, as some of these mechanisms may lend themselves to preventive intervention. Interventions aimed at improving the serious socioeconomic consequences of treated end-stage renal disease are also receiving increasing attention, and have been shown to improve patient outcomes.

Humans↗
PubMed1995

Mental health and choice between managed care and indemnity health insurance.

OBJECTIVE: Populations enrolled in various health insurance plans may differ in their health care needs. Whether mental health affects choice among competing health plans is not clear. This study examined self-selection by participants in a Swiss indemnity insurance plan that was transformed into a managed care organization that controlled access to specialists through gatekeeping and restricted coverage for psychiatric treatments. METHOD: Information regarding past use of health services and health status was provided by 421 persons who joined the new managed care organization and 222 nonjoiners. The mental health and somatic health characteristics of these two groups were compared. RESULTS: In the year preceding the creation of the managed care organization, the nonjoiners had made on average 2.3 more visits to psychiatrists than the joiners but 0.0 to 0.6 more visits to other physicians. The nonjoiners were more likely to have used psychoactive medications but not other medications. The rates of treatment for depression were similar in the two groups. The joiners reported significantly lower mental health status, but not somatic health status, than the nonjoiners. CONCLUSIONS: Both mental health status and past use of mental health services strongly affected choice of health insurance plan. The effects of somatic health and use of somatic health services on selection were consistently weaker. People who join managed care organizations may have substantial uncovered needs for psychiatric care. Minimum mandatory benefits for mental health care may be an effective countermeasure to unequitable self-selection.

Adolescent↗
PubMed1994

Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs.

BACKGROUND: People who take analgesic drugs frequently may be at increased risk of end-stage renal disease (ESRD), but the extent of this risk remains unclear. METHODS: We studied 716 patients treated for ESRD and 361 control subjects of similar age from Maryland, Virginia, West Virginia, and Washington, D.C. The study participants were interviewed by telephone about their past use of medications containing acetaminophen, aspirin, and other nonsteroidal antiinflammatory drugs (NSAIDs). For each analgesic drug, the average use (in pills per year) and the cumulative intake (in pills) were examined for any association with ESRD. RESULTS: Heavier acetaminophen use was associated with an increased risk of ESRD in a dose-dependent fashion. When persons who took an average of 0 to 104 pills per year were used for reference, the odds ratio of ESRD was 1.4 (95 percent confidence interval, 0.8 to 2.4) for those who took 105 to 365 pills per year and 2.1 (95 percent confidence interval, 1.1 to 3.7) for those who took 366 or more pills per year, after adjustment for race, sex, age, and intake of other analgesic drugs. When persons who had taken fewer than 1000 pills containing acetaminophen in their lifetime were used for reference, the odds ratio was 2.0 (95 percent confidence interval, 1.3 to 3.2) for those who had taken 1000 to 4999 pills and 2.4 (95 percent confidence interval, 1.2 to 4.8) for those who had taken 5000 or more pills. Approximately 8 to 10 percent of the overall incidence of ESRD was attributable to acetaminophen use. A cumulative dose of 5000 or more pills containing NSAIDs was also associated with an increased odds of ESRD (odds ratio, 8.8), but the use of aspirin was not. CONCLUSIONS: People who often take acetaminophen or NSAIDs have an increased risk of ESRD, but not those who often take aspirin.

Acetaminophen↗
PubMed1994

End-stage renal disease attributable to diabetes mellitus.

OBJECTIVE: To determine the proportion of end-stage renal disease associated with diabetes mellitus in a biracial population, using population-attributable risk estimates. DESIGN: Case-control study. SETTING: Population-based study in Maryland, Virginia, West Virginia, and Washington, D.C. PARTICIPANTS: 716 newly treated patients with kidney failure aged 20 to 64 years and 361 age-matched controls. MEASUREMENTS: Self-reported history of diabetes mellitus, including type, duration, treatment, and complications. RESULTS: Persons with insulin-dependent diabetes (odds ratio, 33.7) and non-insulin-dependent diabetes (odds ratio, 7.0) were at greater risk for end-stage renal disease than were persons without diabetes. The odds ratio was only slightly increased for diabetes lasting less than 15 years, but the ratio increased more than 20-fold for diabetes lasting 15 years or more. The population-attributable risk for kidney failure was 21% for insulin-dependent diabetes and 21% for non-insulin-dependent diabetes (42% overall). A similar proportion of end-stage renal disease was attributed to diabetes in whites (44%) and in blacks (41%). Insulin-dependent diabetes had a relatively greater effect on the incidence of kidney failure in whites; in contrast, non-insulin-dependent diabetes had a relatively greater effect on kidney failure in blacks. CONCLUSIONS: Diabetes mellitus has a major effect on the incidence of end-stage renal disease in nonelderly adults. In black persons, diabetes may be responsible for a larger proportion of end-stage renal disease than is suggested by the use of clinical diagnoses of underlying renal disease made by patients' nephrologists. Prevention of end-stage renal disease associated with diabetes mellitus (both insulin-dependent and non-insulin-dependent diabetes) requires increased attention from laboratory and clinical researchers.

Adult↗
PubMed1993

Randomized trial of use of a monetary incentive and a reminder card to increase the response rate to a mailed health survey.

Insufficient response rates are a frequent problem in mailed epidemiologic health surveys. As part of a health survey of 1,235 young adults conducted from November 1992 through January 1993 in Geneva, Switzerland, a randomized factorial trial was carried out to assess the contributions of two tactics to increase response rates. The first incentive was the promise of sending 10 Swiss francs (7 US dollars) to respondents; the second was a red postcard, mailed 2 days after the questionnaire, which reminded potential participants to complete the questionnaire. The most effective strategy according to interim analysis was to be selected for follow-up mailings. Two weeks after the first mailing, response rates were 65% for those who had received both incentives, 57% for those who had been offered the money reward only, 54% for recipients of the reminder card, and 48% for those who had received neither incentive (p based on chi 2 (3 df) test < 0.001). The relative hazards of responding were 1.34 (95% confidence interval 1.15-1.55) for the money reward and 1.22 (95% confidence interval 1.05-1.41) for the reminder card. Follow-up mailings to all nonrespondents included both incentives. At the end of data collection, 1,007 persons (82%) had returned the questionnaire. The final response rates were 83, 84, 82, and 78% in the four groups, respectively (p = 0.29). Both the promise of a monetary reward and a reminder postcard considerably improved early response rates. The use of both incentives in follow-up mailings brought final response rates above 80%, except for those who had received no initial incentive. Testing various combinations of incentives in the early stages of a mailed health survey may be a generally useful strategy.

Adult↗
PubMed1993

Effectiveness of the Waksberg telephone sampling method for the selection of population controls.

The effectiveness of the Waksberg telephone sampling method and practical aspects of its implementation were evaluated during the selection of control subjects for a population-based case-control study conducted in Maryland, Virginia, West Virginia, and Washington, DC, in 1991. The first stage of the two-stage sampling procedure was equivalent to simple random sampling. Each telephone number selected was dialed up to 13 times to establish the type of connection. Residential connections were used to generate additional telephone numbers in the second stage by changing the last two digits. Overall, 3,860 telephone numbers yielded 1,311 residences. The proportion of residences was higher in the second stage (54%) than in the first (11%), while that of numbers "not in service" was lower (12% vs. 67%, respectively). Fewer calls (8,735) were made than would have been required by a simple random sampling procedure (up to 18,522). The geographic distribution of residences was similar at both stages of sampling. At the end of enrollment, each sampling unit had yielded 9.8 residences, but only 64% reached 9-11 residences. Compliance rates were 96% for screening (1,259 of 1,311 residences), 90% for interviewing (362 of 403), and 86% overall. Relative to simple random sampling, the Waksberg method considerably reduced the total number of telephone calls, but the sampling process was more complex to manage. This method is particularly suitable for selecting population controls when the density of residential connections is low and variables of interest are not homogeneous within sampling units. Random digit dialing remains an effective method for selecting population controls.

Data Collection↗
PubMed1993

Projections of hypertension-related renal disease in middle-aged residents of the United States.

OBJECTIVE: To establish nationwide projections for hypertension-related renal disease among middle-aged residents of the United States and compare disease burden in demographic subgroups. DESIGN: Integrated analysis of data from the US Census, the National Health and Nutrition Examination Survey of 1976 through 1980 (NHANES II), the 1971 through 1975 NHANES I Epidemiologic Follow-up Study, the Hypertension Detection and Follow-up Program trial, and the US Renal Data System. POPULATION: African-American and white residents of the United States, aged 30 to 69 years. MAIN OUTCOME MEASURES: Incidence rates and counts of hypertension, hypertension-related hypercreatinemia, and hypertension-related end-stage renal disease (ESRD). RESULTS: Each year, approximately 1.8 million middle-aged Americans develop hypertension, 140,000 develop hypertension-related hypercreatinemia, and 5300 develop hypertension-related ESRD. African Americans are at increased risk for hypertension (relative risk [RR], 1.6; population-attributable risk [PAR], 5%), hypercreatinemia if hypertensive (RR, 2.4; PAR, 18%), ESRD if hypertensive with hypercreatinemia (RR, 2.7; PAR, 32%), and hypertension-related ESRD overall (RR, 8.0; PAR, 44%). Compared with women, men are at increased risk for hypertension (RR, 1.3; PAR, 13%) and hypertension-related ESRD (RR, 1.6; PAR, 23%). Most cases of hypercreatinemia in hypertensives (73%) occur among those with mild hypertension. CONCLUSIONS: Progression to ESRD is rare in persons with hypertension-related renal disease, and factors other than blood pressure probably play an important role. A large proportion of hypertension-related renal disease cases occur among population subgroups considered to be at low risk. Interventions that favorably influence factors associated with the progression of hypertension-related renal disease in African Americans, in men, and in persons with mild hypertension, hold the greatest potential for reducing the population burden of hypertension-related ESRD.

Adult↗
PubMed1993

A prospective study of blood pressure and serum creatinine. Results from the 'Clue' Study and the ARIC Study.

OBJECTIVES: To describe associations of past and current blood pressure levels with serum creatinine levels and hypercreatinemia in the general population. POPULATION: 1399 middle-aged residents of Washington County, Maryland, who had their blood pressure measured during a cancer screening campaign in 1974 (the "Clue" Study) and had their blood pressure and serum creatinine level measured in an atherosclerosis risk factors study from 1986 through 1989 (the Atherosclerosis Risk in Communities [ARIC] Study). DESIGN: Nonconcurrent prospective study. The outcome variables were serum creatinine level and hypercreatinemia (serum creatinine > 115 mumol/L in men, > 97 mumol/L in women) measured from 1986 through 1989. Main predictors were 1986-1989 blood pressure values (cross-sectional association) and 1974 blood pressure values (longitudinal association). Gender-adjusted associations were assessed and compared by linear and logistic regression. RESULTS: Both serum creatinine and hypercreatinemia were better predicted by past than by current blood pressure values. Creatinine values exhibited a gradual and statistically significant association with blood pressure levels measured in 1974, even across "normal" values of blood pressure and creatinine. The association with 1986-1989 blood pressure measurements was weaker and nonsignificant. The odds of hypercreatinemia in 1986-1989 were increased 1.5-fold to twofold, with a 20 mm Hg increment in 1974 blood pressure values, but the odds remained constant across 1986-1989 blood pressure values. CONCLUSIONS: Blood pressure and creatinine level are associated in the general population. The observed association was stronger when a number of years had elapsed between the assessments of blood pressure and creatinine level. These findings are consistent with the hypothesis that blood pressure elevations, even below the hypertensive range, may induce early renal damage.

Blood Pressure↗
PubMed1993

The epidemiology of hypertension-related renal disease.

An increasing number of population-based studies and clinical trials have examined the role of blood pressure in renal disease. Recent reports indicate that elevations of blood pressure, even within the normotensive range, may result in renal damage. The available evidence suggests that blood pressure reduction diminishes and may completely prevent the progressive deterioration of renal function in persons with established renal insufficiency. Blood pressure reduction with an angiotensin-converting enzyme inhibitor may provide the best means of achieving this goal, but other antihypertensive medications may be equally effective. Nonpharmacologic interventions can be used to lower blood pressure in hypertensive persons and prevent the development of hypertension in those with blood pressure in the high-normal range. Other recent studies examined the role of environmental nephrotoxins, unrecognized viral infections, lower socioeconomic status, access to health care, and genetic factors as determinants of renal disease and hypertension in the general population. Despite their overall importance, known risk factors for hypertension-related renal disease fail to explain the excess risk of this entity in blacks and other racial minorities.

Blood Pressure↗
PubMed1993

Cause of death in patients with end-stage renal disease: death certificates vs registry reports.

OBJECTIVES: The purpose of this study was to assess agreement on cause of death reporting in end-stage renal disease patients by comparing death certificates and reports to an end-stage renal disease registry. METHODS: Death certificates and registry reporting forms were retrieved for a random sample of 335 treated end-stage renal disease patients who died between 1980 and 1986 in Maryland. On the registry form, patient death was ascribed to 1 of 22 precoded causes by the patient's nephrologist of record. Corresponding death certificates were coded, according to rules of the International Classification of Diseases, 9th edition, by a trained observer unaware of the registry report. Agreement was measured by the kappa statistic. RESULTS: Overall cause of death agreement was poor (31%), and varied by the following categories: renal disease (40% on death certificates vs 0% on registry reports), cardiovascular disease (26% vs 47%), infectious disease (16% vs 22%), cancer (7% vs 5%), and withdrawal from therapy (0% vs 3%). Agreement was higher for transplant recipients than for dialyzed patients. CONCLUSIONS: Death certificates and registry reports yield different descriptions of mortality in end-stage renal disease patients. These sources of information should not be used interchangeably. Improvements to International Classification of Diseases coding of renal diseases and the determination of the reliability and validity of the US Renal Data System reporting process are necessary steps in the development of renal disease epidemiology.

Abstracting and Indexing↗
PubMed1992

Epidemiology and prevention of blood pressure-related renal disease.

AIM: To examine the relationship between blood pressure and end-stage renal disease. METHOD: Review of recent reports on blood pressure in relation to renal function. BACKGROUND: The incidence and prevalence of treated end-stage renal disease are increasing progressively in economically developed countries. To combat this problem, the treatment of established end-stage renal disease must be complemented by strategies to treat and prevent risk factors for the development of renal failure. RESULTS: Severe hypertension and malignant hypertension are well accepted as risk factors for renal insufficiency. Recent reports suggest a strong relationship between blood pressure and renal function, throughout the entire range of blood pressure. Most blood pressure-related renal disease can probably be attributed to mild hypertension or a high normal blood pressure. CONCLUSIONS: Additional clinical trials are needed to assess the value of different antihypertensive drugs and different levels of blood pressure control in preserving renal function in subjects at risk of blood pressure-related renal disease. Primary prevention of hypertension may be an important complement to the treatment of established hypertension in reducing the burden of renal disease in the community.

Humans↗
PubMedDate not supplied

Distributions of smokers by stage: international comparison and association with smoking prevalence.

OBJECTIVES: The goals of this study were to describe the distribution of smokers by stage of change in Geneva, Switzerland; to compare this result with distributions observed in other countries; and to assess whether, across samples from different countries, the stage distribution of current smokers was associated with the prevalence of smoking. METHODS: Two mailed surveys were conducted in Geneva in 1995-1996, in a representative sample of residents (n = 742) and in a representative sample of university members (n = 2,270). A literature review produced seven studies describing the stage distribution in representative samples. RESULTS: In the Geneva population, 74% of smokers were in the precontemplation stage, 22% in contemplation, and 4% in preparation. In the university sample, the corresponding figures were 72, 20, and 8%. Our results were similar to other European samples, but less favorable than in American samples, where these distributions were typically 40, 40, and 20%, respectively. Across all samples, a low prevalence of smoking was associated with a more favorable stage distribution (r = 0.88, P = 0.002). CONCLUSIONS: Interventions in Europe need to take into account the large proportion of precontemplators repeatedly observed among smokers. A shift to the right of the distribution of current smokers across stages may help increase quit rates and thereby reduce smoking prevalence. This hypothesis should be tested in prospective intervention studies.

Adolescent↗
PubMedDate not supplied

On quitting smoking: development of two scales measuring the use of self-change strategies in current and former smokers (SCS-CS and SCS-FS).

Smoking-cessation advice may be more effective and acceptable if it is based on strategies used by people who quit smoking on their own. The objective of this study was to identify these self-change strategies and to develop and validate questionnaires measuring the frequency of their use in current and former smokers. Development of questionnaire items was based on qualitative data provided by 120 current and former smokers, and the validation study was conducted by mail in 638 smokers and ex-smokers in Geneva, Switzerland, from 1996 to 1998. We identified 5 distinct and interpretable self-change strategies in current smokers and 5 strategies in former smokers, and measured their frequency of use with a 19-item questionnaire in current smoker (SCS-CS) and with a 17 item questionnaire in former smokers (SCS-FS). Eight items and 2 strategies were common to both current and former smokers. the scales fulfilled criteria of test-retest reliability, and content, construct, and predictive validity. Participants who quit smoking between the baseline survey and the 1-month follow-up had higher baseline scores for all self-change strategies (+0.65 to +1.16 standard deviation units) than participants who remained smokers at follow-up. These scales may be used to describe and understand the processes of smoking cessation and relapse, as well as to produce input data for computer systems which produce individually-tailored smoking cessation advice.

Adolescent↗
PubMedDate not supplied

Associations between the stages of change and the pros and cons of smoking in a longitudinal study of Swiss smokers.

To develop effective smoking prevention interventions, we need to identify modifiable variables, such as the "pros and cons" of smoking, that predict self-initiated smoking cessation. Our objective was to assess associations between the pros and cons of smoking and the stages of change, both cross-sectionally and longitudinally, in a cohort of smokers. In cross-sectional comparisons, the pros of smoking were 0.19-0.31 standard deviation (SD) higher and the cons 0.79-0.87 SD lower in the precontemplation than in the preparation stage. In follow-up data, progressing from precontemplation to contemplation and from contemplation to preparation was associated with substantial and significant increases in the cons (+0.71 SD and +0.50 SD, respectively). No longitudinal associations were found between changes in pros of smoking and progress through stages. Thus this study added evidence from longitudinal data to published evidence from cross-sectional data about the association between the cons of smoking and the stages of change. Intervention studies are necessary to establish whether this association is causal.

Adult↗