Acquired anaemia and polycythaemia.
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Africa↗
Biomedical subjects
A Rougemont
Publications and source records attributed to A Rougemont.
When providers and community leaders define health priorities: the results of a Delphi survey in the canton of Geneva.
The Delphi method was used to determine the health priorities in one Swiss canton. The opinion of various groups concerned, either as health professionals or as representatives of the general population, was gathered to identify the health determinants and health problems perceived as most important, to clarify the reasons for these choices, and to recommend interventions to be undertaken in order to improve the situation in the identified priority areas. Five panels, including health professionals as well as selected leaders of community groups with no direct involvement in health, were given the opportunity to reply to two rounds of questionnaires. There was a high convergence of opinion on health determinants and problems to be given priority between panels and between the first and second round. Priorities identified are mainly physical problems (cardiovascular disease, respiratory and breast cancer, AIDS, injuries due to road accidents, chronic back pain), psychosocial disorders (depression, suicide, violence in the family, stress), and problems of substance abuse (alcohol and tobacco). Unemployment and social isolation were chosen because of their perceived impact on health. Very few interventions were proposed in the medical technical or research areas. This may be due partly to the fact that good quality care is widely available and accessible in Geneva, whereas preventive programmes have not received enough attention in the past. Through the identified priorities and the proposed activities, a new vision of health emerges which gives more importance to psychosocial problems and the social environment. In this context, health promotion is seen as essential, acknowledging that sustained change in individual behaviours can only occur if the social and cultural context is taken into consideration. In conclusion, the results of this survey show that the Delphi method is a useful tool to reach consensus on health priorities and corresponding activities among a variety of actors.
Delphi Technique↗
What does a single determination of malaria parasite density mean? A longitudinal survey in Mali.
Temporal variations of blood parasite density were evaluated in a longitudinal study of young, asymptomatic men in a village with endemic malaria in Mali (West Africa). Our main intention was to challenge the value of a single measure of parasite density for the diagnosis of malaria, and to define the level of endemicity in any given area. Parasitaemia and body temperature were recorded three times a day in the wet season (in 39 subjects on 12 days) and in the dry season (in 41 subjects on 13 days). Two thousand nine hundred and fifty seven blood smears (98.5% of the expected number) were examined for malaria parasites. We often found 100-fold or greater variations in parasite density within a 6-hour period during individual follow-up. All infected subjects had frequent negative smears. Although fever was most likely to occur in subjects with a maximum parasite density exceeding 10000 parasites/mm3 (P = 0.009), there was no clear relationship between the timing of these two events. Examples of individual profiles for parasite density and fever are presented. These variations (probably due to a 'sequestration-release' mechanism, which remains to be elucidated) lead us to expect a substantial impact on measurements of endemicity when only a single sample is taken. In this study, the percentage of infected individuals varied between 28.9% and 57.9% during the dry season and between 27.5% and 70.7% during the wet season. The highest rates were observed at midday, and there were significant differences between days. Thus, high parasite density sometimes associated with fever can no longer be considered as the gold standard in the diagnosis of malaria. Other approaches, such as decision-making processes involving clinical, biological and ecological variables must be developed, especially in highly endemic areas where Plasmodium infection is the rule rather than the exception and the possible causes of fever are numerous.
Adult↗
Estimating the burden of disease in one Swiss canton: what do disability adjusted life years (DALY) tell us?
BACKGROUND: Examining life expectancy and general mortality rates, the health of the population of Geneva can be described as one of the best in the world. However, in some areas Geneva fares worse than the rest of Switzerland or Europe. To re-appraise the current health priorities of the Genevan population, we analysed the relative importance of specific diseases and injuries calculating DALYs. METHODS: We followed the procedures developed for the Global Burden of Disease (GBD) study to ensure comparability. Some adaptations were made for mortality coding. Disability was estimated based on data for countries classified as Established Market Economies (EME) in the GBD study. RESULTS: Non-communicable diseases accounted for 79% of the disability adjusted life years (DALY), injuries represented 12%, and communicable diseases and other disorders 9%. Ischaemic heart disease was the largest single contributor to DALY, followed by unipolar major depression. Neuropsychiatric disorders and mental health accounted for more than 23% of DALY. CONCLUSIONS: Some of the most important problems identified-depression, osteoarthritis and alcohol abuse-would have been overlooked in an analysis based solely on mortality data. The most striking finding is the importance of mental health problems. The main limitation is the lack of morbidity data for Geneva.
Adolescent↗
Setting health priorities in a Swiss canton: what do different methods tell us?
STUDY OBJECTIVE: Despite excellent mortality indicators, there is clear evidence that the health status of the population of Geneva could be improved if more attention and resources were devoted to prevention strategies. To identify a set of robust health priorities an original approach was used triangulating results between three methods. METHODS: The study calculated potential years of life lost, disability adjusted years of life lost, and conducted a Delphi survey to gather the opinion of health professionals and the general public. MAIN RESULTS: Several health conditions were unanimously selected by all three methods as top priorities: cardiovascular diseases, AIDS, respiratory cancer, breast cancer for women, suicide and traffic accidents. In addition, two determinants-alcohol abuse and tobacco abuse-for which a clear conceptual link could be established between all methods were chosen. Connections between priorities identified through the DALY and the Delphi method lead to further inclusion of chronic back pain and depression. Some issues solely identified through the Delphi survey were included as they were consistently considered important by professionals and the lay public alike-violence in the family, unemployment, social exclusion. CONCLUSIONS: These results indicate that health priorities, and by extension health care priorities, would benefit from using a mix of quantitative and qualitative research methods. The triangulation of results allows for a broader perspective and makes results more acceptable.
Attitude↗
Breast-feeding in Geneva: prevalence, duration and determinants.
A telephone survey was carried out with the objective of measuring the prevalence, duration and determinants of breast-feeding in the canton of Geneva, between August and December 1993. The participants were 278 out of 320 families with a telephone number in Geneva, from a random sample of families in which a child had been born in Geneva in the preceding 15 months. Prevalence of breast-feeding at 1 day of life was 93.3%, at 3 months 62.5%, at 4 months 51.1%, at 6 months 28.1%; median duration was 4.2 months. For complete (exclusive or predominant) breast-feeding, results were: 1 day 87.3%, 3 months 37.5%, 4 months 19.4%, 6 months 3.8%; median duration 2.4 months. Initial prevalence of breast-feeding was significantly higher in girls (97.2%) than in boys (89.4%, p < 0.01). Duration of breast-feeding was shorter in children of women who smoked (p < 0.001). Relative risks for no breast-feeding at 4 months were 1.53 (95% confidence limits 1.20-1.96) for less than 15 cigarettes per day during pregnancy, and 3.65 (2.19-6.09) for 15 cigarettes or more. Duration of breast-feeding was shorter if the mother worked as an employee. Prevalence and duration were higher if the mother was originally from Africa, Asia, Middle-East or Latin American countries. Although the initial prevalence of breast-feeding was relatively high, only half of children were breast-fed at 4 months. Promotive efforts are needed to increase the duration of breast-feeding, in particular by legislation on maternal protection. Further studies are required to clarify gender differences in breast-feeding.
Age Factors↗
Public health importance and risk factors for cercarial dermatitis associated with swimming in Lake Leman at Geneva, Switzerland.
Fifteen cohorts of healthy bathers were recruited at four Lake Leman beaches between 3 July and 23 August 1996 to assess the public health importance of cercarial dermatitis in Geneva, Switzerland. Telephone follow-up interviews were carried out after 2-7 days. Overall, 153 bathers out of 555 reported probable cercarial dermatitis at follow-up. Median daily attack rate was 27.7% (2.2-57.7%). Of the cases, 11.1% noticed more than 30 skin lesions, 19.6% described severe itching, 50.3% used a drug treatment, 3.9% visited a doctor and 15% claimed they would reduce their bathing activities. History of cercarial dermatitis, time spent in the water, hour of the day, barometric pressure and maximum daily atmospheric temperature predicted disease occurrence in multivariate analysis. While a benign disease, cercarial dermatitis may have a negative impact on the local water recreation industry. The identification of risk factors for the disease may help produce better preventive recommendations for the bathers.
Adolescent↗
Seasonality and malaria in a west African village: does high parasite density predict fever incidence?
In this cohort study, the authors studied the effect of blood malaria parasite density on fever incidence in children in an endemic area with 9 days' follow-up of 1- to 12-year-old children during two time periods: the end of the dry season (May 1993: n = 783) and the end of the rainy season (October 1993: n = 841) in Bougoula, West Africa (region of Sikasso, Mali). The cumulative incidence of fever (temperature > 38.0 degrees C) was 2.0% in the dry season and 8.2% in the rainy season (p < 0.0001). In the rainy season, the risk of fever was increased in children of ages 1-3 years (relative risk (RR) = 2.5, 95% confidence interval (CI) 1.6-4.1); in those with an initial parasitemia > 15,000/microliter (RR = 2.7, 95% CI 1.4-5.4); in children with an enlarged spleen (RR = 2.0, 95% CI 1.2-3.3); or in those with anemia (hematocrit < 30%: RR = 1.8, 95% CI 1.1-2.9). In the dry season, anemia was the only predictor of fever incidence. In the rainy season, the best predictors of fever were, in order, age (< 4 years), enlarged spleen, and high parasite density. Even in the higher risk groups, the cumulative incidence was < 20%. The authors conclude that most children with high parasite density do not develop fever subsequently. The association between parasite density and fever varies according to age and season. Since even high levels of parasite density do not reliably predict fever incidence, parasite density should be considered as just one of a group of indicators that increase the probability of a fever of malarial origin.
Africa, Western↗
[Educational strategies and tools in a public health program at the University of Geneva].
In the Swiss context, the newly developed MPH programme at the University of Geneva is experimental in educational matters. Indeed the programme is fully learner-centered and community-oriented. Throughout the curriculum students plan, implement and evaluate intervention programmes or/and research projects related to health problems of the communities they are in charge of. In this article, we describe the educational strategies and tools used in this MPH curriculum (professional profile, mind-mapping procedures, field-work either on research projects or on intervention programmes, group work and evaluation procedures). These strategies and tools might assist some educational experimentation in MPH programmes in search of public health relevance and pedagogic efficacy.
Certification↗
[Prone sleeping position and other risk factors in sudden infant death syndrome: a prevalence study in Geneva].
A survey by telephone interviews has been carried out in 1993 in the canton of Geneva, in order to measure the prevalence of 3 risk factors for the sudden infant death syndrome (SIDS) and to evaluate the potential for SIDS prevention based on these factors: prone sleeping position, tobacco smoking by the parents during pregnancy, and no complete breast-feeding at 8 days of age. 278 families participated to the study, of 320 families who could be contacted by telephone in Geneva, from a random sample of 550 families having had a child in Geneva in the preceding 12 months. 40% of the infants had been put to bed in the prone position on the preceding evening 18% of the mothers had smoked during pregnancy. Prevalence of low birth weight was 4.9% for 0 to 4 cigarettes per day during pregnancy, 17.2% for 5 cigarettes and more. At one week, 16.5% of children were not exclusively breast-fed. On the basis of these results, it can be estimated that an effective prevention programme, centered on prone sleeping position could decrease the incidence of SIDS by 50% or more. An even greater fraction of cases, up to 80%, could be avoided by the prevention of the 3 studied factors. These estimates show the need to develop a mother and child health programme in Switzerland.
Adult↗
A community-skills program in a preclinical curriculum.
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Clinical Competence↗
Prospective versus retrospective measurement of change in health status: a community based study in Geneva, Switzerland.
STUDY OBJECTIVES: To compare prospective and retrospective measurements of change in health status. DESIGN: Health status was measured using a French language version of the short form 36 (SF-36) health survey on two occasions one year apart--in 1992 and 1993. Differences in SF-36 scores measured prospectively were compared with the patients' single item retrospective evaluation of change in health (transition item). SETTING: This was a community based study among members of two health insurance plans in Geneva, Switzerland. PARTICIPANTS: Altogether 831 young adults (mean age 30 years at baseline). MAIN RESULTS: Health status remained stable on average during the study period. The retrospective rating correlated well with changes in health measured prospectively: those who said in 1993 that their current health was "much worse" than in 1992 experienced an average decrease of 1.06 SD on the eight SF-36 scales, while those who said that their health was "much better" recorded an average improvement of 0.43 SD. The associations between prospective and retrospective assessments of change were approximately linear for all scales but physical functioning. The transition item also discriminated between time periods: transition reported for 1991-92 did not correlate with changes recorded for 1992-93. Relative validity analyses indicated that the transition item was better suited to capture changes in general health than changes in purely physical or mental aspects of health. CONCLUSIONS: The concordance between retrospective and prospective measures of change in health suggests that both are sensitive, to some extent, to true changes in health status. Using both types of assessment may improve the reliability of measurements of change.
Adult↗
Seasonality, malaria, and impact of prophylaxis in a West African village I. Effect of anemia in pregnancy.
The importance of malaria as a cause of anemia in pregnancy in endemic areas remains controversial. The prevalence of anemia in pregnant women following the dry (May) and the rainy (November) seasons was compared in two successive years in Bougoula village (region of Sikasso, Mali). Phase I (1992) was observational and included 172 pregnant women and 208 controls. In Phase II (1993, 174 pregnant women and 206 controls), malaria prophylaxis with proguanil (200 mg/day) and chloroquine (300 mg/week) was offered to pregnant women. A strong seasonal variation in the prevalence of moderate to severe anemia in pregnant women (hematocrit < 30%) occurred in Phase I (dry season = 8.7%, rainy season = 41.2%). This variation was present only in women of parity lower than five, and paralleled variation in parasitemia. In Phase II, the seasonal variation of anemia was suppressed in women under malaria prophylaxis (presence of antimalarial metabolites in urine), and the overall prevalence of moderate to severe anemia in pregnancy decreased by 55.5% (22.8-74.3%). We conclude that malaria is the major cause of anemia in pregnancy in this region. A high priority should be given to prevention of malaria in pregnancy.
Adolescent↗
Seasonality, malaria, and impact of prophylaxis in a West African village. II. Effect on birthweight.
The impact of malaria on low birthweight was investigated in Bougoula village (Sikasso region, Mali). In two successive years, pregnant women were followed until delivery. Phase I (1992) was observational, with 135 complete observations. Phase II (1993) included 126 participants, who were offered malaria prophylaxis with proguanil (200 mg/day) and chloroquine (300 mg/week). The results show that 1) infants of first and second pregnancies had lower birth weights (-382.7 +/- 62.6 g; P < 0.0001) compared with higher rank pregnancies; 2) strong seasonal variation in birthweight was observed in Phase I, with an annual cycle, a nadir in January, and an amplitude of 372.4 g (P = 0.0002); 3) parasitemia measured during pregnancy was associated with lower birthweight in infants from first and second pregnancies, but not from higher parity mothers; and 4) malaria prophylaxis taken for 20 weeks or more in Phase II suppressed the seasonal variation of birthweight and the effect of low parity (+423.4 +/- 118.8 g; P = 0.0004). We conclude that malaria in pregnancy has an important negative impact on birthweight in first and second pregnancies. Prophylaxis with proguanil and chloroquine is an effective prophylaxis when taken for 20 weeks or more.
Adult↗
[Malaria and pregnancy in endemic zones: questions about method and seasonality].
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Bias↗
[Eating behavior of 12-16-year olds of French-speaking Valais: cross-sectional survey among 962 secondary students].
Eating habits that are potentially harmful are picked up during the teens. The aim of the study is to identify the main eating habits of 12-16 year-old teenagers of central Valais in order to plan better targeted health promotion interventions. The study design is cross sectional. An anonymous questionnaire was taken by a sample of 962 teenagers. Some results: 25.2% did not have breakfast every day, 37.0% did not eat neither fruit nor vegetable the day before, 58.2% had a soda drink the day before, 5.5% of the 12 of the 16 year-old ones and 51.2% year old ones drink some alcohol over the weekends. Possible health promotion interventions are listed.
Adolescent↗
[Availability and quality of necessary data for establishing health assessment in the canton of Geneva: implications for the monitoring of the development of problems and impact of health policies].
The global health assessment of the population of the canton of Geneva, based on the WHO's 38 "Health-for-ALL" targets, shown several gaps in the health information system. The quality of the available data is discussed in regard of various criteria (type of statistics, representativeness, frequency of data collection, diffusion, comparability, concern for validation). Two examples are presented: 1.) The incidence of low birthweight shows how a hospital-based statistics indicator can accurately reflect a trend over time, but provide a biased estimation of a risk level. 2.) The evolution of several indicators concerning drug consumption shows how important it is to validate these indicators in order to allow an adequate interpretation. Such a validation is seldom made. The present situation could be improved by a more efficient structure of the canton's health statistics.
Data Collection↗
Does sponsorship matter in patient satisfaction surveys? A randomized trial.
The purpose of this study was to assess the impact of sponsorship of a mailed satisfaction survey on response patterns and patient satisfaction ratings, and to establish whether satisfaction ratings depend on the timing of response. The study was part of a patient satisfaction survey conducted in a medical group practice in Geneva, Switzerland. All persons who had received an outpatient visit at the medical practice in the last week of September 1993 were assigned randomly to receiving the survey package either on university letterhead or on the medical practice letterhead. Participation rates were 80.5% and 80.4% in the two groups, respectively. The sponsorship of the survey had no detectable impact on response speed or response completeness. Six out of seven satisfaction scores were higher in the "medical practice" group, but the differences were not statistically significant. As data collection progressed, the cumulative satisfaction rating decreased gradually. This association was statistically significant but moderate. Whether a satisfaction survey is sponsored by a university or a health care provider does not seem to affect survey results. However, low survey response rates may moderately bias satisfaction estimates toward higher values.
Data Collection↗