Biomedical subjects

V Wietlisbach

Publications and source records attributed to V Wietlisbach.

At least 19 recordsLinked to original sources

PubMed1998

Time trends in the treatment of acute myocardial infarction in Switzerland from 1986 to 1993: do they reflect the advances in scientific evidence from clinical trials?

Three acute coronary care surveys (1986, 1990, and 1993) were conducted in the Swiss region of Vaud-Fribourg on all men aged 25 to 64 years hospitalized for a definite myocardial infarction (218, 224, and 167 cases). Nearly all patients received anticoagulants and nitrates. The proportion of patients treated increased significantly, between 1986 and 1990, for antiplatelet drugs (from 51% to 96%) and thrombolytics (from 9% to 44%) and, between 1990 and 1993, for beta-blockers (from 57% to 78%) and angiotensin-converting enzyme inhibitors (from 26% to 43%). The use of calcium antagonists and antiarrhythmics dropped over time. Coronary arteriography and angioplasty were increasingly performed (53% and 18% in 1993), although progressively postponed in-hospital stay. The observed trends reflect a rapid translation of clinical trials into medical practice. However the use of thrombolytics could be raised further by shortening the hospitalization delay (median: 3 hours in 1993) and door-to-needle time (median: 47 minutes) which remained stable over time.

Adrenergic beta-Antagonists↗

PubMed1996

Air pollution and daily mortality in three Swiss urban areas.

Particulate air pollution, in association with other common urban air pollutants, has been associated with various measured health endpoints, including the incidence and duration of respiratory symptoms, lung function, absence from work or school due to respiratory illness, hospitalization for respiratory disease, and cardiopulmonary disease mortality. In this study, the association between daily mortality and air pollution was assessed in Zurich, Basle, and Geneva (Switzerland) for the time period 1984 through 1989. Various regression modeling techniques were used to estimate the effect of air pollution on mortality, to control for time trends, seasonal factors, and weather variables, and to assess the sensitivity of the results. A positive, statistically significant association between daily mortality counts and measures of ambient air pollution in all three cities was observed. Mortality was associated with total suspended particulate pollution, sulfur dioxide, and nitrogen dioxide. The strongest association was with a 3-day moving average (including the concurrent day and the preceding 2 days) of these pollutants. The estimated mortality-air pollution effects were not highly sensitive to regression modeling techniques used to control for seasonality, long-term trends, and weather variables.

Aged↗

PubMed1995

Physical activity assessment using a pedometer and its comparison with a questionnaire in a large population survey.

The aim of this study was to evaluate the use of the pedometer in epidemiologic research on physical activity. Within the framework of a health examination survey in 1988-1989, physical activity was assessed in a representative population sample of 493 men and women aged 25-74 years who were residents of Switzerland. They wore a pedometer for 1 week at work and during leisure time, and the results, converted into steps per day, were compared with answers to a questionnaire. The average number of steps per day decreased from 11,900 to 6,700 and from 9,300 to 7,300 for men and women, respectively, in the youngest to the oldest age groups. For men, categorized according to type of physical activity at work, there was a highly significant difference in the number of steps (p < 0.001), whereas in women the results were associated with leisure-time physical activity (p = 0.003). For both sexes, practicing sports more than once a week was associated with an important increase in steps per day. Analyzing the number of steps according to the day of the week and occupational category produced an unexpected result: Men with a physically active job engaged in more leisure-time physical activity on the weekend. The pedometer proved to be useful in assessing physical activity in a large, free-living population.

Adult↗

PubMed1995

Time trend and determinants of blood lead levels in a Swiss population over a transition period (1984-1993) from leaded to unleaded gasoline use.

This study analyzes the trend and determinants of blood lead levels in a Swiss region (population 770,000) over the 10-year period following the introduction of unleaded gasoline in 1985. The consumption of unleaded fuel increased rapidly, accounting in 1988 for 36% and in 1992 for 65% of all gasoline sales. Blood lead levels were measured in three representative samples (n = 1700) of the adult population within the framework of a health examination survey carried out in 1984/1985, 1988/1989, and 1992/1993. The geometric mean blood lead levels were, respectively, 0.59, 0.42, and 0.33 mumole/liter in men, 0.41, 0.29, and 0.25 mumole/liter in women. Similar trends have been observed across all age groups, occupational classes, and categories based on smoking, drinking, and dietary habits. The overexposure of city residents, in comparison to village residents, fades out over the observation period. These findings suggest that the changeover from leaded to unleaded gasoline has been the major cause of the blood lead decline. Wine drinking, cigarette smoking, and age appear to be significant determinants of blood lead for both sexes in all three surveys. In contrast, the association is inverse for milk consumption. The multivariate regression analysis shows that wine drinking remains the most important predictor of blood lead, whereas the influence of age increases with time and overcomes the effect of smoking in the third survey.

Adult↗

PubMed1995

Methadone treatment and risk of HIV infection in drug users without legal access to clean injection equipment.

The particular situation of the Swiss canton of Vaud (population 550,000) provides favourable observational conditions to assess the efficacy of a methadone treatment scheme in reducing the risk of human immunodeficiency virus (HIV) infection among drug users. On the one hand, the canton has a long tradition of methadone treatment dispensed by medical practitioners. On the other hand, no legal access to clean injection equipment was provided up to 1989. For the 754 drug addicts having entered at least one course of treatment at the end of 1988, HIV status was assessed through two surveys conducted at mid-1986 and at end 1988 among the private practitioners and in the screening centers, hospitals, medico-social institutions and prisons. The overall annual HIV seroconversion rate shifted only slightly from 13% in the first study period (1984 to mid-1986) to 11% in the second period (mid-1986 to end 1988). In both periods, patients no longer on treatment, mostly stable abstainers, were the less exposed to HIV infection with a relative risk of 0.65 (p < 0.05). For those still on treatment, the risk of infection was associated directly (p < 0.001) with the frequency of courses and inversely (p < 0.001) with the duration. Between patients with more than 18 months spent on treatment and those with less than 6 months, the relative risk gradient was 0.8 and 1.4 before mid-1986 and widened out to 0.3 and 2.1 later on. This is mainly due to an increasing HIV incidence among newcomers into treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

Comparison of serum lipoprotein(a) distribution and its correlates among black and white populations.

BACKGROUND: Epidemiological data on serum lipoprotein(a) (Lp(a)), a presumably strong risk factor for coronary artery disease in White populations, has mostly been derived, in Black populations, from small samples. This study compares the distribution and the determinants of serum Lp(a) in Blacks and in Whites using large representative samples and the same methods in both populations. METHODS: The distribution and the correlates of serum Lp(a) were investigated in population-based samples of 701 Blacks in the Seychelles and 634 Whites in Switzerland, aged 25-64 years. Serum Lp(a) was quantified using a commercial immunoradiometric assay. RESULTS: The distribution of serum Lp(a) was similarly skewed in both ethnic groups, but median Lp(a) concentration was about twofold higher in Blacks (210 mg/l) compared to Whites (100 mg/l). The proportions of individuals with elevated serum Lp(a) (> 300 mg/l) was about 50% higher in Blacks (37.5%) than in Whites (25.2%). In both ethnic groups, serum Lp(a) was found to correlate with total cholesterol, LDL-cholesterol and apoprotein B but not with HDL-cholesterol, alcohol intake, smoking, and body mass index. The variance in serum Lp(a) concentration explained by any combination of these factors was smaller than 5.3% in the two populations. CONCLUSIONS: The measured factors did not explain the higher levels of serum Lp(a) found in Blacks compared to Whites. These findings are consistent with the hypothesis that genetic factors account for much of the variation of serum Lp(a) in both populations.

Adult↗

PubMed1993

[Outcome and analysis of participation in the 2d MONICA survey (1988-1989) of cardiovascular risk factors].

Two Swiss regions, the cantons of Vaud and Fribourg (VD-FR) and the canton of Ticino (TI), take part in the international research project MONICA (MONItoring trends and determinants in CArdiovascular disease). In this framework, two surveys were respectively carried out in 1984-86 and in 1988/89 to determine the distribution of the major cardiovascular risk factors in the adult population. This article presents the outcome of the sampling procedure and participation for the second survey. A two-stage sampling procedure was performed by randomly drawing first communes (51 in VD-FR region; 25 in TI region) and then individuals out of the communal registry offices (3300 in VD-FR; 2000 in TI). In the two regions, 2011 and 1458 persons respectively attended the medical examination, leading to overall participation rates of 61% and 73%. As the sex and age distribution of the sample and of the participants is very close to that of the population, a major selection bias is unlikely. For the VD-FR region, the improvement in the participation (57% in the first survey) is due mainly to a better response from foreign nationals and older persons, whereas in the TI region the drop in recruitment (78% in the first survey) may reflect a saturation point reached by the population after several years of an intensive prevention programme against coronary heart disease initiated in 1984. In both regions, unmarried people represent the only population group in which the participation rate has decreased. On the basis of a questionnaire proposed to the non participants, unmarried status, sedentary leisure activities and a previous cholesterol check appear as factors significantly associated with a higher refusal rate.

Adult↗

PubMed1993

[Smoking, blood pressure and body weight in the Swiss population: MONICA study 1988-89].

Two Swiss regions, the cantons of Vaud and Fribourg (VD-FR) and the canton of Ticino (TI), take part in the international research project MONICA (MONItoring trends and determinants in CArdiovascular disease). In this framework, three surveys are planned to monitor the prevalence of the principal risk factors. The second survey was carried out in 1988/89 on 2011 participants aged 25 to 74 for the VD-FR region and on 1458 participants aged 35 to 64 for the TI region. This article is devoted to the results concerning smoking habits, blood pressure, body height and weight. In the VD-FR region, the percentage of regular smokers steadily decreases with age, from 44% for men and 36% for women in the 25-34 age group to 15% and 10% respectively in the 65-74 age group. Inversely, the proportion of participants with high blood pressure rises steeply with age from nearly zero in the 25-34 group to more than a quarter in the 65-74 group. Similar risk factor levels are observed in the TI region. Two significant trends show up in comparison with the first survey (1984-86) for the latter region: the decreases in mean blood pressure levels for both sexes and in the proportion of regular smokers for men. However, these trends are to be interpreted cautiously because of potential measurement bias between surveys.

Adult↗

PubMed1993

[Blood lipids in the Swiss population: MONICA study 1988-89].

The second population survey of the Swiss MONICA project took place in 1988-89 in the cantons of Vaud, Fribourg and Ticino. Blood lipids (total, LDL, and HDL cholesterol as well as apolipoproteins A-I and B) were measured in 3341 individuals aged 25-74 years belonging to a representative sample of the three cantons' population. Total and LDL cholesterol values were high on average, especially among patients aged 45 and over: total cholesterol was > 6.5 mmol/l in 27% (age 25-34) to 58% (age 45-54) and in 15% (age 25-34) to 64% (age 65-74) of men and women, respectively. HDL cholesterol values were relatively stable with age, at a higher level in women (median 1.5 mmol/l) than in men (median 1.2 mmol/l). To summarize, about 1 out of 5 people had cholesterol values placing them at low risk for the development of coronary heart disease, whereas 1 out of 4 were at increased risk. Apolipoprotein B, a component of LDL cholesterol, and apolipoprotein A-I, a component of HDL cholesterol, were measured for the first time in a large representative sample of the Swiss population. The distribution of both apolipoproteins was, in the aggregate, very similar to the distribution of the corresponding LDL and HDL cholesterol. A comparison of cholesterol values measured in 1988-89 with values previously measured in the same population (MONICA population survey 1984-85) did not show any reduction with time.

Adult↗

PubMed1992

[Developments in the treatment of myocardial infarction in Switzerland 1986-1990: results of a population survey].

The Swiss cantons of Vaud and Fribourg participate in the international MONICA project (MONI-toring of trends and determinants in CArdiovascular disease). Within this context, drug therapies and procedures were recorded during two separate years (1986 and 1990) for all hospitalizations of men aged 25 to 64 with the diagnosis of myocardial infarction. The medical files were reviewed to classify this diagnosis as possible or definite on the basis of the symptoms, the ECG results and the enzymatic tests. The two study populations (n = 318 in 1986 and n = 332 in 1990) are comparable with respect to age, history of ischemic heart disease and initial care. In 1990, half of the patients arrived at hospital in less than 3 hours, the median time delay being 4 hours for those first attending a general practitioner and 2 hours for those transferred directly. The frequency of treatments between 1986 and 1990 is compared only for cases with a definite diagnosis of myocardial infarction (respectively n = 217 and n = 223). The proportion of patients given thrombolytic therapy rose from 9% to 44% (p < 0.005) and from 51% to 95% (p < 0.005) for those treated with antiplatelet drugs, whereas the proportion fell from 72% to 55% (p < 0.005) for calcium blockers and from 33% to 24% (p < 0.05) for inotropic drugs. The use of anticoagulants (in 98% of patients) and of beta blockers (in 57%) remained stable across time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗

PubMed1992

[Prevention of cardiovascular diseases is effective. Initial program evaluation of the canton Tessin (1984-1989)].

This study measures and evaluates the effects of the CVD prevention programme which has been underway in the Canton of Tessin (Switzerland) since 1984. The programme was designed with the following objectives: --high blood pressure: each Tessin inhabitant should be aware of the admissible blood pressure limits, the consequences of surpassing the norm, as well as know his or her own blood pressure count and have it measured at least once a year; --tobacco consumption: a positive image of non-smokers is promoted, as well as the respect of non-smoker's rights. The population, particularly the young, are "invited" not to smoke; eating habits: each Tessin inhabitant will be provided with the information necessary to enable him/her to make rational choices concerning content in order to ensure a balanced diet, rich in fibres and low in saturated fats; activity: physical activity, at least 20 minutes three times a week, is promoted for all age groups; early warning symptoms:information will be provided to enable inhabitants to recognize indications of cardiac distress in order to diminish the time between the first pain and hospitalisation; A vast and varied information campaign was set up to pursue these objectives. Much of the campaign was implemented through use of various media (television, radio, daily and weekly press), and seconded with the periodic distribution of information tracts to all the households of the district. The mass media campaign was complemented with a variety of activities for all ages: from poster competitions, to the edition and sale of recipe books, to specific activities with professional and voluntary associations are a few examples.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular Diseases↗

PubMed1991

[Incidence of use of various myocardial infarct treatments in 2 Swiss regions].

Two regions in Switzerland (Vaud-Fribourg and Ticino) participate in the WHO MONICA project (MONItoring of trends and determinants in CArdiovascular disease). Within this context, all hospitalizations of men for ischemic heart disease will be recorded during a period of ten years. All cases are classified according to uniform criteria, in three categories: definite myocardial infarction, possible myocardial infarction or no myocardial infarction. In 1986, the records were completed with a summary of treatments. The treatment of 334 patients with definite myocardial infarction, aged between 25 and 64 years, surviving after 27 days are analyzed (VD-FR: 217; TI: 117). Results show that anticoagulants were administered in a routine fashion (in 97% of the cases), whilst thrombolysis, applied in 1986 by only one hospital in each area, concerned only 9% of the patients. As compared to Ticino, VD-FR distinguished itself by its significantly higher use of anti-arrhythmia drugs (69% versus 47%; p less than 0.005), nitrates (97% versus 86%; p less than 0.005) and beta-blockers (57% versus 43%; p less than 0.05). Furthermore, patients from VD-FR spent more time in the intensive care unit (6.4 versus 3.7 days; p less than 0.005) and participated more frequently in rehabilitation programmes (47% versus 12%; p less than 0.005). The discussion compares the observed therapy with results published in the literature.

Adrenergic beta-Antagonists↗

PubMed1991

Lifestyle and environmental factors as determinants of blood lead levels in a Swiss population.

The determination of blood lead levels was included in a Swiss population survey on cardiovascular risk factors in 1984-1985; 931 men and 843 women aged 25 to 75 years participated in the study. Mean blood lead levels (+/- SD) were 0.63 +/- 0.27 mumole/liter for men and 0.44 +/- 0.19 mumole/liter for women, respectively, with a slight increase with age for both sexes. These values are below the maximum level recommended by the Commission of the European Community in 1977; 18 cases were found with blood lead higher than 1.5 mumole/liter and in six of these, a professional exposure was suspected. Smoking habits, drinking habits, and consumption of dairy products were selected as lifestyle descriptors and educational level, occupational category, and size of the community as sociodemographic indicators. Smoking and alcohol consumption show a direct association with blood lead, consuming dairy products an inverse one. Occupation and level of education are significantly related to blood lead only for men, blue-collar workers and less-educated men being more exposed. A higher blood lead level in cities was only found for women presumably because they stay at home more often than men and are therefore more sensitive to local exposure. In a multiple stepwise logistic regression, the lifestyle indicators showed a consistently stronger effect on blood lead than sociodemographic indicators. For men, smoking has an effect on blood lead for blue-collar workers much stronger than that for nonindustrial employees and may compound in some way the professional exposure to lead. This stresses the fact that interactions between lifestyle and environmental factors on blood lead are significant, complex, and need further investigation.

Adult↗

PubMed1990

[Total cholesterol, HDL-cholesterol and blood pressure in relation to life style: results of the first population screening of the Swiss MONIKA Project].

To evaluate the association of individual health habits with levels of cardiovascular risk factors such as serum cholesterol and blood pressure, data from a representative population sample of 860 men and 788 women, aged 25 to 64 years and residing in Western Switzerland, were analyzed cross-sectionally. The data had been collected during 1984/85 as a part of the WHO MONICA project, an international research project on the epidemiology of cardiovascular diseases. In age-adjusted analysis, a score of prudent diet was a reasonably strong inverse correlate of total cholesterol in men (p less than 0.001) but less so in women (p = 0.11); the diet score was unrelated to HDL cholesterol. In both genders, alcohol consumption was associated with elevated levels of systolic and diastolic blood pressure (men: both p less than 0.001; women: p = 0.05 and 0.01 respectively) and of HDL cholesterol (men and women: p less than 0.001). Coffee consumption was unrelated to either blood lipids or blood pressure. In both men and women, leisure-time exercise was a predictor of a low-risk lipid profile, i.e. a low total cholesterol/HDL ratio (both p less than 0.001). Better educated persons, especially women, revealed consistently lower levels of cardiovascular risk factors. The independent character of these lifestyle-risk factor-associations was largely confirmed in a multivariate analysis, with cigarette smoking emerging as another significant predictor of a deteriorated lipid profile, while education was not an independent determinant of biological risk factors. Lifestyle variables, including body mass index, explained 9 to 19% of variance in cardiovascular risk factors, with relative weight being the strongest of the predictors related to behaviour. Entering age and sex into the regression models enhanced the predictive power of the equations to 16 to 26% explained risk factor variance. We conclude from this population-based, cross-sectional study that personal health habits such as diet, exercise, alcohol consumption and smoking, as well as body weight are significantly and independently related to blood lipid and blood pressure levels; the apparent size of effect of these behavioural traits on biological risk factors for cardiovascular diseases was only modest, but it may nevertheless be relevant to prevention.

Adult↗

PubMed1990

[Physical examination in screening for breast cancer: who benefits?].

A survey was undertaken among a representative sample of the female population, aged 20 to 74, of the Canton of Vaud, Switzerland (total population 550,000) to assess the knowledge, attitudes and practices of women in respect to breast cancer and its prevention. The present study focuses on access by women to medical preventive measures (breast examination by physician and information on breast self-examination). The data are analyzed in relation to the individual risk factors affecting women, in particular age. While with age the risk of breast cancer grows in a linear fashion, the proportion of women having their breast examined by a physician declines. Women over 50 who had no children before the age of 30 constitute an especially high risk category, with the lowest access to information and prevention. This is explained in large part by the fact that they consult gynecologists less often. In this regard it should be noted that a visit to a gynecologist's office is associated much more often with breast examination than a visit to a family physician. It is important to take such findings into account in providing more appropriate and complete care for those groups. This involves sensitization of the physician and improved information for the women themselves.

Adult↗

PubMed1990

Some determinants of body weight, subcutaneous fat, and fat distribution in 25-64 year old Swiss urban men and woman.

Data from a predominantly urban sample of 116 men and 130 women aged 25-64 years and collected in 1984/85 as a part of the Swiss WHO MONICA project, were analysed cross-sectionally to study the interrelationship between relative weight, subcutaneous fat and fat distribution, as well as the dependence of these anthropometric characteristics on behavioral and sociodemographic factors. Skinfold thicknesses were found to increase with age almost linearly in women, while in men they increased only before age 40 to 45. Subcutaneous fat was, but fat distribution was not, highly correlated with relative weight in both sexes. Alcohol consumption, healthy dietary habits (inversely), and exercise (inversely) were all significantly related to subcutaneous fat in men, while the relatively strongest predictors of female skinfold thicknesses were smoking (inversely), coffee consumption, and education (inversely). In multivariate analysis, environmental factors explained up to 10% of skinfold variance in male subjects and between 10 and 15% in females. Fat distribution was more influenced by environmental factors in men (about 8% of explained variance) than in women (about 4%). In men, truncal fat depended more on lifestyle that did upper arm fat, with smoking (directly) and exercise (inversely) being relatively most predictive of abdominal fat. We conclude that, although relative weight, subcutaneous fat, and fat distribution correlate intra-individually, they are not equivalent and interchangeable anthropometric characteristics. This is reflected by the varying associations of the three fatness indicators with age and environmental factors such as smoking, diet, exercise, and education. Gender seems to be an important modifying factor of environment-body fat-associations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗

PubMed1990

Methadone treatment in medical private practice: outcome according to the number of courses followed.

In the Swiss Canton of Vaud, methadone treatment is mostly provided by the private medical practitioners. 562 opioid dependent persons followed at least one course of treatment between 1976 and 1986; at that time, 209 of them had completed a first course, 118 a second one and 31 a third one. Evolution of the persons was observed from the end of their last course to the end of the study. Outcome was evaluated according to the rank of the last course. Whatever its rank, each course resulted in about 17% of stable abstainers and 6% of chronic opioid-dependent persons. In contrast, the risks to start a new course, to be imprisoned and to enter into a therapeutic community showed a clear gradient with the rank of the course: they were about 38%, 27% and 10% respectively one year after a first or a second course, and rose to 43%, 38% and 28% one year after a third course.

Adult↗

PubMed1989

Education, disease prevalence and health service utilization in the Swiss National Health Survey "SOMIPOPS".

The relation among education, disease prevalence, and frequency of health service utilization was analyzed using data from the Swiss National Health Survey SOMIPOPS, conducted in 1981-1983 on a randomly selected sample of 4,255 individuals, representative of the entire Swiss population. The prevalence of several important cardiovascular, respiratory, digestive, osteoarticular, and psychiatric disorders was higher among less educated individuals; only allergic conditions were directly associated with indicators of social class. More educated individuals reported lower frequencies of general practitioner visits, but higher frequencies of specialized consultations. These findings confirm that education is an important determinant not only of mortality but also of morbidity and health-care utilization and require careful consideration in terms of the planning and evaluation of health services.

Adult↗