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Biomedical subjects

A Morabia

Publications and source records attributed to A Morabia.

At least 19 recordsLinked to original sources
PubMed2005

[Determinants of hypercholesterolemia in Geneva: should the focus be on genes or environment?].

Do genetic (G), or environmental (E), factors primarily determine blood lipid concentrations in the Geneva population? On-going research on the causes of hypercholesterolemia in populations based on data collected by the Bus Santé Survey is summarized. About 2/3 of the HDL-cholesterol variance could not be explained by the most important 5 of 10 environmental factors and 9 of 275 common genetic variants identified in the analyses. The remaining 1/3 of the variance was explained mainly by obesity, smoking, alcohol intake, age, and gender. The common polymorphisms played a much smaller role. GxG, GxE, and ExE interactions were the weakest determinants. Environmental factors appear to be the main determinants of hypercholesterolemia in populations. Measurement of genetic traits for clinical or public health purposes is currently not useful.

Environment↗
PubMed2004

Are there reliable predictors of postoperative pain?

BACKGROUND: The purpose of this study was to identify the preoperative determinants of severe postoperative pain. METHODS: Potential predictors were assessed using a questionnaire submitted on the day before surgery. Pain at rest, and pain during coughing/mobilization, were measured using visual analog scales on the day of surgery and on the following 2 days. The type of postoperative pain management was not standardized and was prescribed by the anesthesiologist in charge. Multivariate logistic regression models explaining postoperative pain were developed in Group I, comprising 304 consecutive patients undergoing orthopedic or intraperitoneal surgery, and validated in Group II, comprising 145 independent patients. RESULTS: Of the 62 variables examined by univariate analysis, only five were found to increase the risk of severe postoperative pain in Group I at rest and six factors during cough/mobilization. In the multivariate model for pain at rest, general anesthesia, expectation of postoperative pain, and chronic sleeping difficulties increased the risk of severe postoperative pain. In Group II, only chronic sleeping difficulties remained (OR: 3.97, 95% Cl: 1.69-9.29). In the multivariate model during cough/mobilization, intraperitoneal surgery, fear of postoperative pain, and having a relative with a history of pain increased the risk of severe postoperative pain in Group I. Intraperitoneal surgery OR 2.45 (95% Cl = 1.01-4.50) and having a relative with a history of pain OR 2.06 (95% Cl = 1.005-4.50) remained in Group II. CONCLUSION: Of the many factors that may influence postoperative pain, chronic sleeping difficulties emerge in this population of patients as the strongest determinant of pain at rest. Intraperitoneal surgery and having a relative with a history of pain are the strongest determinants of pain during cough/mobilization. These findings make physiological sense and deserve more attention by anesthesiologists.

Adolescent↗
PubMed2004

History of medical screening: from concepts to action.

The objective of medical screening is to identify disease in its preclinical, and therefore hopefully still curable, phase. This may have been an old quest in medicine but it became historically possible when at least four conditions were met: the availability of simple, valid and acceptable forms of tests, the discovery of effective treatments, the establishment of a theory of screening, and the wide access to health care. Five selected examples that illustrate the history of medical screening are reviewed: screening for psychiatric disorders in the United States army as it is one of the oldest screening programmes; screening for syphilis as it used one of the earliest screening tests; screening for diabetes as one of the first modern forms of mass screening; screening for cervical cancer using the Pap test as one of the greatest successes of screening; and screening for breast cancer by mammography as this offers a good opportunity to discuss the development of modern evaluation of screening programmes. The evaluation of the impact of screening on human health slowly progressed, from obvious changes in the vital statistics such as the decline in incidence of syphilis, to less obvious changes such as the decline in mortality of cancer of the uterus, to finally more subtle changes, such as the impact of mammographic screening on breast cancer mortality. Methods of evaluation had therefore to adapt, evolving from simple surveys to case-control studies and randomised trials. The history of screening is short, but very rich and mostly still to be written.

Breast Neoplasms↗
PubMed2003

Impact of 'Mad Cow Disease' publicity on trends in meat and total vitamin A consumption in Geneva between 1993 and 2000.

BACKGROUND: In March 1996, revelations about the possible risk for humans of the 'mad cow disease' epidemic had a sudden impact on the diets of European populations. OBJECTIVE: To assess changes in meat and nutrient intakes in adults living in Geneva, Switzerland from 1993 to 2000. DESIGN: Independent annual cross-sectional surveys (4047 women and 4092 men total). MAIN OUTCOME MEASURE: Dietary habits assessed and compared to baseline (January 1993-April 1996) via validated semi-quantitative food-frequency questionnaire. RESULTS: Women beef abstainers increased from 8.9 to 14.9% in late 1996 (P<0.001) and 13.3% in 1997 (P<0.05); among meat consumers, in late 1996 meat/beef intakes declined -10/-12% (both P<0.05). From 1997 to 2000 most intake levels drifted back toward those at baseline, but chicken intakes were significantly (all P<0.05) greater each year (+19% in 2000 (P<0.001). Consistent but less dramatic changes were observed among men. From late 1996 until 2000, liver abstention was significantly (all P<0.05) greater (women from 60 to 78%; men from 61 to 73% in 2000; (both P<0.001). The only nutrient intakes that decreased significantly (all P<0.05) each year from 1997 through 2000 were retinol and total vitamin A women: -22% (P<0.001); -11% (P<0.05) respectively; men: -16% (P<0.001); -10% (P<0.05) respectively, in 2000). Total vitamin A intakes exceeded the dietary reference intake (DRI) for liver eaters (women 185%, men 153%), but were below the DRI for liver abstainers (women 83%; men 66%) in 2000. CONCLUSION: The decreases in beef and liver consumption since late 1996 led to the discovery of a long-term disparity in the retinol and total vitamin A intakes of liver eaters vs abstainers.

Animals↗
PubMed2003

Measuring the habitat as an indicator of socioeconomic position: methodology and its association with hypertension.

STUDY OBJECTIVES: (1) to develop an indicator of socioeconomic position based on the social standing of the habitat (SSH), that is, the residential building, its immediate surroundings, and local neighbourhood; (2) to assess the relation of SSH to two usual markers of socioeconomic position (education and occupation) and a known, socially determined health outcome (hypertension). DESIGN: Population survey measuring SSH, detailed educational and occupational histories, and blood pressure. The SSH is a standardised assessment of the external and internal aspects of someone's building (or house), and of the characteristics of its immediate surroundings and local neighbourhood. SETTING: A sample of participants to the Bus Santé survey between 1993 and 1998, in Geneva, Switzerland. PARTICIPANTS: 588 men and women, aged 35 to 74. MAIN RESULTS: The SSH index was highly reproducible (kappa=0.8). Concordance of SSH with education or occupation was good for people of either high or low socioeconomic position, but not for those with medium education and/or occupation. There was a higher prevalence of hypertension in the lowest compared with the highest groups, defined on the basis of education or occupation, but the SSH was the only indicator that showed a higher prevalence of hypertension among people in the middle of the social spectrum. CONCLUSIONS: People of medium education or occupation are heterogeneous with respect to their habitat. Those living in habitats of medium social standing may be most affected by hypertension but this association could not be revealed on the basis of education and occupation alone. The habitat seems to capture different aspects of the socioeconomic position compared with the usual indicators of social class.

Adult↗
PubMed2002

Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease.

Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58,515 women with invasive breast cancer and 95,067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for >/=45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver.

Adult↗
PubMed2002

Evaluation of do not resuscitate orders (DNR) in a Swiss community hospital.

OBJECTIVE: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions. DESIGN: Prospective clinical interventional study. SETTING: Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland. PARTICIPANTS: Nine junior physicians in postgraduate training. INTERVENTION: Information on the ethics of DNR and implementation of new DNR orders. MEASUREMENTS AND MAIN RESULTS: Accurate understanding, interpretation, and use of DNR orders, especially with respect to the patients' involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients' involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision. CONCLUSION: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision.

Aged↗
PubMed2001

Validation of self-reported smoking status by simultaneous measurement of carbon monoxide and salivary thiocyanate.

OBJECTIVE: The objective of this study was to determine the validity of tobacco questionnaires when using as gold standard either a single biomarker or a combination of two biomarkers. METHODS: The methods were self-reported smoking compared with salivary thiocyanate and expired carbon monoxide in a 1996, population-based, Swiss survey of 552 men and 565 women. RESULTS: Sensitivity of self-reported smoking relative to salivary thiocynate or carbon monoxide alone was low (38.2% for salivary thiocyanate > or = 100 mg/L, 56.4% for salivary thiocyanate > or = 150 mg/L and 62.6% for carbon monoxide > or = 9 ppm). When defining true positive smokers as people with high concentration of both salivary thiocyanate and carbon monoxide, overall, sensitivity was 88.6% and specificity was 87.2%. In women, sensitivity increased from 85 to 89% when removing subjects exposed to passive smoking. When excluding heavy smokers, sensitivity decreased to 63% in men and to 71% in women. Older women had tendency to misreport smoking. CONCLUSIONS: This comparison of questionnaire data with the simultaneous measurement of salivary thiocyanate and expired carbon monoxide indicates that valid responses can be obtained for self-reported, current smoking in population-based surveys. However, the validity of questionnaires can be underestimated if the gold standard (of exposure to tobacco smoke) is either high levels of carbon monoxide or high levels of salivary thiocyanate.

Adult↗
PubMed2001

Physical activity of urban adults: a general population survey in Geneva.

OBJECTIVES: Describing the distribution of physical activity in populations is of major importance for developing public health campaigns to prevent sedentarism. METHODS: A population-based survey conducted during 1997-1999 in Geneva, Switzerland, included 3410 randomly selected men (n = 1707) and women (n = 1703), aged 35 to 74 years. Percentiles P10, P50, and P90 summarised the distributions of the total energy expenditure and of the percents used in moderate intensity activities (3 to 3.9 times the basal metabolism rate (BMR), e.g., normal walking, household chores), and in high and very high intensity activities (> or = 4 BMR, e.g., brisk walking, sports). RESULTS: The total energy expenditure (median 2929 kcal/day in men, 2212 kcal/day in women) decreased with age. Prevalence of sedentarism, defined as less than 10% of total energy expended in > or = 4 BMR activities, was 57% in men and 70% in women. Men expended 12% (median) of their total energy in 3 to 3.9 BMR and 8% in > or = 4 BMR activities. Corresponding percentages in women were 11% and 5%. The highest prevalence of sedentarism was in older age, women, and lower socio-economic status persons. CONCLUSION: Most of Geneva population is sedentary. Promoting physical activity should target children, adults and elderly, and physical activities which would be both attractive and financially affordable by most people.

Activities of Daily Living↗
PubMed2001

Prevalence of anal incontinence and other anorectal symptoms in women.

We studied the prevalence of anal incontinence and other anorectal symptoms in women and evaluated the proportion of those who had sought medical help. A structured questionnaire was distributed to 1228 women attending the obstetrics and gynecology outpatient clinics (general, antenatal, urogynecology) of our university hospital. We also screened an additional sample of 984 women, representative of the general population aged 35-74. The prevalence of anal incontinence was 5.6% in the general outpatient clinic, 6.7% in the antenatal clinic, 15.9% in the urogynecology clinic and 4.4% in the general population. Only 20% of women affected by anal incontinence from the general outpatient clinic had reported their symptoms to a medical practitioner. Anal incontinence affects many women, but only a minority seek help. Obstetriciangynecologists should systematically inquire about the presence of this symptom.

Adult↗
PubMed2001

Role of nasopharyngeal culture in antibiotic prescription for patients with common cold or acute sinusitis.

The aim of the present study was to assess the hypothesis that, when present in nasopharyngeal secretions, Streptococcus pneumoniae. Haemophilus influenzae, and Moraxella catarrhalis play a pathogenic role early in the course of an upper respiratory tract infection. Adults with a clinical diagnosis of acute sinusitis or common cold were enrolled. Participants were randomly assigned in a double-blind manner to receive azithromycin 500 mg daily or placebo for 3 days. The effect of treatment on symptom evolution in the predefined subset of patients with Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis in their nasopharyngeal secretions was assessed. Of 265 patients enrolled, 132 received placebo and 133 azithromycin. Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis was identified in nasopharyngeal secretions of 77 patients (29%). In this predefined subgroup of patients with Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, resolution of symptoms by day 7 occurred in 73% of those treated with azithromycin compared with 47% of those who received placebo (P=0.007). The median time before resolution of symptoms was 5 days in the azithromycin group compared to 7 days in the placebo group. Respiratory complications requiring antibiotic treatment occurred in 19% of patients in the placebo group and in 3% of the azithromycin group (P=0.025). In the remaining 188 patients without Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, resolution of symptoms by day 7 was similar in both groups (69% in the placebo group vs. 64% in the azithromycin group [P=0.75]). Antibiotic treatment is of clinical benefit for patients with acute sinusitis or common cold when Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis is present in nasopharyngeal secretions. This observation provides new insights into the pathogenic role of these bacteria in the early stage of the common cold.

Acute Disease↗