From disease surveillance to the surveillance of risk factors.
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Epidemiologic Methods↗
Biomedical subjects
A Morabia
Publications and source records attributed to A Morabia.
Passive smoking, active smoking, and education: their relationship to weight history in women in Geneva.
OBJECTIVES: This study was undertaken to determine the relationship of education and tobacco smoke to lifetime weight history in women. METHODS: Information on passive smoking, active smoking, and weight history was collected from 928 women aged 29 to 74 years selected from the general population of Geneva, Switzerland. Multivariate analysis of variance was performed for weight, weight at age 20, and weight changes since age 20. RESULTS: Education was inversely related to weight at age 20, current weight, and weight gain since age 20. The least educated group had a current weight of 4 kg more than the most educated group. Differences across smoking categories were small: passive smokers had the highest current weight (63.4 kg) and former active smokers had the lowest (60.4 kg). Weight gain since age 20 tended to be smaller in former and current active smokers (5.5 to 7.2 kg) than in passive smokers (8.3 to 10.4 kg) and those never exposed (9.1 kg). CONCLUSIONS: In this sample, education was an important predictor of women's current weight and weight history. Passive and active smoking had little long-term effect on weight.
Adult↗
Reproductive characteristics of a population of urban Swiss women.
OBJECTIVE: To describe the variability of reproductive life, from menarche to menopause, in the Geneva female population. DESIGN: Women's Health Survey, 1992-1993. SETTING: Mobile epidemiology unit of a University Hospital. SUBJECTS: One thousand and thirty-two women aged 30 to 74 years, resident in Geneva, Switzerland. MAIN OUTCOME MEASURE: Menstrual and reproductive history. RESULTS: A 'typical' woman of Geneva has her menarche at 13 years, regular 28 day cycles with 5 days of menstrual flow. She is 26 years old when she first gives birth and has her last baby (which is typically the second) at age 31. She has 37 years of potential fecundity and a natural menopause at age 50. In addition, 11% of the women have tried to be pregnant during two years without success, 67% have ever used oral contraceptives, 20% had a first birth at age 30 or more and 23% were nulliparous. Younger women reported earlier ages at menarche. Women with lower education tended to be a younger age at the birth of her first child. CONCLUSIONS: In this first study of the reproductive characteristics of women in Geneva, nulliparity and a late first birth appeared unusually frequent, especially when compared with American or Chinese women. The observed distributions of reproductive history are compatible with the very high incidence rate of breast cancer in the Geneva population.
Adult↗
Gln-Arg192 polymorphism of paraoxonase and coronary heart disease in type 2 diabetes.
Paraoxonase is a high-density-lipoprotein-associated enzyme capable of hydrolysing lipid peroxides. Thus it might protect lipoproteins from oxidation. It has two isoforms, which arise from a glutamine (A isoform) to arginine (B isoform) interchange at position 192. The relevance of this polymorphism to coronary heart disease (CHD) in non-insulin-dependent diabetic patients was investigated in case-control study. Of the 434 patients, 171 had confirmed coronary artery disease; the other 263 had no history of such disease. The B allele and AB+BB genotypes were associated with an increased risk of coronary heart disease. Compared with subjects homozygous for the A allele (AA genotype), the odds ratio of CHD for subjects homozygous for the B allele was 2.5 (95% CI 1.2-5.3) and that for those heterozygous for the B allele was 1.6 (95% CI 1.1-2.4), suggesting a codominant effect on cardiovascular risk. When subjected to multivariate analysis, the B allele remained significantly associated with CHD (odds ratio 1.94, p = 0.03). The paraoxonase gene polymorphism is thus an independent cardiovascular risk factor in non-insulin-dependent diabetic patients. A possible explanation for this finding is that activity of the paraoxonase B isotype does not protect well against lipid oxidation, a major atherogenic pathway.
Arginine↗
Poppers, Kaposi's sarcoma, and HIV infection: empirical example of a strong confounding effect?
Are there empirical examples of strong confounding effects? Textbooks usually show examples of weak confounding or use hypothetical examples of strong confounding to illustrate the paradoxical consequences of not separating out the effect of the studied exposure from that of second factor acting as a confounder. HIV infection is a candidate strong confounder of the spuriously high association reported between consumption of poppers, a sexual stimulant, and risk of Kaposi's sarcoma in the early phase of the AIDS epidemic. To examine this hypothesis, assumptions must be made on the prevalence of HIV infection among cases of Kaposi's sarcoma and on the prevalence of heavy popper consumption according to HIV infection in cases and controls. Results show that HIV infection may have confounded the poppers-Kaposi's sarcoma association. However, it cannot be ruled out that HIV did not qualify as a confounder because it was either an intermediate variable or an effect modifier of the association between popper inhalation and Kaposi's sarcoma. This example provides a basis to discuss the mechanism by which confounding occurs as well as the practical importance of confounding in epidemiologic research.
Confounding Factors, Epidemiologic↗
[Consumption of calcium-rich food in the adult population of French-speaking Switzerland and of Tessin].
Food intake high in calcium content is important in the development of skeleton and the prevention of osteoporosis. From a public health perspective, it is therefore important to know the dietary calcium intake of a population. Two population surveys in the French and Italian parts of Switzerland (MONICA, 1988-1989, and Geneva, 1991), were combined to study nutritional habits related to calcium intake. A random population sample, aged 35 et 65 years, answered to a 24 hour recall questionnaire, either self-administered (MONICA, cantons of Vaud, Fribourg and Tessin, N = 2734) or by phone (canton of Geneva, N = 475). In the 4 cantons, for the previous day, 60% of participants ate dairy products, particularly whole milk and cheese. They drunk 3-4 dl/day of milk. A significant proportion (10%) of french and italian speaking Swiss did not consume any food high in calcium content. In Geneva, the mean daily calcium intake was 656 mg in men and 489 mg in women. In conclusion 1) eating habits related to calcium intake are similar across cantons; 2) women consume dairy products more frequently than men, but in smaller quantities; 3) about 60% of men and 80% of women do not get the daily amount of calcium recommended for the prevention of osteoporosis.
Adult↗
Empirical evaluation of the influence of control selection schemes on relative risk estimation: the Welsh nickel workers study.
OBJECTIVE: To perform an empirical evaluation of the theory that relative incidence rate (RIR) and relative risk (RR) can be directly estimated from case-control studies that have different sampling schemes of controls. METHODS: With data from the South Wales nickel refinery workers (SWNRW) study, a nested case-control study of the relation of nickel exposure to respiratory cancers, was conducted within each of four fixed subcohorts that differed for stability of exposure, incidence rates and RIR. Odds ratios (ORs) and confidence intervals (CIs) were estimated either with all available controls or with randomly sampled subsets of controls. RESULTS: Respiratory cancers were not rare as risk of nasal and lung cancer in workers unexposed to nickel varied from 15% to 26% over the full risk period. The RIR was adequately estimated by the OR when controls were identified concurrently to case occurrence throughout the risk period. The RR was well approximated with the OR when controls were a sample of the study base. CONCLUSIONS: These results add empirical support to the theory that the RIR or the RR can be validly estimated in case-control studies. Overall, this theory is relatively tolerant of large departures from the stability assumptions of exposure and of incidence.
Case-Control Studies↗
Influence of white cell count on surgical decision making in patients with abdominal pain in the right lower quadrant.
OBJECTIVE: To evaluate the influence of white cell count (WCC) on the decision to operate on patients with right lower abdominal pain. DESIGN: Open study. SETTING: University hospital, Switzerland. SUBJECTS: 221 adult patients admitted to emergency department with right lower abdominal pain. INTERVENTIONS: Surgeons were unaware of the WCC until after they had initially decided whether to remove the appendix. They were told the result and asked if it would influence their final decision. MAIN OUTCOME MEASURE: Whether surgeons changed their minds about operation when told the initial WCC. RESULTS: 112 Patients (51 men and 61 women) were operated on, of which 44 men (52%) and 42 women (31%) had histologically confirmed appendicitis. The decision to operate was influenced by the initial WCC in only 6 patients (3%, 95% confidence interval (CI) 0.6 to 4.9%). At follow up after 30 days the change of decision in the 6 patients had been correct in 5. CONCLUSION: The WCC did not significantly influence surgical decision-making in the group of patients who were suspected of having acute appendicitis.
Abdominal Pain↗
A cohort study of drug users' compliance with zidovudine treatment.
OBJECTIVES: Determine whether patients who have acquired the human immunodeficiency virus through injecting drug use receive less antiviral medication (zidovudine) than comparable patients of other risk groups considering access to, acceptance of, and compliance with treatment. DESIGN: Historical cohort study. SETTING: Human immunodeficiency virus outpatient clinic. PATIENTS: Human immunodeficiency virus-infected subjects eligible for zidovudine treatment between January 1, 1989, and January 1, 1992, comparing injecting drug users (IDUs) with non-IDUs ("others"). MAIN OUTCOME MEASURES: Proposal, acceptance, start of, and compliance with zidovudine treatment. RESULTS: One hundred fifty-one IDUs and 162 other human immunodeficiency virus-positive subjects became eligible for zidovudine treatment between January 1, 1989, and January 1, 1992. Both groups were proposed zidovudine as often, but zidovudine treatment was refused by 14.9% of IDUs compared with 7.1% of others (P = .029). The IDUs needed considerably more time than other subjects to accept zidovudine therapy (median delay between indication and start of zidovudine treatment, 61 days vs 30 days, P = .0001). After accepting, IDUs were as compliant with treatment as others: 81.3% vs 83.2% were good compliers, and rises of mean corpuscular volume of erythrocytes after 3 and 6 months of treatment were similar in both groups. Former drug users and IDUs receiving methadone were started on zidovudine treatment more often and complied better with treatment than active drug users. Absence of housing and presence of psychiatric diagnosis (both more prevalent in IDUs) were associated with less zidovudine treatment and worse compliance. CONCLUSION: Injecting drug users tend to delay the start of zidovudine treatment. However, once they have started, their compliance is no worse than the compliance of patients from other risk groups. These results have important implications for clinical trials, medical care, and public health.
Adult↗
Post-infection transitory partial correction of thrombocytopenia in May-Hegglin anomaly.
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Adolescent↗
[Nutritional balance of the diet of the adult residents of Geneva].
Diet of the Swiss population has probably changed over the last 10 years, but these changes have not been recorded yet by nutritional studies. In the present study, 3 registered dieticians interviewed over the telephone 626 adults, resident of Canton Geneva, using a 24 hour recall. Interviews were performed during the 7 days of the week. Participants were randomly selected according to their age, sex and nationality. Participation was 80%. The following caloric (C) and nutritional intakes in proteins (P), lipids (L), carbohydrates (CH) and alcohol (A) were recorded: In non Swiss men: C = 2464 kcal/j., P = 16.2%, L = 32.4%, CH = 44.4%, A = 7.0%; in Swiss men: C = 2752 kcal/j., P = 15.3%, L = 34.0%, CH = 43.5%, A = 7.1%; in non Swiss women: C = 1897 kcal/j., P = 16.4%, L = 35.1%, CH = 46.5%, A = 2.4%; in Swiss women: C = 1865 kcal/j., P = 15.0%, L = 35.3%, CH = 46.0%, A = 3.2%. Total caloric intake and iron intake decreased with age. Older women ate less calcium than younger. In summary, the most important determinants of diet are age and sex. Proportion of lipids is relatively low in both men and women. Small differences related to nationality were observed in men.
Adult↗
[Development and validation of a semi-quantitative food questionnaire based on a population survey].
An auto-administered, semi-quantitative food frequency questionnaire was developed to assess evolution of dietary habits in the Geneva population. For this purpose 626 adults, aged 35 years or more and residents of Canton Geneva, were interviewed using a 24 hour recall technique. The questionnaire comprises the 80 food items or homogeneous food groups contributing to more than 90% of the intake in calories, proteins, lipids, carbohydrates, alcohol, cholesterol, calcium, vitamin D and retinol, and to more than 85% of dietary fibers, carotene and iron. To complete the food frequency questionnaire, participants indicate for each of the 80 food items or groups their frequency of consumption and whether their usual portion is equivalent to a reference portion listed in the questionnaire (median portion in the sample), smaller (first quartile of the portion distribution in the sample) or larger (third quartile of the portion distribution in the sample). The questionnaire can be filled in about 20 minutes. To test the new questionnaire we submitted it to a sample of 27 men and 29 women randomly selected from the 626 subjects who participated to the original survey. Mean intakes obtained using the food frequency questionnaire agree well with those obtained using the 24 hour recall for all subgroups defined by age, sex or nationality. The food frequency questionnaire tends to slightly underestimate the absolute intakes of alcohol, fibers and calcium since it is based on a subsample of all food items consumed according to the 24 hour recall interviews. These results suggest that the semi-quantitative food frequency questionnaire is a good alternative to 24 hour recalls to assess mean nutrient intakes in the adult population of Canton Geneva.
Adult↗
Applicability of decision analysis to everyday clinical practice: a controlled feasibility trial.
OBJECTIVE: To determine whether decision analysis is applicable to routine management of suspected pulmonary embolism in an emergency care setting. DESIGN: Controlled feasibility trial. SETTING: Emergency center of a university hospital. PATIENTS: Outpatients (n = 84) admitted with clinical and scintigraphic evidence of pulmonary embolism. INTERVENTIONS: Patients were treated either with the usual clinical work-up for pulmonary embolism (control group) or using a decision analysis model with three options: no action: angiography followed by treatment if positive; treatment without angiography. RESULTS: All six senior residents in the decision analysis group agreed to fully participate for the 16 months of the study. Summarizing the decision analysis model in a graph was critical to obtain acceptance from all the physicians. Decision analysis (n = 43) and control (n = 41) patients underwent similar numbers of angiographies. However, angiographies for patients who had intermediate clinical probabilities of pulmonary embolism, between 25 and 75%, were more frequent in the decision analysis group (9/13 = 69%) than in the control group (7/20 = 35%). Agreement between clinical probability and lung-scan result was stronger in the decision analysis group. CONCLUSIONS: Decision analysis was successfully used to manage all patients suspected of having pulmonary embolism admitted to an emergency center during the 16-month trial. There was no insuperable obstacle to acceptance of clinical decision analysis by the physicians. Decision analysis may have resulted in a better discrimination between low and intermediate clinical probabilities of pulmonary embolism.
Adult↗
Contribution of D-dimer plasma measurement and lower-limb venous ultrasound to the diagnosis of pulmonary embolism: a decision analysis model.
The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study has shown that clinical evaluation and lung scanning may substantiate or exclude pulmonary embolism with reasonable probability in approximately half of the patients in whom it is suspected; for the remainder, pulmonary angiography is considered the gold standard diagnostic test. We performed a decision analysis to assess the potential of two noninvasive tests, D-dimer plasma measurement and lower-limb B-mode venous ultrasound, for reducing the number of pulmonary angiograms necessary to diagnose pulmonary embolism. Our decision model addresses hypothetical patients in the emergency ward with suspected pulmonary embolism and abnormal lung scan results. Results show that D-dimer measurements of less than 500 micrograms/L could be used reliably to exclude pulmonary embolism in patients with an abnormal but not high-probability (inconclusive) lung scan. D-dimer measurements of greater than 500 micrograms/L have no positive predictive value for pulmonary embolism and should be followed by ultrasound, which may replace pulmonary angiography when it discloses deep venous thrombosis. Pulmonary angiography should be performed when ultrasound is negative because of its presumably low sensitivity for deep venous thrombosis in patients with pulmonary embolism. A D-dimer measurement of less than 500 mu/L does not exclude pulmonary embolism in patients with a high clinical suspicion of pulmonary embolism. On the basis of the results of the PIOPED study, we calculated that the combination of D-dimer measurement and ultrasound might reduce the requirement for pulmonary angiography by one third among patients with inconclusive scan results and intermediate clinical probability of pulmonary embolism.
Angiography↗
Non-fibrous dust load and smoking in dental technicians: a study using bronchoalveolar lavage.
A study was conducted with transmission electron microscopy to find whether bronchoalveolar lavage could be used to identify subjects with occupational exposure to mineral particles. Non-fibrous mineral particles in bronchoalveolar lavage (BAL) fluid from 46 dental technicians and 41 white collar controls with lung diseases but free from occupational exposure to dusts were analysed. The total particle concentration in BAL fluid was significantly higher in dental technicians than in controls (12.18 x 10(5) particles/ml of BAL fluid, v 2.03 x 10(5) particles/ml, p < 0.001). Dental technicians had significantly more crystalline silica, aluminium, and alloys containing nickel and chromium. There was a non-significant twofold increase of total particle concentration in the lungs of dental technicians who were smokers compared with non-smokers. The results strongly support the use of BAL fluid analysis to assess dust accumulation in workers in heavily exposed occupations such as dental technicians. This is a valid method to evaluate occupational exposure to non-fibrous mineral particles, and may be useful to determine the occupational aetiology of some respiratory diseases.
Bronchoalveolar Lavage Fluid↗
[Analyzing the effects of the physician-patient relationship].
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Drug Prescriptions↗
[Drug prices in Switzerland: European comparison of "comfort" drugs].
We compared the average Swiss prices of so-called "comfort medicines" with the prices operating in several other European countries. These drugs, which are numerous in Switzerland, were defined as having no demonstrable efficacy or as being prescribed for physiopathological entities of uncertain scientific basis. The comparison shows that the average price of comfort medicines in Switzerland is not different from the German price (-17%, ns), but is higher than in Sweden (+35%, p < 0.05), France (+61%, p < 0.01) and Italy (+65%, p < 0.01). Furthermore, the average price of innovative new chemical entities is strongly correlated with that of the comfort medicines in all the countries considered and despite the vastly different therapeutic value of these two categories of drugs.
Drug Costs↗