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Biomedical subjects

Alfredo Morabia

Publications and source records attributed to Alfredo Morabia.

At least 55 records · Page 3Linked to original sources
PubMed2003

Trends in risk factors for the major "lifestyle-related diseases" in Geneva, Switzerland, 1993-2000.

PURPOSE: Continuous monitoring of health determinants in populations is necessary to predict future disease burdens. The objective of this study was to assess the prevalences of major risk factors for lifestyle diseases for 8 years (1993 to 2000) in representative samples of the general population. METHODS: Independent cross-sectional surveys representative of adults aged 35 to 74 years (4228 men and 4190 women) in Geneva, Switzerland, conducted continuously between 1993 and 2000. RESULTS: Prevalence of hypertension decreased 15% in men and 10% in women (trend p's<.0001), while overweight/obesity prevalences increased 10% in men and 8% in women (trend p's<.05). The prevalences of smoking (men: 29%; women: 24%) and physical inactivity (men: 44%; women: 50%) remained high and unchanged, and the dietary unsaturated/saturated fat ratio did not change (men: 0.40; women: 0.48). CONCLUSIONS: Because of the persistent high prevalence of risk factors, the global burden of chronic diseases is likely to grow in the next decade and beyond. Continuous monitoring provides reliable trends, beyond seasonal and sampling variations.

Adult↗
PubMed2003

No physical activity x CETP 1b.-629 interaction effects on lipid profile.

INTRODUCTION/PURPOSE: Being physically active may improve the lipid profile by increasing high-density lipoprotein (HDL) cholesterol (HDL-C) concentrations. Cholesteryl ester transfer protein (CETP) transfers cholesteryl esters from HDL to lipoproteins of lower density. The potential interactive effects of physical activity and the CETP A-C polymorphism on exon 1b.-629 (CETP 1b.-629) with lipid profile were investigated in a population-based cross-sectional survey. METHODS: 1720 men and women, ages 35-74 yr, were randomly selected from the general adult population of Geneva, Switzerland, throughout 1999-2000. A validated physical activity questionnaire measured total energy expenditure and the percentage thereof used in high-intensity activities (% high-intensity activity, e.g., brisk walking, sports). CETP 1b.-629 was assayed with PCR and allele-specific oligonucleotide hybridization. The study had 80% power to detect lipid profile differences from 0.10 to 0.15 mmol x L-1 ( approximately 4-6 mg x dL-1) between gender-specific (CETP genotype x % high-intensity activity) subgroups. RESULTS: HDL-C (mmol x L-1) was higher in men and women with the AA genotype (respectively, 1.26 and 1.56) versus those with CC (1.14 and 1.46) (P < 0.0001, P < 0.002). Before stratification into CETP subgroups, a greater % high-intensity activity (upper tertile) was associated with higher HDL-C only in men (1.24 vs 1.19 in lower tertile, P < 0.0005). However, no statistically significant (CETP 1b.-629 x % high-intensity activity) interactions with lipid profile were detected in either gender. CONCLUSION: The effects of the CETP 1b.-629 A-C polymorphism on blood lipid concentrations appear to be unchanged by the different observed physical activity levels in a mostly sedentary population.

Adult↗
PubMed2003

Trends in risk factors for lifestyle-related diseases by socioeconomic position in Geneva, Switzerland, 1993-2000: health inequalities persist.

OBJECTIVES: We report on trends in risk factors for lifestyle-related diseases among socioeconomic position (SEP) groups. METHODS: We continuously surveyed the adult population of Geneva, Switzerland, for 8 years (1993-2000) with independent, cross-sectional surveys of representative samples (4207 men and 3987 women aged 35-74 years). Age-adjusted linear regression slopes estimated annual risk factor trends. Interaction terms were tested for trend differences between SEP groups. RESULTS: Overall, low-SEP persons had the worst risk factor profiles. Eight-year trends indicate that (1) number of pack-years smoked decreased by half a pack-year among high-SEP female current smokers only; (2) obesity prevalence more than doubled from 5% to 11% among high-SEP men only; (3) systolic and diastolic blood pressures decreased similarly in all SEP groups; (4) unsaturated-to-saturated dietary fat ratio declined in the low-SEP group only; and (5) physical inactivity and current/former cigarette smoking prevalences remained unchanged in all SEP groups. CONCLUSIONS: Smoking, obesity, high blood pressure, and physical inactivity are more prevalent among low-SEP persons. Most socioeconomic risk factor differences remained stable in the 1990s. Thus, social inequalities in chronic disease morbidity and mortality will persist in the next decades.

Adult↗
PubMed2002

Quality of life of Do-Not-Resuscitate (DNR) patients: how good are physicians in assessing DNR patients' quality of life?

QUESTIONS UNDER STUDY: To assess 1) the impact of quality of life evaluation on the implementation of Do-Not-Resuscitate (DNR) orders by physicians, 2) the accuracy of physicians' estimation of DNR patients' quality of life. METHODS: A 10-month prospective clinical study in a community hospital including 255 DNR patients and 9 physicians in postgraduate training. Outcomes of interest were the influence of quality of life on the DNR decision and the assessment from patients and physicians of five different components related directly or indirectly to quality of life: mental (the Mini Mental State Examination), physical (the Activities of Daily Living) and social (Framingham Disability), degree of pain (visual analogical scale of pain) and of depression (Geriatric Depression Scale). RESULTS: Quality of life intervened in more than 70% of the DNR decisions. However, physicians underestimated quality of life components of DNR patients (Kappa <0.4 for each functionality). Severe depression, social isolation and physical dependence influenced negatively patients' perception of their quality of life (p <0.01). CONCLUSION: Physicians often (71%) rely on the assumed quality of life of their patients in their DNR decision but unfortunately tend to underestimate it. Greater involvement of patients in the DNR decision could improve quality of care.

Decision Making↗
PubMed2002

Smoking (active and passive) and breast cancer: epidemiologic evidence up to June 2001.

The first generation of studies evaluating the association between exposure to tobacco smoke and breast cancer merely compared active to nonactive smokers, with varying degrees of detail in the definition of active smoking. With rare exceptions, studies of this kind failed to show an effect of smoking on breast cancer risk. However, such analysis is probably insufficient. The most recent reports on the smoking-breast cancer connection have two characteristics. Some have separated women exposed to passive smoking from those nonexposed to either active or passive smoke. Other reports have focused on factors that modify the effect of smoking on breast cancer incidence, such as genetic markers or hormone receptors. A minority of reports combines these two characteristics. This review addresses the epidemiologic evidence for a link between smoking and breast cancer and discusses the implications of this evidence for future studies.

Adult↗
PubMed2002

Prescription of hypnotics and tranquilisers at the Geneva prison's outpatient service in comparison to an urban outpatient medical service.

OBJECTIVES: Examine whether an overconsumption of tranquillizers exists in prison and discuss possible reasons. METHODS: Comparative study during three weeks at Geneva: prison outpatient service and Medical Policlinic (MP) of the University Hospital. RESULTS: When comparing the 113 (prison) and 151 (MP) male patients younger than 39 years, we found important differences concerning the quality and quantity of prescriptions of psychoactive drugs: ten times more prison patients than patients from the MP were treated with benzodiazepines (BZD). The differences persisted even when considering only prisoners who were not known to be street drug, alcohol or long time BZD consumers. CONCLUSIONS: The differences cannot be explained by the high percentage of drug addicts in prison. Our results suggest the importance of factors related to the prison environment.

Adult↗
PubMed2002

The development of a questionnaire to assess past year physical activity in a multi-ethnic/racial urban population.

OBJECTIVES: Describe the development of a questionnaire to assess past year physical activity, including activities of daily living, in a multi-ethnic/racial cohort. Describe energy expenditure (EE) patterns in the sample used for questionnaire development. METHODS: 24-hour activity recalls were collected from a convenience sample (N = 367) at four New York City health agencies (October 1999-February 2000). EE was determined at the population, subgroup, and individual level. EE distributions were compared. RESULTS: Activities identified were similar to those on established questionnaires. Subgroup and individual EE differences were noted. Median EE at the Chinese and Puerto Rican sites were lower than those at the Caribbean or Dominican sites. No clear age pattern was apparent. Overall, a greater percentage of daily EE was spent in low intensity activities. The resultant 30-minute interviewer-administered questionnaire ascertains patterns (frequency and duration) of domain-specific (recreational, household, occupational, and transportation) activity. This information combined with published intensity levels provides summary EE measures. CONCLUSION: Variation in EE levels requires information on activity type and amount. Summary activity measures can be used to rank individuals analogous to nutrient food frequency measures.

Activities of Daily Living↗
PubMed2002

Assessing efficacy of chronic therapy when disease is characterized by frequent relapses: the example of schizophrenia.

In assessing the efficacy of therapy for schizophrenia, the effect of medication on relapse needs to be distinguished from the influence of relapse on medication. Typically, effective medication prevents relapse, but relapse generally induces medication. Conventional analyses using either treatment or disease as outcome do not separate these two effects. We propose an alternate approach that uses both treatment and schizophrenic relapse as random variables. Data from 58 schizophrenic patients, with up to 60 consecutive monthly determinations of antipsychotic medication and schizophrenic events, were analyzed using a bivariate transition model with random effects. This analysis revealed that the risk of current schizophrenic relapse is reduced by continuous medication (previous month and current month) but not necessarily by discontinuous medication.

Adult↗
PubMed2002

The controversial controversy of a passionate controversialist.

Alvan Feinstein was among the pioneers who perceived the need to apply epidemiologic principles and methods to clinical medicine. In his attempt to convert his peers to his own views, he was very liberal in criticizing the work of others. Epidemiologists still recall his 1988 article in Science entitled "Scientific Standards in Epidemiologic Studies of the Menace of Daily Life," in which he criticized observational epidemiology for its lack of scientific rigor. In this context, Feinstein's work has also been the center of controversies. One in particular, related to the fact that he carried out research and consulted for industries, in particular the tobacco industry, has tainted the last years of Feinstein's career. My purpose in this article is to discuss Feinstein's relationship with the tobacco industry. It is not to judge the validity of his work. Against this background, a question of historic relevance, one that can be discussed on the basis of some evidence, is whether Feinstein, world-reknowned epidemiologist and editor of this journal from 1982 until his recent death, helped the tobacco industry to publish articles minimizing the deleterious effects of smoking in the Journal of Chronic Diseases and (since 1988) the Journal of Clinical Epidemiology. To address this question I have searched the articles related to the effects of tobacco that were published in the Journal since 1978. The tobacco industry has had the opportunity, via its consultants, to defend its own ideas in the "Variance and Dissent" section. Perhaps in hindsight Feinstein could be criticized for not having clearly indicated the sponsorship of the tobacco industry behind these publications, of which he was fully aware. However, this does not suffice to infer that he was the tobacco industry's "man." Feinstein's attitude in matters of publication appears balanced.

Epidemiology↗
PubMed2002

Symptoms and clinical and radiological signs predicting the presence of pathogenic bacteria in acute rhinosinusitis.

A minority of patients with upper respiratory tract infections (URTI) have a bacterial infection and may benefit from antibiotherapy. In previous investigations we showed that in patients suffering from acute rhinosinusitis associated with the presence of Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis in their nasopharygeal secretions, resolution of symptoms was significantly improved by antibiotic treatment. The present analysis was performed to determine whether specific clinical symptoms or signs observed during careful endoscopic examination of the nasal cavities could help the clinician to identify a subset of patients with moderate forms of acute rhinosinusitis infected with pathogenic bacteria. Detailed clinical histories were obtained and medical examinations performed in 265 patients (138 females, 127 males; mean age 35 years) presenting with a < 4-week history of URTI symptoms but who did not require immediate antibiotic therapy for severe rhinosinusitis. The presence of three pathogenic bacteria (S. pneumoniae, H. influenzae and M. catarrhalis) was determined in all patients by culture of nasopharyngeal secretions. Azithromycin (500 mg/day for 3 days; n = 133) or placebo (n = 132) were randomly given to all patients in a double-blind manner. Pathogenic bacteria were found in 77 patients (29%). The clinical signs and symptoms significantly associated in a multivariate model with the presence of bacteria included colored nasal discharge (p < 0.003), facial pain (p < 0.032) and radiologically determined maxillary sinusitis (complete opacity, air-fluid level or mucosal thickening > 10 mm) (p < 0.001). This 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. In the group of patients with positive bacterial cultures, resolution of symptoms at Day 7 was observed in 73% of patients treated with azithromycin and in 47% of patients in the placebo group (p < 0.007). We conclude that signs and symptoms of acute rhinosinusitis in patients with mild-to-moderate clinical presentations are poor predictors of the presence of bacteria.

Acute Disease↗
PubMed2002

An assessment of non-randomized medical treatment of long-term schizophrenia relapse using bivariate binary-response transition models.

The analyses of observational longitudinal studies involving concurrent changes in treatment and medical conditions present difficulties because of the multitude of directions of potential relationships: past medication influences current symptoms; past symptoms influence current medication; and current medication is associated with current symptoms. In the context of a long-term study of non-randomized pharmacological treatment of schizophrenic relapse, we present an analysis of bivariate discrete-time transitional data with binary responses in an attempt to understand the transitional and concurrent relationships between schizophrenia relapse and medication use. A naive analysis does not show any association between previous medication and current relapse. However, we provide evidence suggesting that current treatment may impact current relapse for those who have previously taken medication, but not for those who haven't taken medication in the past. When univariate models are specified to assess these associations, the bivariate nature of the problem requires a choice of which response, relapse or medication, should be the dependent variable. In this case, the choice of relapse or medication as a dependent variable does matter. Hence, our results derive from models where both relapse and medication are treated as dependent variables. Specifically, we specify a bivariate log odds ratio for current relapse and current medication use and a separate univariate logit component for each of these outcomes. Each of these components contains transitional associations with previous relapse and medication. Such models represent extensions of univariate transitional association models (e.g. Diggle et al. (1994)) and correspond to bivariate transitional models (e.g. Zeger and Liang (1991)). We incorporate changes in transitional associations into the full-data parametric model for final inference, and investigate if these temporal changes are due to learning effects or the impact of drop-out. We also perform residual analyses and sensitivity analyses in the context of missing data patterns.

Journal Article↗
PubMed2002

Physical activity may modulate effects of ApoE genotype on lipid profile.

Increased levels of physical activity may improve the lipid profile, but is this effect identical across apolipoprotein E (apoE) genotypes? A population-based cross-sectional survey conducted from 1999 to 2000 included 1708 randomly selected men and women aged 35 to 74 years. A validated physical activity questionnaire measured, for each participant, the total energy expenditure and its percentage used in high-intensity activities (%high-intensity activity), eg, brisk walking and sports. The effects of the apoEx%high-intensity activity interaction on the lipid profile were investigated by using multiple linear regression models. Among men, increased %high-intensity activity had greater protective effects in the apoE4 group regarding (1) high density lipoprotein (HDL) cholesterol (P<0.001), compared with either the apoE2 (interaction P=0.05) or apoE3 (interaction P<0.03) groups, and (2) triglycerides (P<0.03), compared with the apoE3 group (interaction P=0.07). A 10% increase of %high-intensity activity by an apoE4 man would correspond with a 0.07-mmol/L increase in HDL cholesterol and a -0.15-mmol/L decrease in triglycerides. Among women, only the protective effects of physical activity on HDL cholesterol in the apoE4 group versus the apoE2 group was statistically significant. Spending a larger fraction of the total energy expenditure in high-intensity activities may counteract the atherogenic effects of the epsilon4 allele on the lipid profile.

Activities of Daily Living↗
PubMed2002

Ages at initiation of cigarette smoking and quit attempts among women: a generation effect.

OBJECTIVES: This study sought to determine whether the age at initiation of regular cigarette smoking and the likelihood of quitting smoking through age 35 differ among women from younger versus older generations. METHODS: Annual population-based, random surveys (total of 3676 female residents of Geneva, Switzerland, aged 35-74 years) were conducted from 1992 to 1998. RESULTS: Women younger than 55 years were more likely to be past or current smokers, began smoking earlier (median age < 20 years), and smoked more cigarettes per day than older women, yet attempted to quit smoking more often before age 35 (log-rank P <.001). CONCLUSIONS: Young female smokers have a higher propensity to quit smoking compared with older women. Encouraging young smokers to quit-in addition to preventing nonsmokers from starting-may be an important facet of reducing cigarette smoking prevalence among adolescents.

Adolescent↗