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Biomedical subjects

A Morabia

Publications and source records attributed to A Morabia.

At least 55 records · Page 3Linked to original sources
PubMed2000

Obesity and other health determinants across Europe: the EURALIM project.

STUDY OBJECTIVE: EURALIM (EURope ALIMentation), a European collaborative study, aimed to determine and describe the extent to which European data on risk factor distributions from different populations could be pooled and harmonised in a common database for international comparisons. SETTING: Seven independent population-based surveys from six European countries (France, Italy, Northern Ireland/United Kingdom, Spain, Switzerland, the Netherlands). METHODS: Data for 18 381 women and 12 908 men aged 40-59 were pooled in a common database. Central statistical analyses on major cardiovascular risk factors were conducted with careful consideration of methodological issues, including differences in study designs, data assessment tools, and analytic techniques used. MAIN RESULTS: Because of the detected variability among methods used, direct comparisons of risk factor distributions and prevalences between studies were problematic. None the less, comparisons of within population contrasts by sex, age group, and other health determinants were considered to be meaningful and apt, as illustrated here for obesity. Results were targeted and disseminated to both the general public and public health professionals and framed in the context of a European information campaign. CONCLUSIONS: International and national comparisons between existing locally run studies are feasible and useful, but harmonisation methods need improvement. Development of an international risk factor surveillance programme based on decentralised data collection is warranted. In the meantime, risk factor contrasts across populations can be used as a basis for targeting needed public health intervention programmes.

Adult↗
PubMed2000

[Symptoms and clinical and radiological signs predicting the bacterial origin of acute rhinosinusitis].

A minority of patients with common cold and upper respiratory tract infections have a bacterial infection and may benefit from antibiotic therapy. The present analysis set out to determine whether there were clinical symptoms or signs which could help the clinician to identify a subset of patients with moderate forms of acute rhinosinusitis who are infected with pathogenic bacteria. Detailed clinical history and medical examination were obtained from 265 patients (mean age 35 years, 138 females and 127 males) presenting symptoms of upper respiratory tract infections but no fever above 38 degrees C. The presence of three pathogenic bacteria (S. pneumoniae, H. influenzae or M. catarrhalis) was determined in all patients by culture of nasopharyngeal secretions. Aggravating factors for severity of rhinosinusitis, such as severe nasal obstruction, inferior and/or middle turbinate hypertrophy, oedema of the middle meatus mucosa and septal defects, were not associated with the presence of bacteria. Pathogenic bacteria were found in 77 patients (29%). The clinical signs and symptoms which were significantly associated in a multivariate model with the presence of bacteria included facial pain (p < 0.003), coloured nasal discharge (p < 0.003) and radiological maxillary sinusitis (complete opacity, air-fluid level or mucosal thickening greater than 10 mm) (p < 0.002). This, the best predictive model, had a sensitivity of 69% and a specificity of 64% and therefore could not be used either as a screening tool or as a diagnostic criterion for bacterial rhinosinusitis. We conclude that signs and symptoms of acute rhinosinusitis in patients with a mild to moderate clinical presentation are poor predictors of the presence of bacteria. In agreement with previous studies, culture of nasopharyngeal secretions may identify patients who would benefit from antibiotic treatment. Thus, antibiotic therapy should not be prescribed in the absence of bacteriological evidence.

Adolescent↗
PubMed1999

[Evaluation of drug prescription in the primary care clinic in Geneva in 1997].

INTRODUCTION: The analysis of drug prescription in a primary care clinic is a useful tool to evaluate the quality of medical care provided to outpatients. METHODOLOGY: We analysed drug prescriptions of the first consultations with 701 patients attending between May 14 and June 6 1997, and compared this data to previous surveys conducted in 1988, 1991 and 1993. RESULTS AND DISCUSSION: The three most common diagnoses were hypertension, lumbar pain and diabetes. The prescription of non steroidal antiinflammatory drugs (NSAID) increased from 7.1% in 1988 to 20% in 1997. For acute lumbar pain physicians prescribed NSAID to 58% of patients and paracetamol only to 33%. Further, doctors often prescribed muscle relaxants although an additional antalgic effect has not been proven. The prescription of psychotropic drugs decreased from 22.5% in 1988 to 12.7% in 1997. ACE inhibitors and calcium antagonists were the most frequently prescribed antihypertensive drugs. Therefore physicians do not follow the American (JNC VI) and our institutional guidelines, which recommend beta-blockers and diuretics as first line agents.

Acetaminophen↗
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

Relation of environmental tobacco smoke to diet and health habits: variations according to the site of exposure.

It has been postulated that the relationship of environmental tobacco smoke (ETS) exposure to cancer or cardiovascular diseases may be confounded by social class or diet because women exposed to ETS by their smoker spouse belong to lower social classes and have an unhealthy diet. In a population survey in Geneva, Switzerland, 914 female never-smokers were interviewed about sociodemographic factors, health habits including a semiquantitative food frequency questionnaire, and exposure to ETS according to the site (home, work, leisure). Compared to women unexposed to ETS, those exposed to ETS at work ate less fibers, cereals, vegetables, lean meat, had a lower intake of iron and beta-carotene, and had a lower total energy intake; women exposed during leisure time ate less cereals, drank less skim milk, and had a lower intake of complex carbohydrates. But the diet of women exposed at home did not differ from the diet of those unexposed to ETS. Thus, "living with a smoker" in Geneva does not necessarily imply adopting his health and dietary habits. We conclude that confounding factors of the association of ETS and disease vary according to site and populations and therefore should not be invoked as a systematic source of bias in all studies.

Activities of Daily Living↗
PubMed1999

Relation of BMI to a dual-energy X-ray absorptiometry measure of fatness.

Dual-energy X-ray absorptiometry (DXA) is a valid technique for measuring the fat, bone and lean (muscle, organs and water) masses of the body. We evaluated relationships of BMI (kg/m2) with independent measurements of fat and lean masses using DXA in 226 adult volunteers. The evaluation was an application of a general approach to compositional data which has not previously been used for describing body composition. Using traditional regression analyses, when lean mass was held constant, BMI varied with fat mass (men r 0.75, P < 0.05; women r 0.85, P < 0.05); when fat mass was held constant, BMI varied with lean mass (men r 0.63, P < 0.05; women r 0.47, P < 0.05). In contrast, a regression model for compositional data revealed that BMI was: (a) strongly associated with log fat mass in both sexes (b1 4.86, P < 0.001 for all women and b1 5.96, P < 0.001 for all men); (b) not associated with bone mass, except in older men; (c) related to lean mass in women but not in men (b3 -4.04, P < 0.001 for all women and b1 -2.59, P < 0.15 for all men). Women with higher BMI tended to have more fat mass and more lean mass than women with lower BMI. Men with higher BMI had more fat mass but similar lean mass to men with lower BMI. Investigators need to be alert to the inaccuracy of BMI to assign a fatness risk factor to individuals, especially among women.

Absorptiometry, Photon↗
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

Confidence of health professionals in public health approaches to obesity prevention.

OBJECTIVE: To assess the views of professionals working in the obesity field on the potential usefulness and feasibility of implementing different types of public health prevention strategies. METHOD: A questionnaire listing 20 public health strategies was mailed to pre-registrants of an international obesity prevention symposium. Respondents were asked to rate how useful and how feasible they felt each of the listed actions would be for the prevention of obesity in their home countries. The list included education-based strategies aimed at changing individual behaviour as well as more radical measures aimed at reducing population exposure to obesity-promoting factors in the environment. RESULTS: A 32% response was obtained. Education-based strategies were seen to be both useful and feasible. Less confidence was expressed in strategies aimed at changing the environment. CONCLUSION: People working in the obesity field tend to feel most comfortable with education-based prevention strategies. Implementation of environment-based strategies needed to encourage and support behaviour change may require the involvement of people from relevant sectors outside the obesity field.

Attitude of Health Personnel↗
PubMed1999

Mixed effects models with bivariate and univariate association parameters for longitudinal bivariate binary response data.

When two binary responses are measured for each study subject across time, it may be of interest to model how the bivariate associations and marginal univariate risks involving the two responses change across time. To achieve such a goal, marginal models with bivariate log odds ratio and univariate logit components are extended to include random effects for all components. Specifically, separate normal random effects are specified on the log odds ratio scale for bivariate responses and on the logit scale for univariate responses. Assuming conditional independence given the random effects facilitates the modeling of bivariate associations across time with missing at random incomplete data. We fit the model to a dataset for which such structures are feasible: a longitudinal randomized trial of a cardiovascular educational program where the responses of interest are change in hypertension and hypercholestemia status. The proposed model is compared to a naive bivariate model that assumes independence between time points and univariate mixed effects logit models.

Biometry↗
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

The association between switching hand preference and the declining prevalence of left-handedness with age.

OBJECTIVES: This study determined the prevalence of left-handedness and of switching hand preference among innately left-handed subjects. METHODS: Subjects of Swiss nationality (n = 1692), participating in a population-based survey in Geneva, Switzerland, completed a questionnaire on innate hand preference and current hand preference for writing. RESULTS: From 35 to 44 years of age to 65 to 74 years of age, the prevalence of innate left-handedness declined from 11.9% to 6.2% (trend P = .007). In these same age groups, the proportion of innately left-handed subjects who switched to the right hand for writing increased from 26.6% to 88.9% (trend P = .0001). CONCLUSIONS: Across generations, we found an increase in the prevalence of switching hand preference among innately left-handed subjects. This phenomenon could be explained by social and parental pressure to use the right hand.

Adult↗
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↗
PubMed1999

"Weight loss preoccupation in aging women": a review.

Preoccupation with body weight leading to frequent dieting has been found to be common in young women of developed countries. Little is known however about body image preoccupation or the prevalence of dieting for weight control purposes in elderly women. The few available reports suggest that preoccupation with weight remain high in elderly women and that pressure to be thin drives normal weight older women to recurrent dieting. After a reminder of the nutritional vulnerability of the elderly recommendations to the health care professionals and health authorities are provided. An increased awareness of eating habits and weight preoccupation in elderly women is needed, since attitudes towards weight may influence the effectiveness of medical advice and health promotion campaigns.

Aged↗
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↗