We aimed to explore the extent to which general practitioners (GPs) in Western Switzerland adhere to Swiss recommendations when assessing fitness-to-drive in the elderly. A random sample of 500 GPs practicing in Vaud, Neuchatel and Jura,... more
We aimed to explore the extent to which general practitioners (GPs) in Western Switzerland adhere to Swiss recommendations when assessing fitness-to-drive in the elderly. A random sample of 500 GPs practicing in Vaud, Neuchatel and Jura, and all GPs certified to conduct fitness-to-drive assessments in Geneva ("experts", n = 69) were invited to participate. They were asked how often they performed twenty procedures (recommended in Swiss guidelines developed by experts in traffic medicine) when assessing older drivers during the previous year, scored on a five-point Likert scale ranging from "never" to "always performed". The GPs were considered to be adhering to the recommended procedure if they performed it often or always. We computed the proportion of GPs adhering to each procedure, and compared GPs with or without specialised expertise. A total of 268 GPs completed the questionnaire (participation rate 47%). The most frequently reported procedures we...
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Objective: Cardiovascular diseases (CVD) are the main cause of death worldwide and despite a higher prevalence in men, mortality from CVD is higher among women. Few studies have assessed sex differences in chest pain management in... more
Objective: Cardiovascular diseases (CVD) are the main cause of death worldwide and despite a higher prevalence in men, mortality from CVD is higher among women. Few studies have assessed sex differences in chest pain management in ambulatory care. The objective of this post hoc analysis of data from a prospective cohort study was to assess sex differences in the management of chest pain in ambulatory care. Setting: We used data from the Thoracic Pain in Community cohort study that was realized in 58 primary care practices and one university ambulatory clinic in Switzerland. Participants: In total, 672 consecutive patients aged over 16 years attending a primary care practice or ambulatory care clinic with a complaint of chest pain were included between February and June 2001. Their mean age was 55.2 years and 52.5% were women. Main outcome measures: The main outcome was the proportion of patients referred to a cardiologist at 12 months follow-up. A panel of primary care physicians as...
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Social deprivation also exists in an industrialised country like Switzerland where there are many different social economic levels; social inequalities have increased in the past years having a major impact on social economic determinants... more
Social deprivation also exists in an industrialised country like Switzerland where there are many different social economic levels; social inequalities have increased in the past years having a major impact on social economic determinants of health. Being aware of these determinants and systematically identifying them in patients has become crucial for the general practitioner in order to improve the way s/he delivers care and interacts with more vulnerable populations. Because the general practitioner is often in contact with people of different socioeconomic levels, s/he is a key witness of social inequalities in health. S/he therefore has a responsibility to document them, to promote health, to prevent disease and be an advocate for the disadvantages in order to influence these social determinants of health.
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Although the performance of the Swiss health system is high, one out of ten patients in general... more
Although the performance of the Swiss health system is high, one out of ten patients in general practitioner's (GP) office declares having foregone care in the previous twelve months for economic reasons. Reasons for foregoing care are several and include a lack of knowledge of existing social aids in getting health insurance, unavailability of GPs and long waiting lists for various types of care. Although long term knowledge of patients or a psychosocial history of deprivation or poverty may help identify individuals at risk of foregoing care, many may remain undetected. We propose then a few instruments to help GPs to identify, in a simple and structured approach, patients at risk of forgoing care for economic reasons; these patients are frequently deprived and sometimes poor.
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One fifth of drivers convicted of drink-driving for the first time will be convicted again for the same offence in subsequent years. Lecture-based educational programmes are believed to reduce recidivism. Little is known about the... more
One fifth of drivers convicted of drink-driving for the first time will be convicted again for the same offence in subsequent years. Lecture-based educational programmes are believed to reduce recidivism. Little is known about the modalities of enhancing the benefits of such programs. This parallel randomised controlled trial measured the effects of the duration of lectures and the presence of a close relative 'in class' on rates of recidivism during the ten years following an initial drink-driving conviction. Of 1588 drivers in the Canton of Geneva convicted of a first-time offence with a blood alcohol concentration (BAC) of between 0.80 and 2.49g/kg from May 2001 to February 2004, 727 agreed to participate and were randomly assigned to either a seven-hour series of lectures, a four-hour series with a friend or close relative, or a brief two-hour lecture. Time until recidivism was retrieved from a national registry that contains details of recidivism that took place up to ten years after the first offence. Significant effects of briefer lectures over the standard day-long series of lectures were observed only during the most influential time period with regards to recidivism levels-the two years following the intervention. Replacing the usual one-day series of lectures by briefer two-hour lectures would reduce, by 25% (CI95%; 3-44%), the risk of recidivism. This study does not support policymakers' decision to rely on a seven-hour series of lectures to decrease DUI recidivism. The advantages of shorter lectures over no lecture still need to be evaluated.
Research Interests: Health Education, Adolescent, Drug Policy, Humans, Female, and 14 moreAlcohol Drinking, Male, Recidivism, Young Adult, Follow-up studies, Aged, Middle Aged, Adult, Time Factors, Driving Under the Influence, Criminals, Psychology and Cognitive Sciences, Blood Alcohol Content, and Medical and Health Sciences
Three-dimensional (3D) printed models of the human skull and parts of it are being increasingly used for surgical education and customized preoperative planning. This study, using the calvaria as a model, provides a methodologic analysis... more
Three-dimensional (3D) printed models of the human skull and parts of it are being increasingly used for surgical education and customized preoperative planning. This study, using the calvaria as a model, provides a methodologic analysis with regard to future investigations aimed at evaluating patient-specific skull replicas. Postmortem computed tomography was used for 3D reconstruction of a skull. The digital model obtained was converted to a physical replica by 3D printing. This copy was compared qualitatively and quantitatively with the original, using both a classical anthropometric and a 3D surface scanning approach. Qualitatively, the replica and the original displayed good qualitative concordance. The quantitative deviations, as measured by osteometric tools, lay partly in the submillimetric area, partly between 1 and 2 mm. The maximum difference was 3.7 mm. On the basis of the surface scans, a mean deviation of 0.2930 mm (±0.2677 mm) and a median difference of 0.2125 mm (0.0000-1.5509 mm) were observed for the inner surface. For the whole object, corresponding figures amounted to 0.9101 mm (±0.5390 mm) and 0.8851 mm (0.000-3.2647 mm). Qualitatively flawless replicas of the skull region investigated are feasible, subject to extensive manual CT image editing. However, neurosurgeons should be aware that models of one and the same patient will vary according to the production chain used by the 3D printing laboratory in charge. Methodologically, both classic anthropological and light-stripe-based comparisons are justified for use in future studies. For trials aimed at assessing mean deviations and topographic distribution patterns, optical 3D scanning technologies can be recommended.
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The University Center of Legal Medicine in Lausanne has started a project for developing a forensic-anthropological data base of "virtual skeletons". Therefore we have conducted three studies concerning the improvement of... more
The University Center of Legal Medicine in Lausanne has started a project for developing a forensic-anthropological data base of "virtual skeletons". Therefore we have conducted three studies concerning the improvement of technical requirements for bones scanned by multi-detector computed tomography (MDCT). Study I deals with the comparison of the surface of real bones versus the one of virtual bones. The purpose was to detect the limits in applying anthropological methods on virtual skeletons as well as to test scanning parameters. The results indicate both, on the one hand an inevitable development of a special scanning protocol for dry bones and on the other hand modifications of classical anthropological methods for using the reconstructed surface of virtual bones. The aim of Study II was to compare the performance of MDCT with the golden standard (conventional X-rays) for its use in investigating the trabecular structure of long bones as well as in taking metrical dat...
In recent years, modern cross-sectional imaging techniques such as multi-detector computed tomography (MDCT) have pioneered applications in various postmortem investigations. Since 2008, MDCT is used in the routine investigation of all... more
In recent years, modern cross-sectional imaging techniques such as multi-detector computed tomography (MDCT) have pioneered applications in various postmortem investigations. Since 2008, MDCT is used in the routine investigation of all bodies examined by the University Center of Legal Medicine in Lausanne. This data pool is opening new opportunities in several research fields. Concerning forensic anthropology, problems, such as insufficient sample composition and lack of individual data, could be solved, if those data can be made available. For this reason, we started to create the anthropological data base of virtual skeletons of Lausanne. Consequently, basic research should focus on data comparability in order to understand limitations of applying conventional anthropological methods on virtual bones. Preliminary studies in the field of virtual anthropology have shown that anthropological investigations can only be performed if the radiological data are of highest quality. Accordi...
Research Interests: Kenya, Adolescent, Humans, Female, Male, and 15 moreRisk factors, Aged, Prevalence, Middle Aged, Adult, Occupational Exposure, Public health systems and services research, Risk Factors, Occupational Diseases, Cross Sectional Studies, Logistic Models, Latent Tuberculosis, Health Personnel, Residence Characteristics, and HIV infections
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... PRIMARY CARE The SODA study (SOmatization, Depression, Anxiety) Lilli HERZIG 1 , Thomas BISCHOFF 1 ,Bernard BURNAND 3 , Bernard FAVRAT 2 , ... Page 6. REFERENCES 1. Fink P, Sorensen L, Engberg M, Holm M, Munk-Jorgensen P. Somatization... more
... PRIMARY CARE The SODA study (SOmatization, Depression, Anxiety) Lilli HERZIG 1 , Thomas BISCHOFF 1 ,Bernard BURNAND 3 , Bernard FAVRAT 2 , ... Page 6. REFERENCES 1. Fink P, Sorensen L, Engberg M, Holm M, Munk-Jorgensen P. Somatization in primary care. ...
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The choice of design between individual randomisation, cluster or pseudo-cluster randomisation is often made difficult. Clear methodological guidelines have been given for trials in general practice, but not for vaccine trials. This... more
The choice of design between individual randomisation, cluster or pseudo-cluster randomisation is often made difficult. Clear methodological guidelines have been given for trials in general practice, but not for vaccine trials. This article proposes a decisional flow-chart to choose the most adapted design for evaluating the effectiveness of a vaccine in large-scale studies. Six criteria have been identified: importance of herd immunity or herd protection, ability to delimit epidemiological units, homogeneity of transmission probability across sub-populations, population's acceptability of randomisation, availability of logistical resources, and estimated sample size. This easy to use decisional method could help sponsors, trial steering committees and ethical committees adopt the most suitable design.
Research Interests: General Practice, Epidemiology, Research Design, Vaccines, Clinical Trial, and 11 moreBiological Sciences, Humans, Cluster Analysis, Vaccine, Randomised Controlled Trial, Sample Size, Large Scale, Randomized Controlled Trials as Topic, Patient selection, Adaptive design, and Medical and Health Sciences
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226 smokers, 105 Swiss (46.5%), and 121 for- eign-born (53.5%), participated in the study. 32.2% (95% CI (24.4%; 41.1%)) of migrants and 9.6% (5.3%; 16.8%) of Swiss patients were not aware of negative effects of smoking. After adjustment... more
226 smokers, 105 Swiss (46.5%), and 121 for- eign-born (53.5%), participated in the study. 32.2% (95% CI (24.4%; 41.1%)) of migrants and 9.6% (5.3%; 16.8%) of Swiss patients were not aware of negative effects of smoking. After adjustment for age, the multivariate model showed that the estimated odds of "igno- rance of health effects of smoking" was higher for people
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Iron deficiency is generally investigated when faced with anemia, or with symptoms that could be related to iron deficiency without anemia. This simple disorder is easy to treat, provided that the diagnosis is correct. Several biological... more
Iron deficiency is generally investigated when faced with anemia, or with symptoms that could be related to iron deficiency without anemia. This simple disorder is easy to treat, provided that the diagnosis is correct. Several biological tests are available, but their interpretation is oftentimes problematic. Pre-analytical factors can interfere with measurements, normal values can change depending on suppliers, and, above all, results from different markers can be contradictory in some clinical situations. The aim of this article is to evaluate how the evolution of scientific knowledge and clinical trials can contribute to a better understanding and greater reliability in the diagnosis of iron deficiency.
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Should we treat iron deficiency without anemia? The simple fact that the question can be formulated already leads to controversies. During the past years, the development of a new formulation of intravenous iron has helped fuel the... more
Should we treat iron deficiency without anemia? The simple fact that the question can be formulated already leads to controversies. During the past years, the development of a new formulation of intravenous iron has helped fuel the controversy. What is the situation in 2012? This article gives a practical point of view on the actual situation and provides indications on the use of new intravenous medications.
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The link between social inequalities and health has been known for many years, as attested by Villermé's work on the "mental and physical status of the working class" (1840). We have more and more insight into the nature of... more
The link between social inequalities and health has been known for many years, as attested by Villermé's work on the "mental and physical status of the working class" (1840). We have more and more insight into the nature of this relationship, which embraces not only material deprivation, but also psychological mechanisms related to social and interpersonal problems. Defining our possible role as physicians to fight against these inequalities has become a public health priority. Instruments and leads, which are now available to help us in our daily practice, are presented here.
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Sex workers constitute a heterogeneous group possessing a combination of vulnerability factors such as geographical instability, forced migration, substance addiction and lack of legal residence permit. Access to healthcare for sex... more
Sex workers constitute a heterogeneous group possessing a combination of vulnerability factors such as geographical instability, forced migration, substance addiction and lack of legal residence permit. Access to healthcare for sex workers depends on the laws governing the sex market and on migration policies in force in the host country. In this article, we review different European health strategies established for sex workers, and present preliminary results of a pilot study conducted among 50 sex workers working on the streets in Lausanne. The results are worrying: 56% have no health insurance, 96% are migrants and 66% hold no legal residence permit. These data should motivate public health departments towards improving access to healthcare for this vulnerable population.
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In recent years many clinical prediction rules (CPR) have been developed. Before a CPR can be used in clinical practice, different methodical steps are necessary, from the development of the score, the internal and external validation to... more
In recent years many clinical prediction rules (CPR) have been developed. Before a CPR can be used in clinical practice, different methodical steps are necessary, from the development of the score, the internal and external validation to the impact study. Before using a CPR in daily practice family doctors have to verify how the rules have been developed and whether this has been done in a population similar to the population in which they would use them. The aim of this paper is to describe the development of a CPR, and to discuss advantages and risks related to the use of CPR in order to help family doctors in their choice of scores for use in their daily practice.
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Social deprivation also exists in an industrialised country like Switzerland where there are many different social economic levels; social inequalities have increased in the past years having a major impact on social economic determinants... more
Social deprivation also exists in an industrialised country like Switzerland where there are many different social economic levels; social inequalities have increased in the past years having a major impact on social economic determinants of health. Being aware of these determinants and systematically identifying them in patients has become crucial for the general practitioner in order to improve the way s/he delivers care and interacts with more vulnerable populations. Because the general practitioner is often in contact with people of different socioeconomic levels, s/he is a key witness of social inequalities in health. S/he therefore has a responsibility to document them, to promote health, to prevent disease and be an advocate for the disadvantages in order to influence these social determinants of health.
Research Interests:
Although the performance of the Swiss health system is high, one out of ten patients in general practitioner's (GP) office declares having foregone care in the previous twelve months for economic reasons. Reasons for foregoing care... more
Although the performance of the Swiss health system is high, one out of ten patients in general practitioner's (GP) office declares having foregone care in the previous twelve months for economic reasons. Reasons for foregoing care are several and include a lack of knowledge of existing social aids in getting health insurance, unavailability of GPs and long waiting lists for various types of care. Although long term knowledge of patients or a psychosocial history of deprivation or poverty may help identify individuals at risk of foregoing care, many may remain undetected. We propose then a few instruments to help GPs to identify, in a simple and structured approach, patients at risk of forgoing care for economic reasons; these patients are frequently deprived and sometimes poor.
Research Interests:
Research Interests:
In many countries, primary care physicians determine whether or not older drivers are fit to drive. Little, however, is known regarding the effects of cognitive decline on driving performance and the means to detect it. This study... more
In many countries, primary care physicians determine whether or not older drivers are fit to drive. Little, however, is known regarding the effects of cognitive decline on driving performance and the means to detect it. This study explores to what extent the trail making test (TMT) can provide indications to clinicians about their older patients' on-road driving performance in the context of cognitive decline. This translational study was nested within a cohort study and an exploratory psychophysics study. The target population of interest was constituted of older drivers in the absence of important cognitive or physical disorders. We therefore recruited and tested 404 home-dwelling drivers, aged 70 years or more and in possession of valid drivers' licenses, who volunteered to participate in a driving refresher course. Forty-five drivers also agreed to undergo further testing at our lab. On-road driving performance was evaluated by instructors during a 45 minute validated op...
Research Interests: Aging, Risk assessment, Humans, Female, Male, and 13 moreFollow-up studies, ROC Curve, Clinical Sciences, Aged, Time Factors, Retrospective Studies, Age Factors, Reproducibility of Results, Risk Assessment, Predictive value of tests, Translational Medical Research, Cognition disorders, and Automobile driving
226 smokers, 105 Swiss (46.5%), and 121 for- eign-born (53.5%), participated in the study. 32.2% (95% CI (24.4%; 41.1%)) of migrants and 9.6% (5.3%; 16.8%) of Swiss patients were not aware of negative effects of smoking. After adjustment... more
226 smokers, 105 Swiss (46.5%), and 121 for- eign-born (53.5%), participated in the study. 32.2% (95% CI (24.4%; 41.1%)) of migrants and 9.6% (5.3%; 16.8%) of Swiss patients were not aware of negative effects of smoking. After adjustment for age, the multivariate model showed that the estimated odds of "igno- rance of health effects of smoking" was higher for people lacking mastery of the local language compared with those mastering it (odds ratio (OR) = 7.5 (3.6; 15.8), p <0.001), and higher for men (OR = 4.3 (1.9; 10.0), p <0.001). Advice to stop smoking was given with similar frequency to immigrants (31.9% (24.2%; 40.8%) and Swiss patients (29.0% (21.0%; 38.5%)). Non- integrated patients did not appear to receive less counselling than integrated patients (OR = 1.1 (0.6; 2.1), p = 0.812). We conclude that the level of knowledge among male immigrants not integrated or unable to speak the local language is lower than among in- tegrated foreign-born and Swiss patients...