Multivariate analysis of dietary patterns in 939 Swiss adults: sociodemographic parameters and alcohol consumption profiles.

A dietary survey of 939 Swiss adults, randomly selected from the population of Geneva and its surrounding communities, was performed according to the history method. A factor analysis, using average weekly intakes for 33 food variables, reveals three principal components of the diet: satiating capacity, healthfulness and culinary complexity. These characteristics, together with the energy content of the diet, were analysed for differences according to sex, age, relative weight index, birthplace, marital status and occupation. All of these sociodemographic variables influence some dimension of dietary habits. Alcohol consumption is positively associated with satiating, protein rich diets, but energy intake from foods does not significantly differ between various groups of abstainers and drinkers. Although the energy contribution of alcoholic beverages is globally additive, we suggest that cultural and societal norms may modulate the relationship of alcohol and diet.

A tentative epidemiologic approach to suicide prevention in adolescence.

During adolescence (by convention, 10-19 years of age), the global mortality rates are relatively low in most countries. Nevertheless, suicidal mortality rates are usually second (after all accidents) or third (after accidents and homicides), depending on the country. Rates in males are regularly higher than those in females. Owing to the universal absence of a systematic recording of parasuicide cases, morbidity data are obviously much more difficult to get and to analyze properly. Data based on hospital admissions give only approximations. Nevertheless, in this age group, parasuicide is expected to be many times more frequent in females than in males. Epidemiologic studies on relapses as well as parasuicide follow-up are rare. Taking into account the number and heterogeneity of known risk factors, suicidal behavior prediction is based on probability statistics: valuable only for groups ("high-risk profiles"), never for individuals. This is particularly true in adolescence, when so many changes occur rapidly. Preventative measures are to be discussed according to their pertinence in each of the three classic levels of prevention.

[Accidents involving children and adolescents: from epidemiological findings to preventive action]. / Les accidents atteignant les enfants et les adolescents: de la connaissance épidémiologique à l'action préventive.

It is generally accepted that improving epidemiological knowledge of accidents in childhood and adolescence leads to a better implementation of more efficient prevention programs. Nevertheless, it is not yet generally admitted that any new preventive measure addressing these accidents has to be evaluated by competent epidemiologists. Obviously, there are exceptions regarding these two rules. Four examples of successful implementation are presented in this paper: safety packaging of aspirin; fences around private swimming pools; changes in minimal drinking and driving age in adolescence; bicycle accidents. The discussion is focused on four intervention levels suggested for the epidemiologists.

[Ethical aspects of intervention studies (author's transl)]. / Aspects éthiques des études d'intervention.

Since the Second World War international ethical codes have been developed which aim to protect the individual in relation to medical experimentation. It is in these codes, rather than in the provisions of different national codes, that the principles applicable to epidemiological intervention studies should be sought. Having recalled the main characteristics of such studies, and particularly those which distinguish them from clinical trials, the authors consider two specific aspects of the issue: the balance between risks and benefits, and informed consent. Concerning the risk/benefit relationship, it appears important to distinguish between primary prevention (the subjects involved are healthy but at risk), secondary prevention (the subjects involved have the disease in question but are asymptomatic) and tertiary prevention (the subjects involved are ill). The principles of informed consent in intervention studies may be drawn from those governing clinical trials, particularly where the intervention can be applied to individuals. When it cannot be individualized (for example, fluoridation of drinking water) the alternative suggested by some authors is that individual consent may be replaced by community consent or that of its representatives. Some implications of the observation of these two types of principles are considered.

[Risk-taking behavior and accidents in adolescence in developed countries]. / Comportement de prise de risque et accidents à l'adolescence dans les pays développés.

Injuries due to accidents are the primary cause of fatalities among adolescents. Between the ages of 10 and 19, mortality caused by accidents augments significantly, and there is an excess of male mortality, increasing with age. This mortality has remained virtually unchanged over the past 25 years, except for a small narrowing of rate differences by sex. Traffic accidents, particularly those involving motorcycles, are the leading cause of accident fatalities. Though not easily assessed, morbidity due to accidents is probably very high, especially among males. Sports accidents are the most frequent. Adolescents appear to be particularly exposed to some risks, but also tend to be careless about safety. Risk-taking is a source of rewards: pleasure, self-affirmation, sense of independence; but it is described by some authors as self-destructiveness, death from accidents reflecting suicidal tendencies. Paradoxical results of prevention have been observed in this age group.

[Violence and aggression in adolescents and young adults. Review of the recent literature]. / Violence et agressivité chez les adolescents et les jeunes adultes. Revue critique de la littérature récente.

A highly topical subject, violence, its consequences as well as its causes, deserve more attention on behalf of the public health authorities. On one hand, nowadays, the concepts in this field tend to become more global than before; however, on the other hand the epidemiological, etiological and therapeutic approaches benefit also from considering more limited behavior categories and age groups. In this review of the international literature, the authors focus their attention on intentional (excluding accidents) and interpersonal (excluding self-destructive behavior) violence. They consider by priority adolescents (10 to 19) and young adults (15 to 24). After a general introduction to the theme and the presentation of the relevant concepts and definitions, the authors, as a complement to their earlier publication on violence, develop epidemiological aspects concerning mortality, morbidity and the sources of information about these two topics. Their view is partly a critical one, including considerations on risk factors and risk predictors. The etiological aspects are developed along three axes : biomedical components, mainly of neuro-psychiatric and neurological nature ; family violence ; the broader social environment. The following part is devoted to care and prevention. In the discussion, several of the main issues considered in the conceptual, epidemiological, etiological as well as curative and preventive approaches are brought up again, with a perspective on presenting new proposals for further consideration and developments as well as on broadening the initial debate of the introduction.

[Food habits of today's adolescents: epidemiological and psychosocial aspects]. / Comportements alimentaires des adolescents d'aujourd'hui: aspects épidémiologiques et psychosociaux.

Adolescence is a period of life often characterized by inconsistent, experimental and risky behaviour. The study of alimentary habits of adolescents is of particular importance since these determine whether nutritional needs will be met. Whereas an epidemiologic approach seeks to determine the number, the role, and the weight of the multiple determinants of these behaviours, a psycho-social approach leads to the consideration of factors much more difficult to quantify. This paper is based on a local pilot study covering 161 male and female apprentices 15 to 21 years of age, as well as on data available from the recent literature. First, a review of common behaviours such as skipping meals, snacking between meals, and concerning food preferences and aversions is presented. We then review in greater depth two recent publications. The first concerns the attraction that soft drinks have for young people and its consequences for micronutrient balance. The second illustrates the relationship between self-body image and various adolescent attitudes and habits involving caloric restriction. Overall, it appears that data currently available to epidemiologists and "preventologists" concerning adolescent feeding behaviour would not allow them either to reassure those pessimists or worry those optimists whose opposing views on the subject appeared in publications prior to the 1980s. Indeed, there have been but few longitudinal studies of the kind which could let one confirm which subgroups of adolescents are truly at risk of particular health problems as a result of specific types of feeding behaviour.

[Food habits of Italian adolescents living in Geneva: effects of integration]. / Habitudes alimentaires d'adolescents italiens résidant à Genève: effets de l'intégration.

Mean food intake of a representative group of 14 year-old Italians (51 boys and 53 girls) is compared to that of Swiss controls (58 boys and 62 girls) according to caloric intake per principal nutrients and per meal. The comparisons also distinguish the Italians born in Geneva from recent immigrants.

[Accidents related to physical education in school: epidemiologic and preventive approach]. / Les accidents liés à l'éducation physique scolaire: approache épidémiologique et préventive.

Generally speaking, this category of accidents seems to cause mostly relatively mild injuries. It could explain, at least in part, why there are so few papers on this topic in the medical literature except for clinical reports usually based on hospitalized cases. The main results of a study of the 9261 physical education accidents registered within five years in primary and secondary schools in Basle and Geneva are used to illustrate their epidemiological characteristics, as well as the localization and the severity of the injuries. The sources of data are the files of the accident insurance companies. Initial operational definitions, data sources, measurement of exposure to risk and the (largely criticized) notion of individual accident proneness are constraints and conditions of a pertinent epidemiological approach which have to be carefully taken into consideration. This approach should be combined with the clinical and the ergonomical approaches in order to get the best possible pictures of the causes, mechanisms and consequences not only of accidents in general but especially of those occurring in physical activities in childhood and adolescence. Some considerations on prevention are briefly outlined here. They intend to take into account the risk factors related to the tasks, the circumstances and especially to the student himself taken as an individual involved in a growth and development dynamics.

[New strategies for prevention in adolescents and young adults]. / Nouvelles stratégies de prévention chez l'adolescent et le jeune adulte.

For various reasons, it is justified to revise the classical strategies of intervention concerning medical and social action to help young people. New behaviours such as drug addiction, for instance, have emphasized the inadequacies of the conventional means of treatment. Since 1970, Youth Advisory Services have appeared in Europe. Their aims may be various: information, counselling, lodging, social and educative help, medical assistance. These services which were created by the community have such ethical and organizational features that it is easy to discern them among the conventional administrative services. Their users are mainly teenagers and young adults whose reasons for consultation are due to various causes. The originality of the methods, facilities and principles of these innovating services may be considered as a decisive contribution to the research of new prevention strategies to help young people.

[Need for professional expertise in institutions and public health services in 4 cantons and Tessin. Hypothesis--objectives--implementation]. / Enquête sur les besoins en matière d'expertise professionnelle dans les services et institutions de la santé de quatre cantons romands et du Tessin. Hypothèse--objectifs--déroulement.

This survey consists in a process of "collaborative reflection" between consultants from a university department of public health and health authorities in five cantons. The goal of this effort is to identify, within a common framework, known and suspected health problems, risk factors, preventive measures as well as priority research needs in these areas. This information is used to determine the need for an increased access to public health experts at the level of the cantons and gives some indication as to the characteristics required of such experts. Since participants in the survey are also responsible for promotion and implementation of concrete actions for prevention, it is anticipated that this project will result in a number of initiatives focused on the problem which have been identified. The methodology used was inspired by methods previously described for problem identification and program planning, such as the Delphi technique, but was adapted in an original way to the particular needs of this survey. In the first phase, interviews with persons responsible for key health administrations and institutions in each canton are conducted in order to identify the maximum number of salient facts, problems and unresolved questions. In a second phase results and problem statements are consolidated, fed back to all participants and, through repeated contacts, completed, redefined and ranked in order of importance. Although the survey is still ongoing, it has already led to the identification of a number of health problems, possible risk factors and research priorities which had hitherto not been formally identified, and to one concrete program aimed at improving preventive intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

[A plan for a randomized evaluation study for improving the memory of the aged]. / Plan d'une étude d'évaluation randomisée de l'entraînement de la mémoire chez les personnes âgées.

The training is realised through exercises carried out during courses and at home. The effectiveness of this training is assessed by psychometric tests (before/after) and a questionnaire for self evaluation (after). An equal number of subjects to be trained and controls are selected among 100 or so voluntary participants.

[First treatment demands for drug abuse: and indicator of developmental trends]. / Les premières demandes de traitement pour toxicomanie: un indicateur des tendances évolutives du phénomène.

The county of Geneva, Switzerland, is part of an international multi-city survey under the auspices of the Council of Europe. This survey is designed to use common indicators for assessing and comparing drug misuse and its evolution in participating cities and regions. Its aim is to improve the strategies for controlling drug misuse. The first indicator under study is the "first treatment demand". Its objectives are to evaluate the treatment demand as well as the evolution of drug misuse in terms of patient characteristics, so as to optimise prevention and treatment policies. All treatment demands for drug misuse that meet the study's entry criteria are recorded in a permanent and centralized data bank, through an anonymous encoded form filled in by the treatment centers at the time of the demand. Later demands by the same patient are merged with the precedent ones. In this way, both the totality of treatment demands and the subset of first demands can be analyzed and information about individual trajectories can be collected. The introduction of this indicator is subjected to various problems due first of all to the illicit character of drug misuse. In particular, the necessary measures to guarantee strict confidentiality make it more difficult to obtain reliable data, especially for the merging of different treatment demands by the same patient. This paper reports on the introduction of the indicator in Geneva and its anticipated results.

[Infant mortality in Switzerland: status and evolution of differences between cantons since 1901]. / Mortalité infantile en Suisse: état et évolution des différences intercantonales depuis 1901.

Both levels and trends of infant death rates differ among the Swiss cantons between 1901 and 1980. These differences seem to persist, since one groupe of cantons stays consistently above, and another group below the mean values. Some socio-economic and demographic correlates of the inter-cantonal differences are analyzed.

[Dietary lipids and serum lipids in adolescents, based on the Geneva study of the precursors of atherosclerosis]. / Lipides alimentaires et lipides sanguins chez les adolescents, d'après l'étude genevoise des précurseurs de l'athérosclérose.

The relationship between serum lipids and nutrition, physical activity and body mass index were studies with a multifactorial analysis of variance in a group of 160 adolescents of both sexes (Table I). These relationships are complex and difficult to demonstrate; they give rise, however, to certain considerations of presumptive characteristics possibly linked with adolescence.

[Improving the effectiveness of health education]. / Rendre l'éducation pour la santé plus efficace.

Discussions concentrated on ways of influencing the behavior of healthy individuals. The following was concluded; 1. Health education is an interdisciplinary activity. It should not merely be aimed at the behavior of individuals but also respect and influence values and institutions of society as well as legislation. 2. Family and school are the most important fields of activity. 3. Health education should be based on experiences from communication sciences. 4. In school, health education should be integrated in as many subjects as possible. Of special importance are the example of the teachers and adequate preparation and training. 5. Health education cannot limit itself to giving information, it also must motivate to a healthy way of life. 6. Exchange of experiences and information in health education should be improved. In Switzerland this can be done by a working party of the Swiss Society for Social and Preventive Medicine. 7. The intervention trials of the Swiss National Research Program can provide important stimuli for innovative approaches to health education is Switzerland.

[Pensions for the aged or housebound: discriminant factors. Study conducted in 4 districts of the canton of Fribourg (Switzerland)]. / Pensions pour personnes âgées ou encadrement à domicile: facteurs discriminants. Etude conduite dans quatre districts du canton de Fribourg (Suisse).

This research forms part of a two centre study (Fribourg et Geneva) on the use of medical and socio-medical services by elderly persons. It was undertaken under the auspices of the national research programme No 8 (Efficiency and effectiveness of the Swiss health system). The study covered 1173 persons aged 65 years or over receiving care in three services (partly medicalized nursing homes, retirement homes and home nursing services) in four french speaking districts of Fribourg Canton. The staff of these services provided cross sectional data on the personal characteristics of their clients or patients, their physical and mental capacities, the specific services provided to them, and some indications on their home circumstances. The results show differences between districts and services in terms of the overall utilisation rate, its structure, and the detailed profiles of specific needs and services. The discussion focusses on the possible interpretations of these differences and on the fundamental problem matching services to needs.

[Health in schools or healthy schools?]. / Santé à l'école ou écoles en santé?

Comparing the existing documentation on the European Network of Health Promoting Schools (ENHPS, in French: REES) and on the French School Health Service, many differences as well as similarities are appearing. In Switzerland, the ENHPS/REES is presently well developed. Facing new attitudinal and behavorial problems in schools, a recent experience in Geneva (Switzerland) includes health promotion as one of its objectives.

[Clinical epidemiology: a new epidemiology?]. / L'épidémiologie clinique: une nouvelle épidémiologie?

The concept of "clinical epidemiology" is well established in the New World; indeed most of the quotations and works cited in this paper come from the United States and Canada. On the other hand, the concept seems to remain controversial in most countries in the Old World. From an exploration of the interface between the approaches used by epidemiologists on the one hand, and clinicians (including psychiatrists) on the other, this paper discusses aspects of the relationship between "conventional" and "clinical" epidemiology; in particular questions are raised as to whether these are part of the same continuum or whether they are separated by a gulf. At present, answers to such questions depend on subjective positions as well as on objective criteria. In order to reach a consensus on these questions, further concertation especially among epidemiologists, will be needed.