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Biomedical subjects

A Morabia

Publications and source records attributed to A Morabia.

At least 19 recordsLinked to original sources
PubMed1999

Long term vascular complications of Coxiella burnetii infection in Switzerland: cohort study.

OBJECTIVE: To evaluate the range of long term vascular manifestations of Coxiella burnetii infection. DESIGN: Cohort study in Switzerland of people affected in 1983 by the largest reported outbreak of Q fever and who were followed up 12 years later. Follow up information about possible vascular disease and endocarditis was obtained through a mailed questionnaire and death certificates. SETTING: Val de Bagnes, a rural Alpine valley in Switzerland. PARTICIPANTS: 2044 (87%) of 2355 people who had serum testing for Coxiella burnetii infection in 1983: 1247 were classed as not having been infected, 411 were classed as having been acutely infected, and 386 were classed as having been infected before 1983. MAIN OUTCOME MEASURES: Relative risk controlled for age and sex and 12 year risk of vascular diseases and endocarditis among infected participants as compared with those who had never been infected. RESULTS: The 12 year risk of endocarditis or venous thromboembolic disease was not increased among those who had been acutely infected. The 12 year risk of arterial disease was significantly higher among those who had been acutely infected (7%) as compared with those who had never been infected (4%) (relative risk 2.2, 95% confidence interval 1.4 to 3.6). Specifically, there was an increased risk of developing a cerebrovascular accident (relative risk 3.7, 1.6 to 8.4) and cardiac ischaemia (relative risk 1.9, 1.04 to 3.4). 12 year mortality was significantly higher among the 411 people who had been acutely infected in 1983 (9.7%; age adjusted relative risk 1.8, 1.2 to 2.6) when compared with the 1247 participants who had remained serologically negative in 1983 (7.0%). CONCLUSIONS: Coxiella burnetii infection may cause long term complications including vascular disease.

Adult↗
PubMed1999

A Swiss population-based assessment of dietary habits before and after the March 1996 'mad cow disease' crisis.

OBJECTIVE: To assess differences in dietary habits in the general population of Geneva, Switzerland, after the 1996 (BSE) crisis. DESIGN: Repeated population-based survey during 1993, 1994, 1995 and 1996. SETTING: The Bus Santé 2000 epidemiological observatory of Geneva, Switzerland. SUBJECTS: A representative sample of 1190 men and 1154 women. MAIN OUTCOME MEASURE: Dietary habits assessed by a semi-quantitative food frequency questionnaire. RESULTS: The proportion of women who reported not having eaten beef was 7.7% in 1993-1995 and went up to 14.6% in 1996 (age-adjusted difference +6.4%, 95% CI +2.4 to +10.4). Among men, the proportion of non-beef-eaters remained constant (5%). There was a sharp increase of women who did not eat liver (+14.7%, +9.1 to +20.3) but less so in men (+2 5.1%, -0.7 to +10.8). Among women who ate meat, the amount of beef intake decreased by 120 g/month (95% CI -208 to -36). While chicken intake increased (+44 g/month, -2 to 88), overall intake of meat (including poultry but not fish) declined by 204 g/month (or 2.7 kg per year). In men the decrease in beef intake was not statistically significant (-48 g/month, -172 to 80), but consumption of chicken increased (+2 56g/month, +8 to +104). Fish intake was stable in both genders. The reduction in intake of animal protein (-3.5 g/day) in women and of retinol intake in both sexes (women -77 micrograms/day; men -56 micrograms/day) was statistically significant. CONCLUSIONS: The BSE crisis coincided with spontaneous differences in food habits, especially in women, that may have nutritional consequences at the population level.

Adult↗
PubMed1999

Effects of smoking and smoking cessation on dietary habits of a Swiss urban population.

OBJECTIVES: To assess whether current smokers eat differently than never smokers and the relation of smoking cessation to dietary change. DESIGN: Population-based survey from 1993-1997. SETTING: The Bus Sante 2000, epidemiologic observatory of Geneva, Switzerland. SUBJECTS: A representative sample of 2301 men and 2306 women resident of Geneva, Switzerland. RESULTS: In both genders, compared to never smokers, current heavy smokers (> or = 20 cigarettes/d) consumed daily less total vegetables proteins (P <0.03), carbohydrates (P<0.0001), saccharose (P<0.01), fibers (P < 0.0001), beta-carotene (P < 0.001), fruit (P < 0.0001) and vegetables (P < 0.04), but they drank more alcohol (P < 0.0001) and more coffee (P < 0.005). In addition, female current smokers ate less energy (P < 0.4), complex carbohydrates (P < 0.002), cereals (P < 0.003), vegetables (P < 0.0001) and less iron (P < 0.02). The diet of ex-smokers tended to become more similar to that of never smokers. When longer duration of smoking cessation increased, the consumption of total carbohydrates and complex carbohydrates increased (P < 0.01 and P < 0.06), and alcohol decreased (P < 0.07) in both genders. CONCLUSIONS: As in other Western countries, the diet of Swiss smokers appears less healthy than that of never smokers in both men and women, while smoking cessation has beneficial aspect on the quality of the diet. Current smoking appears to have an even stronger effect on the diet of women than on the diet of men.

Adult↗
PubMed1999

Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate--a randomized trial.

PURPOSE: To determine the influence of early pain relief on the diagnostic performance of ultrasonography (US) and on the appropriateness of the surgical decision. MATERIALS AND METHODS: A prospective randomized, double-blind placebo-controlled trial with morphine was conducted. A visual analog scale was used to evaluate pain in 340 patients aged 16 years or older. US was performed with a standardized protocol. Diagnosis was confirmed at histologic analysis or, in the patients released without surgery, at follow-up. RESULTS: One hundred seventy-five patients were injected with morphine, and 165 were injected with the placebo. Pain relief was stronger in the morphine group. In the morphine group, US had lower (71.1%) sensitivity (difference, -9.5%; 95% CI, -18.5%, -0.5%) and higher (65.2%) specificity (difference, 11.4%; 95% CI, 1.0%, 21.8%). This group had also a higher positive predictive value (64.6%) and a lower negative predictive value (71.4%), but the differences between this group and the placebo group were not statistically significant. Among female patients, the decision to operate was appropriate more often in the morphine group (75.8%), but the difference between this group and the placebo group was not statistically significant (5.1%; 95% CI, -7.4%, 17.6%). In male patients and overall, opiate analgesia did not influence the appropriateness of the decision. The appropriateness to discharge patients without surgery was 100% in all groups. CONCLUSION: Morphine does not improve US-based diagnosis of appendicitis.

Abdominal Pain↗
PubMed1999

Prevalence and social correlates of cardiovascular disease risk factors in Harlem.

OBJECTIVES: This study examined the prevalence, social correlates, and clustering of cardiovascular disease risk factors in a predominantly Black, poor, urban community. METHODS: Associations of risk factor prevalences with sociodemographic variables were examined in a population-based sample of 695 men and women aged 18 to 65 years living in Central Harlem. RESULTS: One third of the men and women were hypertensive, 48% of the men and 41% of the women were smokers, 25% of the men and 49% of the women were overweight, and 23% of the men and 35% of the women reported no leisure-time physical activity over the past month. More than 80% of the men and women had at least 1 of these risk factors, and 9% of the men and 19% of the women had 3 or more risk factors. Income and education were inversely related to hypertension, smoking, and physical inactivity. Having 3 or more risk factors was associated with low income and low education (extreme odds ratio [OR] = 10.2, 95% confidence interval [CI] = 3.0, 34.5 for education; OR = 3.7, CI = 1.6, 8.9 for income) and with a history of unstable work or of homelessness. CONCLUSIONS: Disadvantaged, urban communities are at high risk for cardiovascular disease. These results highlight the importance of socioenvironmental factors in shaping cardiovascular risk.

Adolescent↗
PubMed1999

Definition and prevalence of sedentarism in an urban population.

OBJECTIVES: The present study sought to formulate a precise definition of sedentarism and to identify activities performed by active people that could serve as effective preventive goals. METHODS: A population-based sample of 919 residents of Geneva, Switzerland, aged 35 to 74 years, completed a 24-hour recall. Sedentary people were defined as those expending less than 10% of their daily energy in the performance of moderate- and high-intensity activities (at least 4 times the basal metabolism rate). RESULTS: The rates of sedentarism were 79.5% in men and 87.2% in women. Among sedentary and active men, average daily energy expenditures were 2600 kcal (95% confidence interval [CI] = 2552, 2648) and 3226 kcal (95% CI = 3110, 3346), respectively; the corresponding averages for women were 2092 kcal (95% CI = 2064, 2120) and 2356 kcal (95% CI = 2274, 2440). The main moderate- and high-intensity activities among active people were sports (tennis, gymnastics, skiing), walking, climbing stairs, gardening, and (for men only) occupational activities. CONCLUSIONS: The definition of sedentarism outlined in this article can be reproduced in other populations, allows comparisons across studies, and provides preventive guidelines in that the activities most frequently performed by active people are the ones most likely to be adopted by their sedentary peers.

Activities of Daily Living↗
PubMed1998

International variability in ages at menarche, first livebirth, and menopause. World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives.

The occurrences and timing of reproduction-related events, such as menarche, first birth, and menopause, play major roles in a woman's life. There is a lack of comparative information on the overall patterns of the ages at and the timing between these events among different populations of the world. This study describes the variability in reproductive factors across populations in Europe, the Americas, Asia, Australia, and Africa. The study sample consisted of 18,997 women from 13 centers in 11 countries interviewed between 1979 and 1988 who comprised the control group in a World Health Organization international, multicenter case-control study of female cancers. All were surveyed with the same questionnaire and methodology. Overall, a typical woman in this study reached menarche at age 14 years and delivered her first live child 8 years later, at age 22. She was 50 years old at natural menopause and had had 36 years of reproductive life. The median ages at menarche varied across centers from 13 to 16 years. For all centers, the median age at first livebirth was 20 or more years, with the largest observed median (25 years) occurring in China. The median delay from menarche to first livebirth ranged from 5 to 11 years. Among the centers, the median age at natural menopause ranged between 49 and 52 years. In most populations, younger women had a first birth at a later age than did older women. This tendency was more accentuated in some populations. These results reveal, perhaps for the first time, the variability of reproductive histories across different populations in a large variety of geographic and cultural settings. Except for menopause, international variability is substantial for both biologically related variables (age at menarche) and culturally related variables (age at first birth). There is a generational effect, characterized by more variability of age at first birth and delay to first birth in the younger than in the older generations.

Adolescent↗
PubMed1998

Lifetime exposure to environmental tobacco smoke among urban women: differences by socioeconomic class.

This study sought to determine cumulative lifetime exposure to environmental tobacco smoke (ETS) among urban women in relation to sociodemographic factors. In a population survey carried out in Geneva, Switzerland, during 1993-1995, a representative sample of 1,883 women aged 35-74 years answered interview questions on lifetime ETS exposure. Exposed women were defined as those who had spent at least 1 hour daily in a smoky environment during 1 or more years. The prevalence of current ETS exposure was 31.0% among 1,458 never or former smokers. Lifetime prevalence was 58.3% among 1,061 never smokers. The home (42.1%) and the workplace (39.6% of employed women) were the most frequent sources of ETS exposure, leisure time activity being a secondary source. Throughout a lifetime, work accounted for the greatest average intensity of exposure (on average, 19 hours of exposure per week), while the longest duration of exposure (on average, 18 years) was in the home. Cumulative lifetime exposure (intensity (in hours/week) x duration) from all sources combined was 308 hours/week-years, which can correspond to 30.8 hours/week over a period of 10 years or 20.5 hours/week over a period of 15 years. Women from low socioeconomic classes had more intense and longer exposures than women from higher socioeconomic classes, mainly because of work exposure. Both the intensity and the duration of lifetime ETS exposure were greater than previously suspected. Reduction of ETS exposure in the workplace should be a public health priority.

Adult↗
PubMed1998

Contribution of smoking to excess mortality in Harlem.

The New York City neighborhood of Harlem has mortality rates that are among the highest in the United States. In absolute numbers, cardiovascular disease and cancer account for the overwhelming majority of deaths, especially among men, and these deaths occur at relatively young ages. The aim of this research was to examine self-reported smoking habits according to measures of socioeconomic status among Harlem men and women, in order to estimate the contribution of tobacco consumption to Harlem's remarkably high excess mortality. During 1992-1994, in-person interviews were conducted among 695 Harlem adults aged 18-65 years who were randomly selected from dwelling unit enumeration lists. The self-reported prevalence of current smoking was strikingly high among both men (48%) and women (41%), even among highly educated men (38%). The 21% of respondents without working telephones reported an even higher prevalence of current smoking (61%), indicating that national and state-based estimates which rely on telephone surveys may seriously underestimate the prevalence of smoking in poor urban communities. Among persons aged 35-64 years, the smoking attributable fractions for selected causes of death were larger in Harlem than in either New York City as a whole or the entire United States for both men and women. Tobacco consumption is likely to be one of several important mediators of the high numbers of premature deaths in Harlem.

Adolescent↗
PubMed1998

Relation of smoking to breast cancer by estrogen receptor status.

It has been suggested that smoking is associated with estrogen-negative breast cancer but not with estrogen-positive breast cancer. A population-based case-control study was conducted in Geneva, Switzerland, to determine the relation of passive and active smoking to breast cancer when the referent unexposed category consisted of women unexposed to active and passive smoke. The 242 patients with breast cancer (cases), in whom estrogen receptor (ER) status was determined on biopsy material, were compared with 1,059 women free of breast cancer (controls). Lifetime history of active and passive smoking was recorded year by year, between age 10 and the date of interview. Prevalence rates of ER+ tumors were 74.7% in pre-menopausal women and 74.2% in post-menopausal women. Post-menopausal active smokers had a lower prevalence of ER+ tumors (70.0%, p = ns). Among pre-menopausal women, the age-adjusted ORs of breast cancer with having smoked an average of > or = 20 cigarettes per day (cpd) during lifetime were 2.7 for ER- tumors and 2.6 for ER+ tumors. Among post-menopausal women, corresponding ORs were 5.7 for ER- tumors and 2.4 for ER+ tumors. Smoking was related to both ER- and ER+ breast cancer in pre- and post-menopausal women, but the strength of the association appeared to be greater for ER- tumors among post-menopausal women.

Aged↗
PubMed1998

Data-based approach for developing a physical activity frequency questionnaire.

Measurement of total energy expenditure may be crucial to an understanding of the relation between physical activity and disease and in order to frame public health intervention. To devise a self-administered physical activity frequency questionnaire (PAFQ), the following data-based approach was used. A 24-hour recall was administered to a random sample of 919 adult residents of Geneva, Switzerland. The data obtained were used to establish the list of activities (and their median duration) that contributed to 95% of the energy expended, separately for men and women. Activities that were trivial for the whole sample but that contributed to > or = 10% of an individual's energy expenditure were also selected. The final PAFQ lists 70 activities or group of activities with their typical duration. About 20 minutes are required for respondents to indicate the number of days and the number of hours per day that they performed each activity. The PAFQ method was validated against a heart rate monitor, a more objective method. The total energy estimated by the PAFQ in 41 volunteers correlated well (r = 0.76) with estimates using a heart rate monitor. The authors conclude that the design of their self-administered physical activity frequency questionnaire based on data from 24-hour recall appeared to accurately estimate energy expenditure.

Adult↗
PubMed1998

Body weight preoccupation in middle-age and ageing women: a general population survey.

OBJECTIVE AND METHODS: The desired weights and dieting behavior of a sample of 1,053 women aged 30-74 years in the general population of Geneva, Switzerland, were explored by means of a questionnaire. Multivariate analyses of variance were performed. RESULTS: Twenty-five percent of the women were satisfied with their weight, whereas 71% wanted to be thinner, although 73% of them were at normal weight. Among women older than 65 years, 62% wanted to lose weight, 65% of them being at normal weight. For women wanting to lose weight, mean desired weight loss amounted to 9% of their current weight. Weight dissatisfaction increased with higher education (p < .001), and with increasing current weight (p < .001). Within the last 5 years, 42% of the women had dieted for weight control, including 67% at normal weight. Thirty-one percent of the women older than 65 years had also dieted, 62% of them being at normal weight. DISCUSSION: A majority of middle-age and ageing women in this general population sample expressed dissatisfaction about their weight. Many attempted dieting, even when they were at normal weight. Considering the vulnerability of the elderly to nutritional deficiencies, dieting to lose weight in normal weight ageing women should be discouraged or closely monitored.

Adult↗
PubMed1998

Validation of questionnaire-based response criteria of treatment efficacy in the fibromyalgia syndrome.

OBJECTIVE: To compare the validity of self-reported questionnaires as response criteria of treatment efficacy in patients with fibromyalgia syndrome. METHOD: At the beginning of the treatment period, 70 fibromyalgia patients, randomly allocated to electro-acupuncture or placebo, underwent a clinical evaluation by rheumatologists and answered 1) a generic quality of life questionnaire--the Psychological General Well-Being Index (PGWB), 2) a specific function and symptom questionnaire, and 3) a pain questionnaire--the Regional Pain Score (RPS). The same evaluation was repeated at the end of the treatment period. Severity of the condition was assessed by a composite outcome score, a combination of different clinical outcome measures forming a clinical severity index. The variations between these questionnaire scores before and after treatment and the variations between the clinical severity indices estimated by clinicians were used as measures of the treatment impact. The first rationale for the validation was a positive correlation between clinical and questionnaire score changes. Another rationale for validation of the new instruments was the ability to identify the different treatment interventions. RESULTS: The correlation between the clinical severity index and the RPS was good (r = 0.62). Moreover, the RPS demonstrated a good discriminant power in detecting patients with effective treatment: it showed a specificity of 74% and a sensitivity of 75%. The PGWB correlated less well with the clinical score and was less discriminant. The specific function and symptom questionnaire showed little additional validity. CONCLUSIONS: Outcomes of syndrome severity such as pain and subjective well-being, as measured by self-reported questionnaires, can be valid instruments to evaluate treatment efficacy in short-term clinical trials. In the current study, the RPS proved to be particularly useful to assess the widespread tenderness of fibromyalgia and demonstrated high discriminative power.

Activities of Daily Living↗
PubMed1998

Teaching physicians about different measures of risk reduction may alter their treatment preference.

We explored during a postgraduate workshop whether basic teaching about absolute and relative effect measures changed physicians' perceptions of the benefit to be derived from modifying particular cardiovascular risk factors. Before and after instruction physicians were asked about the priority they would give to interventions to reduce four risk factors of coronary heart disease in two male patients, aged 35 and 65 years with multiple risk factors. They were given information about the relative risk (RR), absolute risk reduction (ARR) and the number of patients who need to be treated (NNT) to prevent one event associated with the modification of each risk factor. Ratings of 48 of the 67 participating physicians (71.6%) were evaluated. About half did not change their choices regarding the benefit from a particular intervention. Among those who changed, the new choice was in favor of the patient with the higher ARR for three risk factors (hypertension, p = 0.01; smoking, p = 0.002; non-insulin-dependent diabetes, p = 0.05) but not the fourth (left ventricular hypertrophy, p = 0.82). Teaching basic principles of clinical epidemiology to physicians can have an impact on their perception of treatment effects. However, this will not suffice in itself to guarantee that this new knowledge will become part of their clinical practice.

Adult↗
PubMed1998

Parakeets, canaries, finches, parrots and lung cancer: no association.

The relationship between pet bird keeping and lung cancer according to exposure to tobacco smoking was investigated in a case-control study in hospitals of New York City and Washington, DC, USA. Newly diagnosed lung cancer cases (n = 887) aged 40-79 years were compared with 1350 controls with diseases not related to smoking, of the same age, gender and date of admission as the cases. The prevalence of pet bird keeping was 12.5% in men and 19.1% in women. There was no association between ever keeping a pet bird and lung cancer in never smokers (men adjusted odds ratio (OR) = 0.70, 95% confidence interval (CI) 0.15-3.17; women, 1.32, 95% CI 0.65-2.70), or in smokers and non-smokers combined, after adjustment for ever smoking (men: 1.28, 95% CI 0.88-1.86; women: 1.17, 95% CI 0.83-1.64; all: 1.21, 95% CI 0.95-1.56). Risk did not increase in relation to duration of pet bird keeping. Cases and controls kept similar types of birds. There was a tenfold increase of lung cancer risk associated with smoking among non-bird keepers (adjusted OR = 9.15). There was no indication of a synergism, either additive or multiplicative, between smoking and pet bird keeping with respect to lung cancer risk. Either alone or in conjunction with smoking, keeping parakeets, canaries, finches or parrots is not a risk factor for lung cancer among hospital patients in New York and in Washington, DC.

Animals↗