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Biomedical subjects

M Khlat

Publications and source records attributed to M Khlat.

At least 19 recordsLinked to original sources
PubMed2006

[Pregnancy-related deaths. Genesis of the concept and methodological aspects].

Within the past 10 years, the outlook on the causes underlying maternal deaths has evolved, with the advent in the last "International classification of diseases" of the concepts of late maternal mortality and pregnancy-related mortality. Those concepts have led to an enlargement of the field, in terms of the range of causes as well as of the length of the time period at risk. Causes of death traditionally considered as "fortuitous" are now included in the count, given that the notion of pregnancy-related mortality covers all deaths occurring during pregnancy or at the latest one year after pregnancy termination, whatever the cause. Given this background, we critically review the definitions and classification systems of deaths of pregnant or post-partum women, and discuss the philosophy underlying these conceptual changes, and their consequences in terms of data collection and measurement issues.

Cause of Death↗
PubMed2004

[Health of the unemployed in France: literature review].

BACKGROUND: This paper reviews and analyses the main publications concerning health and mortality of the unemployed in France, in order to formulate research orientations for future studies or secondary data analysis. METHODS: The conceptual framework was first set up by assembling the different hypotheses concerning the link between health and unemployment (causality versus selection). A review of the different studies was organized by type: health studies based on data from either cross-sectional health surveys at a national or regional scale, or longitudinal surveys, and mortality studies based on data from follow-up of census samples. RESULTS: Those studies confirm the health disadvantage of the unemployed relative to the employed, in terms of self-perceived health, morbidity, health services utilization and mortality. They provide arguments in favor of both the causality and selection hypotheses. CONCLUSION: The exact nature of the health conditions and causes of death associated with unemployment needs further clarification, as well as the causal pathways.

France↗
PubMed2001

An overview of the health status of migrants in France, in relation to their dietary practices.

OBJECTIVE: To review studies on the morbidity, mortality and nutrition of migrant populations in France. DESIGN: A systematic search of the bibliographic database Medline, and direct contact with associations and institutions concerned with migrants' health. RESULTS: In France, as in other host countries, migrants belong to the lowest socio-economic strata. They have on average better health and lower mortality than the local-born population. Health benefits are particularly noticeable in Mediterranean men, especially for affluence-related diseases such as cancer and cardiovascular diseases. North African men smoke as heavily as the local-born of the same occupational categories, and yet their mortality rates from lung cancer are notably lower. Such a paradox may be the result of a synergy between different phenomena such as the selection of the fittest applicants for immigration and the maintenance of healthy lifestyles from the countries of origin. In contrast, migrant women do not enjoy the same health advantages, possibly because they are less likely to be selected on the basis of their health and because they are often non-working. Adult migrants from southern Europe and North Africa report dietary practices consistent with the typical Mediterranean diet, which is renowned for its positive effects on health. CONCLUSIONS: The diet of Mediterranean adults living in France may partly explain the low rates of chronic diseases and high adult life expectancy observed in migrant men from northern Africa. Information about their diets might provide clues for the design of nutritional education campaigns aimed at low-income people.

Africa, Northern↗
PubMed2001

Evidence for a 'healthy pregnant woman effect' in Niakhar, Senegal?

BACKGROUND: Although it is generally believed that pregnancy exposes women to a wide variety of excess health risks that go beyond the direct obstetric complications of pregnancy, the epidemiological evidence in support of such excess indirect risks is inconclusive. In this article we attempt to document the contribution of indirect causes of death to maternal mortality in rural Senegal by using an epidemiological approach whereby the time spent during pregnancy and postpartum is considered a transient period of exposure to the health hazards of childbearing. METHODS: We use data from an ongoing demographic surveillance system in Niakhar, Senegal and calculate rate ratios comparing death rates in pregnant or recently pregnant women (exposed) with death rates in other women (unexposed), including and excluding direct obstetric deaths. RESULTS: Between ages 20 and 44, pregnancy does not confer additional risks to women. After excluding direct obstetric deaths, exposed women aged 20--39 have surprisingly lower risks of death than unexposed women of the same age. For the very young (15-19) and the very old (45-49), on the other hand, the excess risks associated with pregnancy are considerable and, among women age 45 or older, persist even after excluding direct obstetric deaths. CONCLUSION: The apparent protective effect of pregnancy on women's health that is observed in this study illustrates the paradoxical nature of the concept of indirect causes of maternal mortality, and the difficulties in measuring the risks of death attributable to the pregnancy. Further studies aimed at separating risks attributable to the pregnancy from those that are incidental to the pregnancy are required.

Adolescent↗
PubMed2000

Deaths attributable to childbearing in Matlab, Bangladesh: indirect causes of maternal mortality questioned.

Little is known about the nature of diseases aggravated by pregnancy or the magnitude of mortality from causes indirectly related to pregnancy. This study aims at clarifying the contribution of indirect causes to maternal mortality by analyzing the problem from an epidemiologic perspective, using population-based data from Matlab, Bangladesh, for the period 1976-1993. The time spent during pregnancy and the puerperium was considered a transitory exposure period in women's lives, and death rates were calculated for women aged 15-44 years, while exposed and while not exposed. During or shortly after pregnancy, death rates from all causes are more than twice as high as outside this period. Once direct obstetric causes and injuries are excluded, the death rates among women while exposed are substantially lower than the death rates among women while not exposed. Several interpretations of this finding are discussed, particularly the role of selective factors ("healthy pregnant woman effect"?). This study highlights the complexity of the concept of indirect causes of maternal mortality and clearly illustrates the inherent difficulties in estimating the excess risk of death attached to pregnancy and the puerperium.

Adolescent↗
PubMed2000

Women's health in relation with their family and work roles: France in the early 1990s.

In this paper, the health of women aged 30 to 49 years is analyzed according to the family and work roles which they exercise, based on the 1991-1992 French national health survey. Households are classified based on the amount of their material resources, and a variety of measures of health and of health-related behaviors are considered. Looking at each role separately, the 'healthy married', 'healthy mother' and 'healthy worker' effects are very obvious for almost all health measures, and higher household income per unit of consumption is clearly associated with better health of women. The role patterns of women are not evenly distributed across income levels: housewives and lone mothers are more common at the bottom and middle of the income scale than at the top, while working women without children, married or not, are much more common at the top. In health terms, more heterogeneity is attached to role patterns in the middle of the income scale than at either extreme. In the middle stratum, two groups of women stand out as being clearly disadvantaged in comparison with that of married women with children and a job: (1) lone mothers, particularly in terms of mental health conditions, malaise symptoms and health-related behaviour, and (2) housewives, particularly in terms of physical health conditions. At the bottom of the income scale, no significant disadvantage is found for housewives compared to married working mothers, yet their overall health pattern is somewhat negative. At the top of the income scale, married working women without children, as well as single women do feel more often than married working mothers that they suffer from handicap or discomfort. The findings are discussed in terms of role enhancement and role strain, health selection, the nature of the health disadvantage associated with specific role patterns, and the importance of the structural context in the role framework.

Adult↗
PubMed1998

[Breast feeding effect relative to age of onset of celiac disease].

BACKGROUND: Age at onset and clinical presentation of celiac disease have often been related to the age of gluten introduction into the diet. It has also been shown that breast feeding delays the onset of the disease. PATIENTS AND METHODS: This retrospective study attempts to evaluate the respective contributions of these two parameters in the determination of the age at onset of the symptoms in celiac Tunisian children. RESULTS: One-hundred-sixty-nine children were studied. Mean duration of breast feeding in our population was 9.6 +/- 8.9 months and mean age of gluten introduction was 5.6 +/- 3.2 months. The mean age at onset of the disease was 15 +/- 8.7 months and mean latency time between gluten introduction and onset of the disease was 9.5 +/- 7.8 months. Both variables, duration of breast feeding and age at gluten introduction were strongly correlated to the age at onset of the disease (r = 0.47 and 0.40, respectively). Only breast feeding was correlated to the variable latency time (r = 0.33). Stepwise multiple regression analysis showed that the two variables independently influenced the age at onset with coefficients of regression of 0.90 +/- 0.20 and 0.26 +/- 0.07, respectively. Only breast feeding influenced the latency time with a coefficient of regression equal to 0.26 +/- 0.07. DISCUSSION: Our study confirms the independent effect of breast feeding in the determination of the age at onset of the disease. Breast feeding has two effects: an indirect effect, by delaying the introduction of gluten, and a direct effect, by increasing the latency time between gluten introduction and onset of the disease. CONCLUSION: Prolonged breast feeding, at least until the 6th month, and gluten introduction started at least at the 5th month of life, significantly delay the onset of the disease. Gluten introduction should be done progressively and under breast feeding protection. Introduction of gluten 2 months before weaning has a protective effect.

Age of Onset↗
PubMed1997

Plantar melanoma: a case-control study in Paraguay.

In Paraguay, the plantar surface of the foot is the most common site for malignant melanoma, as it is in several other populations worldwide, most notably in those of African descent. Here, we report the results of the first case-control study of plantar melanoma, carried out in Paraguay. Sixty incident, histologically confirmed cases of plantar melanoma and 256 hospital controls were recruited in 11 hospitals throughout the country during 1988-93. Information was collected on general demographic, social, and lifestyle variables, on external exposures of feet (shoewear, work activities, injuries), and on some constitutional factors (skin, eye and hair color, and pigmented lesions of the feet). Few of the factors examined appeared to be associated with the risk of plantar melanoma. Adjusted for possible confounders, the strongest association was found for reported injuries (odds ratio [OR] = 40.9, 95 percent confidence interval [CI] = 14.8-112.7) and for occurrence of naevi on the soles (OR = 5.9, CI = 2.5-14.3). Walking barefoot did not seem to contribute to the risk although an outdoor workplace was associated with an increased melanoma occurrence (OR = 2.3, CI = 1.1-4.8). Future studies should be aware of problems of recall bias with respect to previous injuries, and ensure that evaluation of pigmentation of the sole is carried out blind to case/control status.

Adult↗
PubMed1997

Fertility levels and differentials in Beirut during wartime: an indirect estimation based on maternity registers.

In this paper, total fertility estimates for Greater Beirut in the mid-eighties and early nineties are presented, and changes in socio-religious differentials of fertility across time are explored. The baseline information was recorded from registration details for all maternities in Beirut and its inner suburbs in 1984 and 1991: age of mother, number of children ever-born, hospital class, and religion of newborn. An indirect method was used to estimate total fertility from the joint distribution of mothers by age and parity, and, using hospital class as a proxy for social class, differentials in fertility were investigated by Poisson regression. The estimates of total fertility for Beirut shifted from 2.60 in 1984 to 2.52 in 1991, and were higher for Muslims than for Christians in the two periods. The regression analysis showed that: (1) the difference between the two religious groups persisted after control for social class, and in fact applied to the lower social class; (2) fertility dropped between the two dates in the lower social class, and more so for Muslims than for Christians. In comparison with other countries of the region, the decline in Beirut was found to be relatively modest. If the trends assessed in this study were to continue, the religious-based fertility differentials would taper off progressively in the capital city of Lebanon.

Fertility↗
PubMed1997

Child survival in Beirut during wartime: time trends and socio-religious differentials.

BACKGROUND: Child mortality estimates in Beirut are presented for the late 1970s and the mid 1980s, and changes in socio-religious differentials of mortality across time are investigated. METHODS: Baseline information was obtained from maternity registries in Beirut in 1984 and 1991. Age of mother, number of children ever born and number of children alive, hospitalization class (1, 2 or 3 within each hospital, depending on the room rate, the services and the doctor's fees), and religion of newborn was recorded. Brass and Macrae's technique was used to convert the proportion dead among children ever born to mothers in age group 30-34 into 5q0 estimates for the reference periods 1978 (1984 data) and 1985 (1991 data). Using hospitalization class as a proxy for social class, religious differentials in child mortality were explored by logistic regression analysis within each period. RESULTS: Overall, 5q0 is estimated at 46 per 1000 in the late 1970s, and at 36 per 1000 in the mid 1980s. The religious differentials in 5q0 mortality estimates were quite large in the former period, with a risk for Muslims relative to Christians of 1.53, which declined to 1.35 in the latter period. The regression analysis of the proportion dead among children ever born; (1) confirmed the magnitude of the religious differentials in child mortality, and their reduction over time; (2) demonstrated the existence of an interaction between religion and social class, as the religious differentials in child mortality were found to be highly prevalent in the lower social classes, and almost insignificant in the middle and upper ones; (3) highlighted the decisive role of differential fertility in generating differential child mortality, with higher fertility and higher child mortality in Muslims, and with the disappearance of religious differentials in child mortality after adjustment for fertility. CONCLUSION: The findings confirm the hypothesis of a reduction over time of religious-based child mortality differences in the capital city of Lebanon, in agreement with the pattern found for religious-based fertility differences. Comparisons with other countries in the region indicate that the war in Lebanon has slowed down the decline in child mortality, causing the country to loose its priviledged position among Arab countries.

Child↗
PubMed1996

Studies of cancer in migrants: rationale and methodology.

Migrant populations comprise substantial numbers of individuals who have undergone a change in their environment, sociocultural and physical. The corresponding changes in risk for different cancers have, therefore, been widely used to infer the relative importance of environmental factors versus inherited predisposition in cancer aetiology. The uncontrolled experiment of migration also provides an indication of the possible effects of certain preventive interventions at the population level--especially with respect to diet. In the past, there has been a surprising lack of attention to analytical methods for migrant data, and we review the epidemiological methods available to best bring out the relevant differences in risk. The major sources of bias which confuse interpretation are also described. Migrant studies are classified into four groups, in a hierarchy corresponding to the amount of information which they can provide, and examples of each type are provided.

Age Factors↗
PubMed1996

Cancer mortality among north African migrants in France.

BACKGROUND: Data on cancer mortality in North African migrants to France (the largest foreign-born community in the country) are presented, providing useful insights both into cancer patterns in North Africa and their changes following migration. METHODS: The cancer mortality in migrants from North Africa (Algeria, Morocco, Tunisia and Egypt) resident in France relative to that of the local-born population, is estimated from mortality data for the period 1979-1985, and population data from the 1982 French census. Risks of death from different cancers were adjusted for important confounding factors such as social status and area of residence. RESULTS: The risks are quite similar for Algerian, Tunisian and Moroccan migrants. Compared to the local-born, those Maghrebian migrants of one or both sexes have higher risks of death from cancer of the nasopharynx, gallbladder and bladder (in Algerians only). Conversely, Maghrebian migrants have lower risks of death from cancer of the oral cavity, other pharynx, oesophagus, stomach, colon, rectum, lung, larynx, melanoma (in Algerians only), kidney and nervous system (except in Tunisians), breast, ovary, and cervix uteri (except in Moroccans). For Egyptian migrants, because of small numbers, few of the estimates are statistically significant. They are at lower risk of death from lung cancer and at higher risk for lymphoma and leukaemia. CONCLUSION: The findings provide confirmatory evidence of the unusual cancer patterns among North African populations, who have low risks for most cancer sites, and high risks for certain cancers, such as of the nasopharynx and bladder.

Adolescent↗
PubMed1996

Mortality and causes of death of Moroccans in France, 1979-91.

"The results of a study by Michele Tribalat showed that the death rates of immigrants in France were surprisingly low: they were not only better than the national average, but far better than the rates specific to the socio-occupational categories the immigrants belonged to. Was this due to observation errors, to selection of the fittest applicants for immigration, or to the fact that immigrants adapted positively, that is, by taking the best (health services, living conditions...) and leaving the worst (overnutrition, road accidents...)? [The authors] investigate these questions here with respect to Moroccans living in France, first by a general analysis, then by a study of the causes of death. They confirm the surprisingly low mortality of Moroccan immigrants. But incidentally, in the case of mobility within France, adult mortality was shown to be roughly 11% lower among men who had changed regions at least once than among those who had not."

Africa↗
PubMed1995

Cancer in Mediterranean migrants--based on studies in France and Australia.

Whether non-European Mediterranean populations also benefit from the protective effect on health of the so-called Mediterranean diet is not know yet, as national mortality statistics are available in neither North Africa nor the Near East. This article investigates the cancer profile of Maghrebian and Near Eastern migrants, by gathering and discussing data from recent studies on cancer mortality in Mediterranean migrants of various origins in France and Australia. In France, the migrants originating from Morocco, and in Australia, the migrants originating from the Near East, have a lower mortality from all cancers than their host countries and than Italian migrants. Concerning specific sites, Moroccan and Near Eastern migrants have a cancer profile which is quite similar to that of the Italian migrants, with relatively low risks compared with the local-born for certain cancers typical of affluent societies (colon and rectum, breast, ovary, and prostate). In addition, the non-European Mediterranean migrants are protected even more than the Italians in the same host country from esophagus cancer, and Moroccans in France have a much lower risk than the local-born for lung cancer. Lastly, they tend to have a relatively high risk for some cancers which are likely to have a viral etiology: e.g., nasopharynx (Italians and Near Easterners), liver (Near Eastern males), and possibly cervix (Moroccans).

Africa, Northern↗