Biomedical subjects
Publications and source records attributed to A Morabia.
The relation of serum retinol and carotenoids to airway obstruction was investigated in a population-based study. Respiratory symptoms and the pulmonary function of 83 white males were assessed in 1979 5 years after their blood had been drawn. Airway obstruction in 1979, defined as a forced expiratory volume in 1 second which was equal to or less than 75% of the forced vital capacity, was associated with a decreased 1974 level of serum retinol.
The relation between body mass index expressed as weight in kilograms divided by height in meters cubed (weight (kg)/height (m3)) and plasma total cholesterol was assessed in a sample of 11,389 US schoolchildren, aged 5-18 years, between 1984 and 1989. Among whites and Hispanics, a statistically significant nonlinear relation was found between weight (kg)/height (m3) and plasma total cholesterol. Mean cholesterol values increased exponentially above the 50th percentile of body mass index. Additionally, mean cholesterol levels as well as the odds of hypercholesterolemia (total cholesterol value greater than 180 mg/dl) were highest among children with weight (kg)/height (m3) values above the 95th percentile. Among black children, weight (kg)/height (m3) did not appear to be related to plasma total cholesterol. Possible explanations as well as public health implications of these findings are discussed.
To investigate the relationship between the reproducibility of measurements of exposure from a frequency questionnaire and inferences from a case-control study, 229 patients were reinterviewed on the telephone an average of 6 weeks after the original interview. Several indices of agreement were computed. Information on smoking and use of alcohol and coffee was quite reproducible, as reflected by most measures of agreement, using grouped or continuous data. Frequency of meat, vegetable, and fruit intake had low reproducibility. For all variables, reproducibility was similar for cases and controls. Reproducibility of the exposure variables was a good predictor of the reproducibility of the relative odds (RO) obtained with the first and the repeat interviews. Lack of reliability of the exposure variable appeared to produce fluctuations in the ROs in either direction, even though the same degree of agreement was observed for cases and controls. This situation may partially explain discrepant findings between case-control studies of diet and chronic diseases.
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The patient's history, physical examination, chest X-ray, electrocardiogram and blood gas analysis cannot provide a firm diagnosis of pulmonary embolism, but they can help to assess its clinical or a priori probability. Lung perfusion scan, associated with ventilation scan or not, can modulate the probability of pulmonary embolism (post-test or a posteriori) as a function of the scan result (high probability, low probability, or indeterminate result). To define the proper indication for pulmonary angiography, it is necessary to examine all the factors related to the nature of the test, the risk, and the data related to pulmonary embolism (outcome, efficacy and side effects of treatment). Decision analysis provides an opportunity to integrate all these factors, and may help in the diagnosis of pulmonary embolism by establishing the indication for pulmonary angiography, depending on clinical probability and the result of the lung scan.
In preventive medicine and occupational health, decision-makers face uncertainty, divergent opinions, and varying needs. In the Swiss aluminum industry, screening for industrial fluorosis illustrates how decision analysis and cost-effectiveness analysis can provide rational and explicit models of decision-making in such contexts. Data on fluoride-exposed potroom workers are used to compare the cost-effectiveness of two strategies: mass screening of fluorosis versus individual detection of the disease on the basis of the worker's symptoms. A decision-analysis and a sensitivity analysis are performed to assess the impact of the screening program for different levels of expected prevalence of the disease. The optimal decision, in economic terms, is the one that minimizes the pension and screening-related costs and maximizes the number of years of full working capacity. Swiss data suggest that a diagnosis of clinical fluorosis is unlikely before 10 years of exposure to fluoride. Between 10 and 30 years of exposure to fluoride, mass screening may be more cost-effective than individual detection of the disease, even when the expected prevalence of the disease in a given industrial setting is less than 10%.
The diet, weight and height of 38 non-institutionalized chronic opiate addicts have been assessed and compared to those of a random sample of the 20-35 year old general population of Canton Geneva, Switzerland. A history questionnaire was administered by specially trained dietitians. Results show that, after adjustment for age and alcohol intake, male addicts have the same caloric intake as non-addicts. However, addicts tend to replace foods that are rich in fat and proteins with foods rich in sucrose and relatively poor in vitamins and minerals. Beer is the major component of their much larger alcohol consumption. On the other hand, the body mass index (kg/m2) of the male addicts is within the normal range, suggesting this may not be a good indicator of their unbalanced diet. This study gives a quantitative assessment, in terms of nutrient intake, of the typical craving for sweet described by opiate addicts.
The hypothesis that vitamin A, or foods rich in vitamin A such as milk, protects against the development of airway obstruction was tested in a subsample of data from the 1971-1975 National Health and Nutrition Examination Survey. The relative risk (estimated by relative odds) of having airway obstruction, defined as a FEV1/FVC less than or equal to 65%, was measured for different levels of nutrient and food group intakes after adjustment for age, sex, Quetelet Index, caloric intake, and cigarette smoking. Among the white respondents (never smokers or current smokers) whose recalled diet could be considered as typical of their usual diet, the relative odds of having airway obstruction was inversely related to vitamin A intake (x2 for trend = 7.2, p less than 0.01). In the analysis by food groups, the adjusted relative odds of airway obstruction for meat and poultry were 2.4 (95% confidence limits: 1.0 to 5.8) and for milk 1.6 (95% confidence limits: 1.0 to 2.5). The association of airway obstruction with lack of vitamin A or milk intake was clearer among smokers. These findings suggest that a diet poor in vitamin A increases the risk of airway obstruction, and are consistent with the previously reported association of chronic bronchitis, milk intake, and smoking.
In November 1984, because of an accident at a chemical plant, the population of a large area in the town of Geneva, Switzerland, was exposed to toxic bromine gas during several hours at concentrations above the short-term exposure limit. We describe the development of the disaster, the reactions of the fire brigade, the police and the first aid services as well as the breakdown of communications that occurred. On-the-spot epidemiological assessment of the exposed area and of the characteristics of the exposure syndrome was combined with the emergency care of 91 self-referred patients that were seen at the University Hospital. Follow-up was obtained one month later. The clinical course was moderate (eyes and upper airways irritation) and self-limiting in all cases. Immediate definition of the exposed population permitted effective follow-up. Such early evaluation could prove to be of crucial importance for managing more serious accidents of a similar nature.
Cardioinhibitory vasovagal syncope with sinus arrest and asystole of 28 seconds' duration occurred during rectosigmoidoscopy in a patient with frequent previous symptoms and a syncopal episode. A ventricular inhibited pacemaker was implanted and the patient has remained asymptomatic for 18 months.
This paper presents the variation in dietary intake, according to sex and age, observed among a representative sample of the over-19-years old residents of Canton Geneva (Switzerland). 576 men and 384 women have been interviewed by 2 specially trained dietitians using a dietary history questionnaire (7.9% of the total population). Differences between sexes are essentially a matter of quantities: in grams or kilocalories, men eat more of all nutriments than women. The energetic intake of the males exceeds by 600 kcal the one of the females. This difference is partly due to a mean alcoholic intake of 44 g for the men and 13.7 g for the women. But the percent of each nutriment in the energetic intake, without alcohol, is the same in both sexes, i.e. 15 +/- 2% of proteins, 40 +/- 6% of lipids and 45 +/- 7% of glucids. The same phenomenon can be seen in Oriental Flandras, in Liège or in Calvados. Age is an important factor influencing all types of nutrient intakes. Our data show that when men or women get older, the percentage of lipids and protids in the energetic intake tends to decrease while the percentage of glucids increases. The total lipid intake decreases with age but the polyunsaturated/saturated fatty acid ration remains constant with age. This observation could be associated with a change in dietary habits of the elderly, a difference of diet from one generation to the other, or the result of a mortality excess among individuals that had an hyperlipidic diet.
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In November 1984, due to an accident at a chemical plant, toxic bromine gas spread into the town of Geneva, Switzerland, at concentrations over five times the maximal admissible concentration (MAC). Monitoring of atmospheric brome concentrations allowed the determination both of the duration of exposure and the geographical area concerned. Description of the immediate measures taken at the time of the accident illustrates how mass panic reactions can be generated or controlled, and clearly shows the vital importance of an effective communication network: it was lacking in this case and caused further insecurity for the population and isolation of the hospital. Immediate and systematic data collection enabled us to carry out an "acute" epidemiological survey of the accident. It is the first report of mass bromine intoxication in the medical literature. 91 patients with symptoms of bromine exposure were seen in the outpatient and casualty departments of the cantonal Hospital, but the clinical course was mild and self-limited in nearly all cases. One patient was admitted for 24 hours. The most common symptoms were upper respiratory tract symptoms, cough and headache. In 20-30% of cases these pesisted for more than three days, and sometimes up to one month. Recording the location of patients at the time when their first symptoms occurred made it possible to define the exposed area with precision. When the initial data collected in this "acute" fashion is reliable, it should be possible to undertake more elaborate epidemiological studies at a later stage if necessary.
In this paper, two oral presentations are combined. The first described the broad aspects of decision analysis and the second mentioned those medical data which need to be gathered in order to apply the model to industrial fluorosis. For this purpose, biological and medical observations were collected, both from workers of the aluminium industry and from controls. The five successive steps for building up a decision tree are then demonstrated, the aim of which being to evaluate the fitness of a screening strategy. A computer programme has been developed which may be applied both to occupational or non occupational diseases. Referring to industrial fluorosis, the computerized decision tree showed that screening with preshift urinary fluor, clinical and radiological signs, plus bone fluor rate is required, as soon as the risk corresponds to a 7% prevalence of the disease.
Medicalization refers to the current practice of providing medical solutions to broad social problems facing the old. This approach is destined to bring about serious economic and sociocultural dilemmas in the coming decades due to the aging trends in Switzerland. On the one hand, additional bed requirements will double, really jeopardizing the present federal savings policy on health and welfare. On the other side, ignoring the specific needs of nearly 20% of the population (as the 65 and over age group are expected to reach in the year 2010), will provoke unwielding social/political tensions. Assigning medical answers to social needs is both expensive and inadequate. This proposition is illustrated by two aspects of Geneva's medical care system for the aged: At the University Geriatric Hospital a large proportion of the patients are admitted for purely social reasons ('home maintenance impossible'). The long term bed stays, medically unjustified, constrains the optimal functioning of this acute care and rehabilitation hospital. The prolonged length of institutionalization reduces the capacity of the elderly out-patients to carry on autonomously. This observation is confirmed by many Swiss medical and sociological surveys which reveal that institutionalization is rarely necessary or desirable in the 10 to 20 first years of post-retirement provided there is an adequate system of social and primary care services available. The drug prescription to those 65 and over consulting at the out-patient department of the Geneva University Medical Policlinic typically amounts to excessive prescription for women and especially of psychoactive drugs.(ABSTRACT TRUNCATED AT 250 WORDS)
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Compared with the dietary recommendations, the adult population of Geneva seems to have an excessive lipid intake and an insufficient intake of carbo-hydrates. This phenomenon is more conspicious in younger adults than in the elderly.