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Alfredo Morabia

Publications and source records attributed to Alfredo Morabia.

At least 19 recordsLinked to original sources
PubMed2007

Wilhelm Weinberg's 1913 Large Retrospective Cohort Study: a rediscovery.

Wilhelm Weinberg, German physician, founder, and president of the Stuttgart Society for Racial Hygiene, published in 1913 the results of a large, retrospective cohort study entitled Die Kinder der Tuberkuloesen (Children of the Tuberculous). The exposed cohort comprised 18,212 children whose 3,246 fathers and 2,022 mothers died of tuberculosis between 1873 and 1902. The unexposed cohort comprised 7,574 children whose 1,830 parents died of causes other than tuberculosis in 1876, 1879, or 1886. He found that children of tuberculous parents had higher mortality rates and lower fertility than did children of nontuberculous parents. Because of its size, rigorous design, and meticulous analysis, Weinberg's cohort study stands as one of the major epidemiologic works carried out before 1945.

Adult↗
PubMed2007

Genetic polymorphisms in folate metabolism and the risk of stomach cancer.

Folate deficiency has been implicated in the etiology of stomach cancer through abnormal DNA methylation and disrupted DNA synthesis and repair. Enzyme-coding genes involved in folate metabolism are often polymorphic. In a population-based study of 305 cases and 427 controls in Warsaw, Poland, we evaluated the risk of stomach cancer in relation to polymorphisms in folate-metabolizing genes, including MTHFR (Ex5+79C>T and Ex8-62A>C), MTR (Ex26-20A>G), and MTRR (Ex2-64A>G, Ex5+123C>T, Ex15+572C>T, Ex15-405A>T, Ex9-85C>T, Ex15-526G>A, and Ex14+14C>T). Polymorphisms in the MTHFR gene were not associated with stomach cancer risk. No notable effect was found for polymorphisms in MTR or MTRR either, although MTR Ex26-20 A>G and MTRR Ex5+123C>T polymorphisms were associated with a borderline increased risk of stomach cancer (MTR Ex26-20A>G, AG/GG versus AA: odds ratio, 1.35; 95% confidence interval, 0.96-1.90; MTRR Ex5+123C>T, CT/TT versus CC: odds ratio, 1.30; 95% confidence interval, 0.93-1.82). We did not find significant interactions between polymorphisms in MTHFR, MTR, and MTRR genes and dietary folate and alcohol consumption. Our study did not identify strong genetic determinants in the folate metabolism pathway for stomach cancer risk.

Adult↗
PubMed2006

Longitudinal study of body composition changes associated with weight change and physical activity.

OBJECTIVE: Weight changes result in fat-free mass (FFM) and body fat (BF) changes. This study determined FFM and BF changes after weight gain or loss and whether these changes differ by gender, physical activity, and age. METHODS: Healthy volunteers, recruited between 1991 and 2003, were followed for 1 y (n = 400) or 3 y (n = 305). Active subjects performed >3 h of physical activity of > or =4.0 metabolic equivalents/wk, sedentary subjects performed <3 h/wk. Body weight and body composition by bioelectrical impedance analysis were determined at year 0, 1, or 3. RESULTS: At years 1 and 3, FFM and BF decreased with weight loss and increased with weight gain. BF was more sensitive (P < 0.03) to weight change than FFM. Compared to weight-stable individuals at year 1, weight gains of 1.0-1.9, 2.0-2.9, and > or =3.0 kg changed FFM by -0.04 (P = 0.90), +0.48 (P = 0.15), and +1.39 kg and BF by +1.35, +1.87, and +3.09 kg, respectively (all P < 0.001). Comparable FFM and BF decreases were observed for weight losses (FFM -0.28 kg, P = 0.38; -0.75 kg, P = 0.04; -1.51 kg, P < 0.001; BF -1.01 kg, P < 0.01; -1.55 kg, P = 0.01; -3.13 kg, P < 0.001). These relations were similar across gender and age strata. At year 1, active individuals were less likely to gain BF with weight gain and more likely to lose BF with weight loss than were sedentary individuals, except for weight losses >3 kg. At year 3, the association between body weight and FFM and BF change was similar between active and sedentary individuals. CONCLUSION: Greater weight changes (>3 kg) are necessary for weight change to have a significant effect on FFM than to have an effect on BF.

Adipose Tissue↗
PubMed2006

Claude Bernard was a 19th century proponent of medicine based on evidence.

The French physiologist Claude Bernard (1813-1878) has the unfair reputation of being ferociously opposed to the use of probabilities and statistics in medicine. In the 19th century, he would have been included among those who opposed the emergence of what would eventually become clinical epidemiology. The truth is that Bernard valued the role of medical statistics in clinical medicine but viewed it as potentially misleading in laboratory-based physiology. He posited that clinical medicine had to be guided by probabilistic evidence as long as physiological mechanisms remained unknown. Bernard praised the clinical researches of Pierre Louis aiming to assess the efficacy of bloodletting in the treatment of pneumonitis. The real objects of Bernard's contempt were the physicians who pretended that medicine was an art strictly based on intuition and tact and who pretended that comparative trials and statistics were useless for clinical medicine. Overall, Bernard was a strong and explicit proponent of the importance of scientific evidence in medical knowledge, be it from experiments or from comparative trials.

Attitude of Health Personnel↗
PubMed2006

Concordant association of lipid gene variation with a combined HDL/LDL-cholesterol phenotype in two European populations.

OBJECTIVE: SNP/phenotype associations are difficult to validate. This comparative study demonstrates significant contribution of candidate genes to the variation of a complex cholesterol phenotype, measured in two general populations by a gene-based approach. METHODS: Independent samples of normolipidemic subjects from two Caucasian populations (371 Swiss and 157 Germans) were selected for a case-control-study (high LDL/low HDL versus low LDL/high HDL) with SNP genotypes as independent factors. We examined locus-specific common SNPs that densely cover the genomic regions of 10 lipid genes. RESULTS: Genotype effects were concordant in both ethnic samples, showing that APOE, ABCA1, CETP, and to a lesser degree LDLR, LIPC, and PLTP explained a substantial part of the genetic variation, whereas LPL was associated in only one sample. APOA1, LCAT, and SRB1 exerted no measurable influence. CONCLUSION: This comparison showed that sets of common SNPs representing candidate regions reproducibly validate significant linkage disequilibrium association with a complex metabolic trait.

ATP Binding Cassette Transporter 1↗
PubMed2006

Gender differentials in the evolution of cigarette smoking habits in a general European adult population from 1993-2003.

BACKGROUND: Describe the recent evolution of cigarette smoking habits by gender in Geneva, where incidence rates of lung cancer have been declining in men but increasing in women. METHODS: Continuous cross-sectional surveillance of the general adult (35-74 yrs) population of Geneva, Switzerland for 11 years (1993-2003) using a locally-validated smoking questionnaire, yielding a representative random sample of 12,271 individuals (6,164 men, 6,107 women). RESULTS: In both genders, prevalence of current cigarette smoking was stable over the 11-year period, at about one third of men and one quarter of women, even though smoking began at an earlier age in more recent years. Older men were more likely to be former smokers than older women. Younger men, but not women, tended to quit smoking at an earlier age. CONCLUSION: This continuous (1993-2003) risk factor surveillance system, unique in Europe, shows stable prevalence of smoking in both genders. However, sharp contrasts in age-specific prevalence of never and former smoking and of ages at smoking initiation indicate that smoking continues a long-term decline in men but has still not reached its peak in women.

Adult↗
PubMed2006

Remarkable change in age-specific breast cancer incidence in the Swiss canton of Geneva and its possible relation with the use of hormone replacement therapy.

BACKGROUND: This article aims to explain the reasons for the remarkable change in age of breast cancer occurrence in the Swiss canton of Geneva. METHODS: We used population-based data from the Geneva cancer registry, which collects information on method of detection, stage and tumour characteristics since 1975. For patients diagnosed between 1997-2003, we obtained additional information on use of hormone replacement therapy from a large prospective study on breast cancer. Using generalized log linear regression analysis, we compared age-specific incidence rates with respect to period, stage, oestrogen receptor status, method of detection and use of hormone replacement therapy. RESULTS: In the periods 1975-1979 and 1985-1989, breast cancer risk increased with age, showing the highest incidence rates among women aged >or= 85 years. From 1997, the age-specific incidence curve changed completely (p < 0.0001), showing an incidence peak at 60-64 years and a reduced incidence among elderly women. This incidence peak concerned mainly early stage and oestrogen positive cancers and was exclusively observed among women who ever used hormone replacement therapy, regardless whether the tumour was screen-detected or not. CONCLUSION: The increasing prevalence of hormone replacement therapy use during the 1990s could explain the important change in age-specific breast cancer incidence, not only by increasing breast cancer risk, but also by revealing breast cancer at an earlier age.

Adolescent↗
PubMed2006

Converging prevalences of obesity across educational groups in Switzerland.

OBJECTIVE: To assess whether the rapid increase in obesity prevalence among persons with higher education levels observed in one U.S. study is also observed in a European adult population. RESEARCH METHODS AND PROCEDURES: This study involved continuous surveillance of the adult population of Geneva, Switzerland (1993 to 2004), with annual random, independent, cross-sectional, representative samples (6635 men and 6558 women, ages 35 to 74 years) and analysis of 12-year trends in obesity prevalence across educational level subgroups. RESULTS: Obesity prevalence in men had an upward trend in the medium education subgroup (p < 0.02), a borderline upward trend in the high education subgroup (p < 0.08), but no trend in the low education subgroup. There was a borderline trend interaction between the male low and medium education subgroups (p < 0.09). Obesity prevalence in women had a borderline increase in the low education subgroup (p < 0.08), an almost borderline increase in the high education subgroup (p = 0.11), but no significant trend in the medium education subgroup. There was no evidence of trend interaction between the female education groups. DISCUSSION: In Geneva, as in the United States, the inverse association between education level and obesity rates has weakened over time among men, but, inconsistent with the U.S. findings, has persisted for women. Explanations may include more physically demanding occupations for men with low education levels and different attitudes toward body image between the sexes.

Adult↗
PubMed2005

Relative contributions of genes, environment, and interactions to blood lipid concentrations in a general adult population.

The authors evaluated the contributions of nine genetic (G) variants (selected from 275 single nucleotide polymorphisms in 11 reverse cholesterol transport pathway genes), five environmental (E) factors (selected from 10), and G x G, E x E, and G x E interactions in explaining population variance of blood lipid concentrations. Total cholesterol, triglycerides, and high density lipoprotein (HDL) cholesterol were measured, and low density lipoprotein (LDL) cholesterol and HDL cholesterol/LDL cholesterol ratio were calculated in a population-based random sample of 1,543 men and women in Geneva, Switzerland, aged 35-74 years in 1999-2001. Explained variances (R2) for HDL cholesterol/LDL cholesterol ratio, HDL cholesterol, and LDL cholesterol, respectively, were 34%, 33%, and 19%, decomposed into main effects of G (6%, 4%, and 5%) and E (25%, 28%, and 11%), with just 3%, 2%, and 3% due to G x G, E x E, and G x E interactions, respectively. Risk factor clustering was only moderate: 70% of study subjects had < or =3 variants, 75% had < or =2 environmental exposures, and 69% had < or =5 of both types of factors. Multiple genes with weak associations, together with more dominating environmental factors, are involved in determining blood lipid concentrations. Interactions added little explained variance. Increasing trends in hypercholesterolemia are attributable to environmental changes affecting populations as a whole. Reducing obesity and smoking and moderating alcohol intake in entire populations should remain the primary strategies for lipid control.

Adult↗
PubMed2005

Small, dense lipoprotein particles and reduced paraoxonase-1 in patients with the metabolic syndrome.

The presence of the metabolic syndrome (World Health Organization definition) and its association with lipoprotein abnormalities suggestive of greater susceptibility to oxidative stress have been analyzed in patients with angiographically defined coronary artery disease. The odds ratio for the presence of the metabolic syndrome was significantly higher in coronary artery disease-positive patients (P < 0.001). The metabolic syndrome was also associated with more severe coronary disease (P < 0.01). Patients with the metabolic syndrome had significantly decreased low-density lipoprotein-cholesterol/apolipoprotein B and high-density lipoprotein-cholesterol/apolipoprotein AI ratios, indicative of the presence of small, dense lipoprotein particles. The syndrome was also associated with reduced concentrations and activities of the antioxidant enzyme, paraoxonase-1. The metabolic syndrome is characterized by smaller, denser lipoprotein particles that increase their susceptibility to oxidative modifications and diminished serum paraoxonase-1, which is a major determinant of the antioxidant capacity of high-density lipoproteins. These may be contributory factors to the increased presence and severity of coronary disease in such patients.

Aged↗
PubMed2005

In a quasi-simultaneous assessment, imprecise cholesterol monitoring and screening tests were improved.

OBJECTIVE: To calibrate Reflotron-measured capillary total cholesterol (cTC) relative to a laboratory-measured venous total cholesterol (vTC) criterion standard for monitoring and screening hypercholesterolemia. STUDY DESIGN AND SETTING: Quasi-simultaneous assessment in 1999-2002 of Reflotron cTC and laboratory vTC in a random sample of 4,269 adult residents of Geneva, Switzerland (calibration development subsample n=3,067; validation subsample n=1,172), by means of bias, precision, correlation, sensitivity, and false positive percentage (calculated as 100-specificity) analyses of Reflotron cTC vs. laboratory vTC measures for predicting hypercholesterolemia. RESULTS: Total bias was small (-0.26 mmol/L), but there was substantial negative drift in Reflotron cTC (annual biases +0.08, -0.17, -0.27, and -0.60 mmol/L in 1999-2002). Overall, 57% of Reflotron cTC measurements for 894 hypercholesterolemic patients underestimated laboratory vTC (2%, 57%, 71%, and 98% in 1999-2002). Prior to calibration, sensitivity was 73% for the development and 35% for the validation subsample, with false positive at 4% (development) and 0.1% (validation). After calibration, sensitivity was 78% for the development and 37% for the validation subsample, with false positive at 5% (development) and 0.2% (validation). Using 95% upper prediction limits (UPL) for individual vTC values increased sensitivity to 99% and 83% and false positive percentage to 30% and 7% for the development and validation subsamples, respectively. CONCLUSION: Crude results of Reflotron-measured cTC have poor sensitivity. Instead, 95% UPL can be used for monitoring and screening. Simply adding 0.8 mmol/L to a patient's observed Reflotron cTC value provides a very good approximation to the 95% UPL.

Adult↗
PubMed2005

Health care and illegality: a survey of undocumented pregnant immigrants in Geneva.

Little is known about the conditions of life and the specific health problems of pregnant, undocumented immigrants. This study describes the socio-demographic characteristics and health problems encountered during pregnancy among uninsured, undocumented immigrants in Geneva, Switzerland. A socio-demographic questionnaire was completed by 134 pregnant and undocumented women (mean age 27.8 years) who attended a free antenatal facility between October 2002 and October 2003. The first control of pregnancy was at a median of 10.5 weeks (range 5-33) of amenorrhoea. They were mostly Latino-American (78%), had a median 12 years of education but almost exclusively performed domestic work (91%) after an average residence in Geneva of 18 months. Half of the 62 mothers had left at least one child in their home country. One out of three had never had a cervical smear test and 13% were not immune to rubella. Unintended pregnancies (83%), mostly resulted from lack of contraception (70%). All but one delivery were simple, with a median maternity inpatient stay of 5 days (range 2-10). This population of undocumented, pregnant immigrants comprised mostly highly educated, young, Latino-American women living in poor housing conditions and wages below the legal minimum. The study identified the high proportion of unintended pregnancies as a major health issue. Future research should target these issues and programs addressing lack of access to preventive measures. As well as this, the specific needs of this hard-to-reach population, such as contraception advice, rubella vaccination and cervical cancer screening, should be supported.

Adult↗
PubMed2005

Mortality after a first episode of status epilepticus in the United States and Europe.

OBJECTIVE: In the last decade several studies have been published on incidence, etiology, and prognosis of status epilepticus (SE) with population-based data from the United States and Europe. The aim of this review is to summarize the available information on the epidemiology of SE and to outline the sources of the variability in reported mortality after SE. METHODS: Comparison of mortality studies in SE from the United States and Europe. RESULTS: The incidence of SE is lower in Europe (9.9-15.8/10,000) than in the United States (18.3-41/100,000). The overall mortality after SE is similar in the two U.S. studies: the case fatality is 21% in Rochester, and 22% in Richmond. All European studies excluded SE after anoxic encephalopathy following cardiac arrest. This exclusion may partly explain the lower case fatality (around 10%) found in two of the European studies. The study from Bologna showed the highest case fatality (33%) even after exclusion of anoxic encephalopathy. The mortality in acute symptomatic SE was higher than for other forms of SE across all studies. CONCLUSIONS: Short-term mortality after SE occurs mainly in the acute symptomatic group. Based on published data, it is not clear if differences in early management and medical treatment have any impact on prognosis or whether the differences can be attributed only to differences in distribution of the underlying causes in acute symptomatic SE. Future studies should address this issue.

Acute Disease↗