Radiological maxillary sinusitis in patients with common cold.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
A Morabia
Publications and source records attributed to A Morabia.
Cost-effectiveness of noninvasive diagnostic aids in suspected pulmonary embolism.
BACKGROUND: Noninvasive instruments such as plasma D-dimer measurement (DD) and lower-limb compression ultrasonography (US) are being increasingly advocated to reduce the number of necessary angiograms in patients having suspected pulmonary embolism (PE) and a nondiagnostic lung scan. We therefore designed a decision analysis model (1) to evaluate the cost-effectiveness of combining these noninvasive diagnostic aids with lung scan and angiography in the diagnosis of PE and (2) to determine the optimal sequence and combination of tests taking into account the clinical probability of PE. METHODS: We performed a cost-effectiveness analysis based on literature data, including data from a management study in our institution. Six diagnostic strategies were compared with the reference, ie, lung scan followed when nondiagnostic (low or intermediate probability) by angiography. In all strategies, PE was ruled out by a normal or near-normal scan, a negative DD (plasma level below 500 micrograms/L), or a negative angiogram. Pulmonary embolism was diagnosed and anticoagulant treatment was undertaken in the presence of a high-probability lung scan, deep vein thrombosis showed by US, or a positive angiogram. In case of a nondiagnostic scan (low or intermediate probability), patients could be either treated or not treated, or undergo other tests, according to the selected strategy. RESULTS: Under baseline conditions (prevalence of PE, 35%), strategies combining DD and US with lung scan, angiography being done only in case of an inconclusive noninvasive workup (DD level > 500 micrograms/L, normal US, and nondiagnostic lung scan), were most cost-effective. This approach yielded a 9% incremental cost reduction and a 37% to 47% decrease in the number of necessary angiograms compared with the reference strategy (scan +/- angiography). For patients with a low clinical probability of PE (< or = 20%), withholding treatment from those with a low-probability lung scan without performing an angiogram proved safe and highly cost-effective (30% cost reduction), provided US showed no deep vein thrombosis. CONCLUSION: The DD test and US are cost-effective in the diagnostic workup of PE, whether performed after or before lung scan, thus allowing centers devoid of lung scanning and/or angiography facilities to screen patients with suspected PE and avoid costly referrals. In patients with a low clinical probability, a low-probability lung scan, and a normal US, treatment may be withheld without resorting to angiography.
Algorithms↗
Duration of hospitalization during the first two years after AIDS diagnosis: a descriptive study.
Has there been a change in the duration of periods of hospitalization during the first two years after diagnosis of AIDS between patients diagnosed before 1988, compared with patients diagnosed since 1988? A cohort of 212 AIDS patients was studied. They were diagnosed before December 31, 1990 and were hospitalized between January 1, 1981 and March 31, 1993 in the University Hospital of Geneva, Switzerland. Overall, the duration of hospitalization did not seem to differ according to the year of AIDS diagnosis, though the more recently diagnosed patients were hospitalized with a more advanced level of immunosuppression. However, the pattern of hospitalization was slightly different. The periods of hospitalization for subjects diagnosed before 1988 were relatively longer soon after the AIDS diagnosis and at a late stage in the course of the disease, whereas for the more recent patients the lengths of hospital stays were more uniform during the whole course of the disease.
Acquired Immunodeficiency Syndrome↗
Interaction fallacy.
We define interaction fallacy as the situation in which heterogeneity of odds ratios suggests an interaction that does actually not exist among the corresponding risk ratios. We provide a hypothetical example of interaction fallacy between the presence of the germ-line BRCA1 mutation, age at first live birth, and breast cancer risk based on data from the literature. More generally, we present a set of hypothetical conditions under which interaction fallacy may occur.
Adult↗
Body mass index compared to dual-energy x-ray absorptiometry: evidence for a spectrum bias.
The objective of this study was to evaluate the accuracy of body mass index (BMI) in the diagnosis of obesity. The relationship of this weight-for-height index to body composition was determined using dual-energy x-ray absorptiometry (DEXA) in 226 Caucasian subjects. BMI-obesity was defined as a BMI greater than 27.8 kg/m2 in males and greater than 27.3 kg/m2 in females. BMI-obesity was weakly sensitive (males: 12.5%, females 13.6%) compared with diagnosis by DEXA, defined as percent body fat mass (%BF) greater than 20% in males and greater than 25% in females. Conversely, the specificity of BMI-obesity was high (males and females: 100%). When analyzing subgroups of subjects according to weight, sensitivity was higher among heavier subjects than among lighter ones. In both sexes and in all subgroups, the specificity was 100%. The clinical implication of this spectrum bias is that, in men or women weighing less than 80 kg, measures of obesity other than BMI, such as bioelectrical impedance, should be preferred.
Absorptiometry, Photon↗
Epidemiology of benign breast disease, with special attention to histologic types.
Explore the source record for details and available documents.
Breast Diseases↗
Postoperative nausea and vomiting: a comparative survey of the attitudes, perceptions, and practice of Swiss anesthesiologists and surgeons.
Managing postoperative nausea and vomiting (PONV) depends on awareness of the problem, the therapeutic measures available, and effective implementation control systems. We mailed 616 PONV questionnaires to all 129 Swiss hospitals with anesthesiological and surgical departments. The responses [192 (31%) completed questionnaires from 87 (67%) hospitals] are representative of Swiss hospital anesthesiologists and surgeons. Anesthesiologists' perceptions of PONV are closer to those found in the literature than surgeons'. More than three quarters of anesthesiologists and less than half of surgeons practice PONV prophylaxis. Half of the respondents are dissatisfied with present antiemetics. Anesthesiologists worry about the cost of PONV prophylaxis, and surgeons are concerned about their lack of theoretical knowledge. Formal PONV policies are rare, with little consensus on treatment responsibilities. Sixty percent of respondents document PONV occurrence, and less than 20% perform any formal PONV audit. This survey identifies factors amenable to improvement regarding PONV management in Swiss hospitals. PONV education is a necessity, particularly for surgeons. Cost needs to be addressed with anesthesiologists. The limited therapeutic efficacy of antiemetics is a concern. PONV management needs standardization, organization, consensus, and research. Better audits and visibility in patients' charts could further improve the quality of PONV management.
Anesthesiology↗
Incidence of first epileptic seizures in the canton of Geneva, Switzerland.
PURPOSE: We wished to determine the incidence of first provoked and nonprovoked epileptic seizures in the canton of Geneva, Switzerland. METHODS: Between June 1, 1990 and May 31, 1991, we collected all cases of suspected epileptic seizures referred to the two hospitals of the county of Geneva, Switzerland and to the private neurologists of the town. The diagnosis probability was based on clinical data from the patient chart and the EEG data. The classification of risk factors proposed by the International League Against Epilepsy (ILAE) Commission on Epidemiology and Prognosis was used. RESULTS: In all, 273 cases were collected. The age-adjusted incidence rate (U.S. population as standard) is 69.4 in 100,000. We observed a bimodal distribution of the cases with age (71 in the group aged 0-10 years and 107.5 in those aged > 60 years). Ninety-seven cases were classified as having provoked seizures (incidence: 25.2 in 100,000). Alcohol consumption (29.8%) and cerebrovascular diseases were the most frequent causes (16.4%). One hundred seventy-six cases were classified as having unprovoked seizures (incidence: 45.6 in 100,000) with the following distribution: seizures in relation with a stable cerebral condition, 69 cases (incidence: 17.9); seizures in relation with an evolutive cerebral condition, 27 cases (incidence: 7); and seizures of unknown etiology, 80 cases (incidence: 20.8). CONCLUSIONS: The incidence rate of first epileptic seizures in the canton of Geneva is quite similar to that reported in a French study (Epilepsia (1990;31:391-394) in which the same methodology for case ascertainment was used. Our data clearly demonstrate that the classification of risk factors proposed by the ILAE Commission on Epidemiology and Prognosis is useful and particularly easy to use in epidemiological surveys.
Adolescent↗
Clinical predictors of mortality from asbestosis in the North American Insulator Cohort, 1981 to 1991.
Recorded mortality from asbestosis has increased markedly in the United States in recent decades, from 0.49 to 3.06 per million persons between 1970 and 1990. Although asbestosis is generally considered to be a slowly progressive disorder, little is known about how clinical and exposure parameters among individuals with asbestosis quantitatively predict subsequent risk of death from asbestosis. We followed 2,609 insulators from the North American insulator cohort 10 yr to determine cause of death and to relate clinical findings to risk of death. This group had undergone clinical and radiologic examination between 1981 and 1983 in 19 cities in the United States. Seventy-four (11.0%) of 674 deaths during the subsequent 10 yr were due to asbestosis, according to the best clinical and radiologic evidence available at the time of death. The 10 yr risk of death (expressed as a percentage) due to asbestosis rose sharply with increasing interstitial fibrosis as identified on the baseline chest X-ray, from 0.9% to 2.4%, 10.8%, and 35.4% for International Labor Office (ILO) profusion categories 0, 1, 2, and 3, respectively. Dyspnea, a low FVC, and/or physical examination findings typical of interstitial fibrosis (rales, clubbing, or cyanosis) raised the risk of subsequent death from asbestosis by 2- to 6-fold. The effect of cigarette smoking on risk of death from asbestosis was small and disappeared after adjustment for ILO profusion score.
Analysis of Variance↗
D-dimer testing for suspected pulmonary embolism in outpatients.
The plasma level of D-dimer, a fibrin degradation product (FDP), is nearly always increased in the presence of acute pulmonary embolism (PE). Hence, a normal D-dimer level (below a cutoff value of 500 micrograms/L by enzyme-linked immunosorbent assay [ELISA]) may allow the exclusion of PE. To assess the negative predictive value of a D-dimer concentration below 500 micrograms/L in outpatients with suspected PE, and the safety of withholding anticoagulant treatment from such patients, we performed D-dimer assays, lower limb venous compression ultrasonography, and lung scans in 671 consecutive outpatients presenting in the Emergency Center of the Geneva University Hospital with suspected PE. Pulmonary angiography was reserved for patients with an inconclusive noninvasive workup. Patients with a normal D-dimer concentration were discharged without anticoagulant treatment and followed for 3 mo. The prevalence of PE was 29%, and D-dimer (using a cutoff of 500 micrograms/L) had a diagnostic sensitivity for PE of 99.5%. Overall diagnostic specificity of D-dimer was 41%, but it was lower among older patients. Of the 198 patients with a D-dimer concentration below the cutoff value, 196 were free of PE, one had a PE, and one had incomplete information because of loss to follow-up. Thus, the negative predictive value of D-dimer concentration fell between 197 of 198 and 196 of 198 cases of PE (99% [95% CI: 96.4 to 99.9]). Using a cutoff value of 4,000 micrograms/L, the overall specificity of D-dimer concentration for PE was 93.1%. In conclusion, a plasma D-dimer concentration below 500 micrograms/L allows the exclusion of PE in 29% of outpatients suspected of having PE. Withholding anticoagulation from such patients is associated with a conservative 1% risk of thromboembolic events during follow-up.
Adolescent↗
Effects of antibiotic treatment in the subset of common-cold patients who have bacteria in nasopharyngeal secretions.
BACKGROUND: Upper-respiratory-tract infection is one of the main causes of overuse of antibiotics. We have found previously that bacteria such as Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae can be isolated from the nasopharyngeal secretions of a substantial proportion of adults with upper-respiratory-tract infections. We have assessed the efficacy of co-amoxiclav in patients with common colds but no clinical signs of sinusitis or other indications for antibiotics. METHODS: Between January, 1992 and March, 1994, 314 patients who presented to our outpatient clinic with common colds were enrolled in the double-blind, placebo-controlled study. They were randomly assigned 5 days' treatment with co-amoxiclav (375 mg three times daily) or identical placebo. Clinical examinations were done at enrolment and on day 5-7 to assess outcome (cured, persistent symptoms, worse symptoms). Seven patients were excluded after randomisation, seven did not have nasopharyngeal aspiration, and 12 did not return for followup assessment. FINDINGS: Of 300 patients with nasopharyngeal aspirates, 72 had negative bacterial cultures, 167 had cultures positive only for bacteria unrelated to respiratory infections, and 61 had cultures positive for H influenzae, M catarrhalis, or S pneumoniae. At 5-day follow-up of these culture-positive patients, the distribution of outcome was significantly better among co-amoxiclav-treated (n=30) than placebo-treated (n=28) patients (cured 27 vs 4%; persistent symptoms 70 vs 60%; worse symptoms 3 vs 36%; p=0.001). Patients on co-amoxiclav also scored their symptoms significantly lower than patients on placebo (p=0.008). Among culture-negative patients (n=230), the outcome distribution did not differ between the treatment groups (p=0.392). INTERPRETATION: The majority of patients with upper-respiratory-tract infection do not benefit from antibiotics and side-effects are frequent. However, for the subgroup whose nasopharyngeal secretions contain H influenzae, M catarrhalis, or S pneumoniae, antibiotics are clinically beneficial.
Adult↗
Relation of breast cancer with passive and active exposure to tobacco smoke.
Studies on passive smoking have consistently shown a tendency toward an increased risk of breast cancer, while studies an active smoking have failed to demonstrate an association. This apparent contradiction may stem from not separating passive smokers from the unexposed when assessing the effect of active smoking. a population based case-control study was conducted in Geneva, Switzerland, between January 1992 and October 1993 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 244 patients with breast cancer (cases) were compared with 1.032 women free of breast cancer (controls). The lifetime history of active and passive smoking was recorded year by year, between the age of 10 and the date of the interview. The adjusted odds of breast cancer for ever active smokers, compared with women unexposed to either passive or active smoke, were 2.2 (95% confidence interval (CI) 1.0-4.4) for an average lifetime consumption of 1-9 cigarettes per day, 2.7% (95% CI 1.4-5.4) for 10-19 cigarettes per day, and 4.6 (95% CI 2.2-9.7) for 30 or more cigarettes per day. Among passive smokers, the adjusted odds ratio was 3.2 (95% CI 1.6-6.3) for being exposed for the equivalent of 2 hours per day for 25 years. The odds ratios were adjusted for known or postulated risk factors of breast cancer, including alcohol and saturated fat intake. There was no evidence of strong selection, detection, or recall biases. Active and passive exposure to tobacco smoke may increase the risk of breast cancer. Additional studies are needed to decide whether the association is causal. Further elucidation of this relation would benefit not only the prevention of breast cancer but also the the prevention of other smoking-related diseases in women.
Adult↗
Diagnosis of pulmonary embolism by a decision analysis-based strategy including clinical probability, D-dimer levels, and ultrasonography: a management study.
BACKGROUND: Assessment of the clinical probability of pulmonary emboli sm, plasma D-dimer measurement, and lower-limb venous compression ultrasonography have all been advocated in the workup of suspected pulmonary embolism, to minimize the requirement for pulmonary angiography in patients with nondiagnostic lung scans. However, their contribution has not been assessed prospectively. METHODS: Three hundred eight consecutive patients who came to the emergency department with suspected pulmonary embolism were managed according to a diagnostic protocol that included clinical probability assessment, lung scan, and sequential noninvasive tests: plasma D-dimer measurement by enzyme-linked immunosorbent assay (a concentration <500 microgram/L ruled out pulmonary embolism) and lower-limb B-mode venous compression ultrasonography (a positive finding was diagnostic of venous thromboembolism). Patients without pulmonary embolism according to the diagnostic workup did not receive anticoagulant treatment. The safety of this approach was assessed by a 6-month follow-up. RESULTS: of the 308 patients, 106 (34%) had a diagnostic lung scan (normal in 43 and high probability in 63). For the remaining 202 patients, noninvasive workup was diagnostic in 125 (62%). Pulmonary embolism was ruled out by a low clinical probability and a nondiagnostic scan in 48 patients and a D-dimer level less than 500 microgram/L in 53; pulmonary embolism was established by a high clinical probability and a nondiagnostic scan in seven patients and by a finding of a deep vein thrombosis on ultrasonography in 17. Therefore, only 77 of these 202 patients underwent pulmonary angiography (negative in 55; positive in 22). At 6-month follow-up (completed for 99.4% of the study population), only two of the 199 patients in whom the diagnostic protocol had ruled out pulmonary embolism (1.0% [95% confidence interval, 0.1 to 3.6]) had a thromboembolic event (pulmonary embolism, one; deep vein thrombosis, one). CONCLUSIONS: This decision analysis strategy yielded a definitive noninvasive diagnosis in 62% of patients with a nondiagnostic scan and appears to be safe.
Adolescent↗
Major causes of deaths between 1901 and 1990 in Geneva, Switzerland.
This is the first analysis of the evolution of major causes of death in the canton of Geneva during the twentieth century. Data was abstracted from handwritten archives of the Federal Office for Statistics. Life expectancy has increased during the century for men and women. There has been a steady decline of the epidemic of tuberculosis during this century. Other epidemics, such as coronary heart disease or lung cancer in males, started during the twentieth century but seem to have already reached a peak. A third group of epidemics such as AIDS or lung cancer in women are still increasing. In the future, surveillance of causes of death should be supplemented with surveillance of exposure to risk factors for these diseases.
Accidents, Traffic↗
[Dietary differences between restaurants and home in a representative sample of the adult population residing in Geneva].
Differences in dietary intakes between those who eat at home and those who eat at the restaurant have not been documented previously. In the present study, three registered dietitians interviewed 626 adult residents of Geneva on the telephone about their diet the day before. Interviews were distributed over the seven days of the week. Participation rate was 80%. Results show that men go more often to the restaurant than women, that young people have lunch at the restaurant more often than older people but that age is not related to having dinner at the restaurant. When a resident of Geneva goes to the restaurant to have dinner, he eats and drinks more than those who eat at home, but the relative content of proteins, lipids and carbohydrates of the diet is not different. In conclusion, in Geneva the diet at the restaurant is very similar to the diet at home. This suggest that the meals in a restaurant tend to adapt to the customer's expectations rather then the opposite. The potential implication for public health is that the priority is to inform the customer about what is a healthy diet, the restaurant owner will follow his client's need.
Adult↗
Smoking prevalence in neighborhood and hospital controls: implications for hospital-based case-control studies.
It is widely believed that the prevalence of smoking among hospital patients is greater than that of the general population because many conditions for which patients are hospitalized are caused by or associated with smoking, and that this increased prevalence may bias results of case-control studies of tobacco-related diseases. For this reason, many authors have suggested excluding from the control series patients hospitalized for tobacco-related illnesses. The present study investigated potential selection bias for hospital compared to neighborhood controls in studying tobacco-related diseases. The 709 cases from six U.S. cities had tobacco-related cancers or myocardial infarction. They were individually matched to one hospital control and to one neighbor. After excluding patients with tobacco-related diseases, hospital controls were less often current smokers and more often former smokers than neighborhood controls. Among male ever smokers, hospital controls tended to smoke more cigarettes per day than neighborhood controls. Compared with the U.S. population, there was an overrepresentation of smokers in neighborhood controls rather than an under-representation of smokers in hospital controls. Relative risk estimates varied according to type of control. Choosing between hospital and neighborhood controls in case-control studies should be dictated by criteria related to the study hypothesis, participation, or cost. In particular, exclusion of hospital controls with diseases known to be tobacco-related seems to be a successful strategy for reducing selection bias.
Adult↗
P. C. A. Louis and the birth of clinical epidemiology.
Pierre Charles Alexandre Louis (1787-1872) has been the direct or indirect mentor of influential U.S. and English scientists in public health, epidemiology, medicine, and biostatistics during the 19th and 20th century. Louis was primarily a clinician, but his name has been more closely associated with the history of epidemiology. There is an imbalance between the fame of Louis's scientific contribution and the scarcity of in depth analyses of his work. The controversy related to the usage of bloodletting for treating inflammatory diseases is one of the most famous episodes of Louis's work. A modern analysis of Louis's data confirms his original conclusions; that is, early bloodletting seems to reduce the duration of a pneumonitis disease in patients who survive from this disease but may also increase the overall short-term mortality. Some basic algebraic mistakes in computations of means tend to attenuate the verdict against bloodletting, but these are trivial relative to the rigor of the overall demonstration and to Louis's methodological contribution to clinical observation. Louis firmly belongs to the history of epidemiology. He deserves a similar place in the history of medicine.
Epidemiology↗
Is intrapartum vibratory acoustic stimulation a valid alternative to fetal scalp pH determination?
OBJECTIVES: To determine the association between fetal heart rate accelerations, whether spontaneous or induced by vibratory acoustic stimulation, and subsequent scalp pH values in presence of a suspicious intrapartum fetal heart rate tracing, and thereby assess the ability of accelerations to predict a concurrent normal fetal scalp blood pH. DESIGN: Prospective observational study of 253 labours involving 421 pH samples. SETTING: Tertiary care university hospital of Genoeva. INTERVENTION: Vibratory acoustic stimulation through the maternal abdominal wall for five seconds prior to fetal blood sampling. MAIN OUTCOME MEASURES: Spontaneous fetal heart rate reactivity (accelerations) in the 10 min preceding vibratory acoustic stimulation, vibratory acoustic-induced reactivity prior to fetal blood sampling, and scalp pH value. RESULTS: The positive predictive value of a reactive fetal heart rate response after vibratory acoustic stimulation was 78% (95% CI 73-84%) and 97% (95% CI 94-99%) for scalp pH values of > 7.25 and > or = 7.20, respectively. Similar observations occurred with spontaneous reactivity. Of concern, 7 out of 31 (23%) occasions where the scalp blood pH was less than 7.20 appeared to be associated with a normal fetal heart rate response to vibratory acoustic stimulation. CONCLUSION: Fetal heart rate acceleration induced by vibratory acoustic stimulation was significantly associated with a normal scalp blood pH higher than 7.25. However, vibratory acoustic stimulation offers no advantage over observation of spontaneous fetal heart rate tracings and cannot safely replace fetal blood sampling during labour.
Acoustic Stimulation↗