Biomedical subjects

V Koehn

Publications and source records attributed to V Koehn.

8 recordsLinked to original sources

PubMed1996

[Regional variations in health services: various methodological problems].

Many studies show strong variation of health consumption between regions, suggesting that theses variations are related to the uncertainty of medical practice or to other factors related to health services or patients attitude. However the statistical interpretation of these variations is far from easy: apart from usual and specific information bias, there are statistical problems when observing incidence of events like health care consumption: it is in fact a rare event, which is observed within small population, and among regions with unequal number of person. Therefore, most of the variation reported might be well explained by a purely statistical phenomenon. This paper presents some aspects of this variability for three common indicators of variation, and suggest the use of ad hoc simulation to get statistical criteria.

Bias↗

PubMed1996

Mobilizing positive reinforcement in communities to reduce youth access to tobacco.

A community intervention to mobilize positive reinforcement for not selling tobacco to young people was evaluated. The intervention had five components: (a) mobilization of community support, (b) merchant education, (c) changing consequences to clerks for selling or not selling to those under 18, (d) publicity about clerks' refusals to sell, and (e) feedback to store owners or managers about the extent of their sales to adolescents. A multiple baseline design experiment was conducted, in which two small Oregon communities received the intervention, while two other continued in baseline. Outlets' willingness to sell was assessed repeatedly by teenage volunteers. The intervention significantly reduced the proportion of stores willing to sell. Mobilizing social and material reinforcement for stores not selling tobacco to young people is a viable means of reducing such sales. It may be especially valuable in communities where laws against sales to minors go unenforced.

Adolescent↗

PubMed1996

Experimental evaluation of a modular approach to mobilizing antitobacco influences of peers and parents.

The experimental evaluation of two components of a community intervention to prevent adolescent tobacco use are described. Youth antitobacco activities (e.g., peer quizzes, sidewalk art, poster and T-shirt giveaways, etc.) and family communications activities (pamphlets to parents and student quizzes of parents) were evaluated in two time-series experiments, each of which was conducted in two experimental and one control community. Students in Grades 6 and 8 and their parents were assessed in a series of four phone surveys in the first experiment and six phone surveys in the second. Implementation of the youth antitobacco and family communications activities led to significantly greater exposure of young people to antitobacco information. They led to increases in parent and youth knowledge about tobacco use and more negative attitudes toward tobacco. In Experiment 2, youths in intervention communities had significantly lower rated intentions to smoke. The findings suggest the value of a modular approach to community interventions for influencing the social context relevant to the onset of adolescent tobacco use.

Adolescent↗

PubMed1994

[Small area variations: surgery for hip fractures in the canton of Vaud].

OBJECTIVES: Studies of small area variations of health care utilization are more and more frequent. Such variations are often considered to be an indication of variations in the quality of medical care. The variations in the rate of operations for hip fractures are among the lowest studied to date, due to the fact that a consensus exists concerning this surgery. Our objective is to examine these variations within the context of relatively small and heterogeneous districts. METHOD: Based on anonymous computerized data on public hospital stays, this study describes the variations in population rates (crude and standardized) of operations for hip fracture among the health districts of the Canton of Vaud for the period from 1986 to 1991. District populations vary from 22,000 to 164,000. Using the extremal quotient (EQ), the importance of these variations was determined. RESULTS: The study population consists of 2363 cases, of which 78% are women. Mean age is 80.4 for women and 70.6 for men. Standardized rates of operation for hip fracture per 100,000 in the Canton Vaud for the years 1986 to 1991 are, respectively: 56; 67; 86; 91; 89 and 94. The EQ for the years 1986 to 1991 are respectively: 8.2; 4.0; 3.5; 2.7; 1.9 and 1.9. The high EQ, especially for the earlier years, are contrary to the initial premise of absence of variation. The progressive implementation in the Canton Vaud of VESKA medical statistics could play a role, as could the small size of many of the districts, with resultant instability of rates. CONCLUSIONS: Considering the wide variations shown here for an operation hardly regarded as subject to variations, it is important to exercise caution in interpreting published data of small area variations.

Aged↗

PubMed1992

Detrimental effect of alcohol intoxication on severity of injuries in male traffic accident victims: a cross-sectional study.

A cross-sectional emergency room study was performed among traffic accident victims aged 16 to 75 years in order to investigate the prevalence of alcohol intoxication (blood alcohol concentration (BAC greater than or equal to 0.8 g/kg) and its potential detrimental effect on injury severity. A BAC greater than or equal to 0.8 g/kg was present in 29% of the male patients. Intoxicated patients had a similar propensity to require inpatient hospital care (65 versus 60%) but had significantly longer hospital stays than the non-intoxicated patients (36 versus 20 days; p less than 0.05), observations which may be explained by the higher prevalence of serious injuries (head and internal injuries) among the intoxicated cohort. This study supports and emphasizes the detrimental effect of alcohol intoxication on the severity of injuries in traffic accident victims, and reinforces the need for further legal and public health measures in preventing alcohol-related traffic accidents.

Accidents, Traffic↗

PubMed1992

Drinking patterns among medical in-patients with reference to MAST categories: a comparative study.

The aim of the study was to describe the drinking patterns and alcohol consumption of patients screened by the Michigan Alcoholism Screening Test (MAST) in a sample of medical patients from a general hospital of a French-speaking, wine-drinking country. Data were recorded using a structured interview administered to 103 consecutively admitted 20-75-year-old MAST-positive patients and 103 age-matched and sex-matched MAST-negative controls admitted to the same ward. Relevant differences between MAST-positive and MAST-negative patients included the frequent report of recent and total abstinence in MAST-positive patients (23% versus 4% in controls), their tendency to drink alone, and less often during mealtimes, at home, or with family or friends than MAST-negative patients. Alcohol consumption was significantly higher in MAST-positive patients of both sexes with 250 and 270 g per week being the optimal discriminative cut-off level of consumption for men and women, respectively (kappa coefficient, 0.70 and 0.81, respectively). Regular drinking was the predominant drinking status of both MAST-positive and MAST-negative patients. This study suggests that a screening test such as the MAST, developed in an English-speaking country may be useful in a French-speaking, wine-drinking country. The test identified patients with drinking patterns that are culturally abnormal, yet in certain respects similar to those of alcoholic patients from other drinking cultures. These findings therefore emphasize the worldwide relevance of the concept of the alcohol dependence syndrome in addition to the transcultural usefulness of alcoholism screening tests.

Adult↗

PubMedDate not supplied

Utilization of hospital resources by alcoholic and nonalcoholic patients: a prospective study.

OBJECTIVE: To measure any difference in the utilization of hospital resources between alcoholic patients and nonalcoholic patients (controls) in a department of internal medicine. DESIGN: Prospective comparative study. Alcoholics were identified as patients with Michigan Alcoholism Screening Test (MAST) scores of greater than or equal to 8. Controls were defined as patients with MAST scores of less than or equal to 4, and matched with alcoholics for sex, age, and time of admission. The length of stay, as well as several indicators of utilization of diagnostic and therapeutic procedures, was used for the comparison of resource utilization. SETTING: General wards of internal medicine of a 1,000-bed city and teaching hospital in Lausanne, Switzerland. PARTICIPANTS: One hundred and three alcoholic patients and 103 controls aged 20-75 years, admitted from September 1, 1988, to March 18, 1989. RESULTS: Alcoholics had the same lengths of stay (16 days), durations of intravenous infusions (six days), and durations of bladder catheterization (one day). Statistically nonsignificant differences were found between alcoholics and nonalcoholics regarding the charges for routine laboratory examinations [693 vs. 734 Swiss francs (Sfrs)], antibiotic therapies (218 vs. 145 Sfrs), and x-ray procedures (568 vs. 774 Sfrs; p = 0.06). The average number of electrocardiograms (two vs. five; p less than 0.005) and the duration of intensive care unit (ICU) stay (one vs. two days; p less than 0.05) were significantly lower for alcoholics than for controls. A total hospital charges index was also lower for alcoholics than for controls (11,900 Sfrs vs. 12,800 Sfrs), but not significantly. CONCLUSION: The authors' results suggest that alcoholics do not use more hospital resources per admission than do nonalcoholics. Moreover, alcoholics tend to use less frequently some procedures, such as the ICU, electrocardiography, and x-ray examinations. Several hypotheses are developed to explain these results in relation to those of previous studies, which showed more use of medical care by alcoholics than by nonalcoholics.

Adult↗

PubMedDate not supplied

Prevalence of malnutrition in alcoholic and nonalcoholic medical inpatients: a comparative anthropometric study.

Available data on the nutritional status of alcoholics is controversial. The present study was conducted to assess the frequency of malnutrition in alcoholic inpatients. The objectives were to (1) compare anthropometric data of hospitalized alcoholic and nonalcoholic patients and (2) evaluate the association between alcoholism and protein-energy malnutrition. It was a cross-sectional comparative study including a stratified analysis to control for potential confounding factors. Alcoholics were identified as patients with a score from the Michigan Alcoholism Screening Test > or = 8 among patients admitted consecutively to the general wards of a department of internal medicine; they were matched for sex, age, and time of admission with nonalcoholic patients (Michigan Alcoholism Screening Test score < or = 4). Nutritional status was assessed using weight, height, midarm circumference, and tricipital skinfold thickness values, which were then used to determine the Quetelet body mass index and the mid-arm muscle circumference. The study took place in general wards of internal medicine in a 1000-bed city and teaching hospital in Lausanne, Switzerland. The participants were 93 alcoholic patients and 93 controls aged 20 to 75 years, admitted from September 1, 1988, to March 18, 1989. Alcoholics were characterized by a low rate of severe protein-energy malnutrition (< 5%); their average body weight was normal, similar to the weight of nonalcoholic inpatients, and not greatly influenced by the presence or severity of concomitant liver disease. However, tricipital skinfold thickness was lower in alcoholics than in nonalcoholics (8 mm vs 10 mm, p < .05, and 13 mm vs 20 mm, p < .01, in men and women, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗