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1.
Resuscitation ; 148: 140-144, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-32004660

RESUMO

AIMS: EEG burst-suppression (BS) heralds poor outcome after cardiac arrest (CA). Within this pattern, identical bursts (IB) have been suggested to be absolutely specific, in isolation. We assessed IB prevalence and their added predictive value for poor outcome in a multimodal prognostic approach. METHODS: We retrospectively analyzed a registry of comatose adults with CA (April 2011-February 2019), undergoing EEG at 5-36 h and 36-72 h. SB and IB were visually assessed. Cerebral Performance Categories (CPC) at 3 months were dichotomized as "good" (CPC 1-2), or "poor" (CPC 3-5). Sensitivity, specificity, positive, negative predictive values of BS and IB for poor outcome were calculated. A multimodal prognostic score was created assigning one point each to unreactive and epileptiform EEG, pupillary light reflex and SSEPs absence, NSE > 75 µg/l. In a second score, IB were added; predictive performances were compared using Receiver Operating Characteristic (ROC) curves. RESULTS: Of 522 patients, 147 (28%) had BS in any EEG (10 [7%] had good outcome and 129 [88%] died). Of them, 53/147 (36%, 10% of total) showed IB, 47/53 (89%) of which within 36 h. IB were 100% specific for poor outcome, and associated with higher serum NSE than BS. However, there was no significant difference between the scores with and without IB for CPC 3-5 (p = 0.116). CONCLUSION: IB occur in 10% of patients after CA. In our multimodal context, IB, albeit being very specific for poor outcome, seem redundant with other predictors.

2.
Resuscitation ; 149: 17-23, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32044334

RESUMO

AIMS: Bilateral absence of cortical somato-sensory evoked potentials (SSEPs) robustly predicts poor outcome after cardiac arrest (CA), but it is uncertain if SSEP amplitudes provide additional information. Here, we examined the prognostic value of cortical SSEP amplitude in comparison with other known outcome predictors. METHODS: We retrospectively determined SSEP amplitudes in a prospective CA registry, identified an amplitude cut-off for worst Cerebral Performance Category (CPC) within three months, and examined correlations of SSEP amplitude with pupillary light reflex (PLR), myoclonus, peak serum neuron specific enolase (NSE), and 24-36 h and 36-72 h EEG (reactivity, epileptiform features). RESULTS: Among 158 patients, 54% awoke. Amplitudes correlated with EEG findings, present PLR, myoclonus, NSE. A cut-off for cortical SSEP ≤ 0.41 µV was 100% specific for poor outcome (95% CI: 96-100%); sensitivity increased marginally vs. SSEPs absence [47% (35-59%) vs 46% (34-58%)] for CPC 4-5. Adding SSEPs ≤0.41 µV to a multimodal prognostic model including EEG, clinical features, and NSE improved prediction for mortality, but not for CPC 3-5 at three months. No statistical correlation between amplitudes and good outcome was observed. SSEP amplitudes correlated inversely with CPC at three months in the overall cohort (r = -0.332; p < 0.0001) but not in the subgroup with present SSEPs (r = -0.102; p = 0.256). CONCLUSION: Decreased SSEPs amplitudes are associated with poor outcome after cardiac arrest; however, adding this to a multimodal prognostic approach including EEG, clinical and blood biomarkers, improves slightly prediction of mortality, but not of poor or good outcome.

3.
BMJ Open ; 10(2): e033021, 2020 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-32066604

RESUMO

OBJECTIVES: The vast majority of residents' working time is spent away from patients. In hospital practice, many factors may influence the resident's working day structure.Using an innovative method, we aimed to compare working time allocation among internal medicine residents using time-motion observations. The first study goal was to describe how the method could be used for inter-hospital comparison. The secondary goal was to learn about specific differences in the resident's working day structure in university and non-university hospital settings. DESIGN: Two separate time-motion studies. Trained peer-observers followed the residents during weekday day shifts with a tablet, able to record 22 different activities and corresponding context (with patient, phone, colleague or computer). SETTING: Internal medicine residencies at a university (May-July 2015) and a non-university (September-October 2016) community hospital. PARTICIPANTS: 28 residents (mean age: 29 years, average postgraduate training: 30 months) at university hospital, 21 residents (mean age: 30 years, average postgraduate training: 17 months) at non-university hospital. OUTCOMES: Time spent with patients and time dedicated to activities directly related to patients; description of main differences of time allocation between hospitals. RESULTS: Cumulatively 1051 hours of observation (566 (university hospital)+486 (non-university hospital)) and 92 day shifts (49+43) were evaluated. Daily working time was 11.5 versus 11.3 hours. A median daily period of 195 min (IQR 179-211, 27.9%) and 116 min (IQR 98-134, 17.2%) (p<0.001) was dedicated to direct patient care, respectively. CONCLUSIONS: We successfully identified differences potentially related to each hospital structure and organisation. Inter-hospital comparisons could help set up interventions aiming to improve workday structure and experience of residents.

4.
Neurobiol Aging ; 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32035845

RESUMO

Given the worldwide increasing socioeconomic burden of aging-associated brain diseases, there is pressing need to gain in-depth knowledge about the neurobiology of brain anatomy changes across the life span. Advances in quantitative magnetic resonance imaging sensitive to brain's myelin, iron, and free water content allow for a detailed in vivo investigation of aging-related changes while reducing spurious morphometry differences. Main aim of our study is to link previous morphometry findings in aging to microstructural tissue properties in a large-scale cohort (n = 966, age range 46-86 y). Addressing previous controversies in the field, we present results obtained with different approaches to adjust local findings for global effects. Beyond the confirmation of age-related atrophy, myelin, and free water decreases, we report proportionally steeper volume, iron, and myelin decline in sensorimotor and subcortical areas paralleled by free water increase. We demonstrate aging-related white matter volume, myelin, and iron loss in frontostriatal projections. Our findings provide robust evidence for spatial overlap between volume and tissue property differences in aging that affect predominantly motor and executive networks.

5.
JAMA Netw Open ; 3(1): e1920185, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-32003817

RESUMO

Importance: The effects of in-hospital physical activity (PA) on outcomes among elderly patients has seldom been assessed. Objectives: To assess PA levels among elderly patients hospitalized for acute medical illness and to examine the association between PA levels and functional decline and other clinical outcomes at discharge. Design, Setting, and Participants: This monocentric cohort study was performed among patients 65 years or older who were admitted for acute medical illness to the internal medicine ward of Lausanne University Hospital, Lausanne, Switzerland, from February 1 through November 30, 2018. Data were analyzed from January 1 through December 2, 2019. Exposures: Daytime and 24-hour PA levels assessed via wrist accelerometers and measured in millig units (mG; 1 mG = 9.80665 × 10-3 m/s2). Mean Outcomes and Measures: Functional decline (defined as a ≥5-point decrease in the modified Barthel Index), risk of bedsores, length of stay (LOS), and inability to return home. Results: A total of 177 patients (106 [59.9%] men; median age, 83 [interquartile range, 74-87] years) were included. Lower mean (SD) PA levels were found in patients using walking aids before admission (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [3] vs 11 [5] mG), those admitted for a reason associated with functional decline (daytime, 12 [6] vs 14 [7] mG; 24-hour, 10 [4] vs 11 [4] mG), or those prescribed physiotherapy (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [4] vs 12 [5] mG). At discharge, functional decline was found in 63 patients (35.6%; 95% CI, 25.6%-43.1%), bedsore risk in 78 (44.1%; 95% CI, 36.6%-51.7%), and inability to return home in 82 (46.3%; 95% CI, 38.8%-54.0%). After multivariate analysis, no association was found between PA levels and functional decline (multivariable-adjusted mean [SE], 13 [1] vs 13 [1] mG for daytime levels [P = .69] and 10 [1] vs 11 [1] mG for 24-hour PA levels [P = .45]) or LOS (Spearman rank correlation, ρ = -0.06 for daytime PA levels [P = .93] and -0.01 for 24-hour PA levels [P = .52]). Patients at risk of bedsores had significantly lower PA levels than those not at risk (multivariable-adjusted mean [SE], 12 [1] vs 15 [1] mG for daytime PA levels [P = .008]; 10 [1] vs 12 [1] mG for 24-hour PA levels [P = .01]). Patients able to return home had significantly higher PA levels than those institutionalized (multivariable-adjusted mean [SE], 14 [1] vs 12 [1] mG for daytime PA levels [P = .04]; 11 [1] vs 10 [1] mG for 24-hour PA levels [P = .009]). Conclusions and Relevance: In this study, lower in-hospital daytime and 24-hour PA levels were associated with risk of bedsores and inability to return home on discharge. These findings are important given that one-third of elderly patients present with hospital-acquired functional decline.

6.
BMJ Open ; 10(1): e031156, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31911512

RESUMO

OBJECTIVE: This study aimed to examine the prevalence and determinants of benzodiazepine prescription among older adults in Switzerland, and analyse association with hospitalisation and costs. DESIGN: Retrospective analysis of claims data. SETTING: The study was conducted in nine cantons in Switzerland. PARTICIPANTS: Older adults aged 65 years and older enrolled with a large Swiss health insurance company participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was prevalence of benzodiazepine prescription. The secondary outcomes were (1) determinants of any benzodiazepine prescription; (2) the association between any prescription and the probability of hospitalisation for trauma and (3) the association between any prescription and total healthcare expenditures. RESULTS: Overall, 69 005 individuals were included in the study. Approximately 20% of participants had at least one benzodiazepine prescription in 2017. Prescription prevalence increased with age (65-69: 15.9%; 70-74: 18.4%; 75-80: 22.5%; >80: 25.8%) and was higher in women (25.1%) compared with men (14.6%). Enrollees with the highest deductible of Swiss Francs (CHF) 2500 were 70% less likely to receive a prescription than enrollees with the lowest deductible of CHF 300 (adjusted OR=0.29, 95% CI 0.24 to 0.35).Individuals with at least one prescription had a higher probability of hospitalisation for trauma (OR=1.31, 95% CI 1. 20 to 1.1.44), and 70% higher health care expenditures (ß=0.72, 95% CI 0. 67 to 0.77). Enrollees in canton Valais were three times more likely to receive a prescription compared to enrollees from canton Aargau (OR=2.84, 95% 2.51 to 3.21). CONCLUSIONS: The proportion of older adults with at least one benzodiazepine prescription is high, as found in the data of one large Swiss health insurance company. These enrollees are more likely to be hospitalised for trauma and have higher healthcare expenditures. Important differences in prescription prevalence across cantons were observed, suggesting potential overuse. Further research is needed to understand the drivers of variation, prescription patterns across providers, and trends over time.

7.
Sleep ; 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31978212

RESUMO

STUDY OBJECTIVES: To explore the clinical significance of pulse wave amplitude (PWA)-drops during sleep as a biomarker for cardiometabolic disorders and describe their main characteristics in a general population sample. METHODS: Cross-sectional study of HypnoLaus cohort, in which 2162 individuals underwent clinical assessment and in-home full polysomnography. PWA-drops were derived from photoplethysmography and processed using a validated automated algorithm. Associations between PWA-drop features (index, mean duration, and mean area under the curve [AUC]) with hypertension, diabetes, and previous cardiovascular (CV) event were analyzed using multivariable-adjusted logistic regression. RESULTS: Two thousand one hundred forty-nine participants (59 ± 11 years, 51% women, 9.9% diabetes, 41.3% hypertension, 4.4% CV event) were included. Mean ± standard deviation (SD) of PWA-drop index, duration, and AUC during sleep were 51.0 ± 20.3 events/hour, 14.0 ± 2.7 seconds, and 527±115 %seconds, respectively. PWA-drop index was lower in women and decreased with age, while its mean duration and AUC increased in men and elderly. Overall, lower PWA-drop index, longer duration and greater AUC were associated with increased odds of hypertension, diabetes, or CV event after adjustment for confounders. Participants in the lowest quartile of mean duration-normalized PWA-drop index had a significantly higher odds ratio (OR) of hypertension (OR = 1.60 [1.19-2.16]), CV event (OR = 3.26 [1.33-8.03]), and diabetes (OR = 1.71 [1.06-2.76]) compared to those in the highest quartile. Similar results were observed for mean AUC-normalized PWA-drop index regarding hypertension (OR = 1.59 [1.19-2.13]), CV event (OR = 2.45 [1.14-5.26]) and diabetes (OR = 1.76 [1.10-2.83]). CONCLUSIONS: PWA-drop features during sleep seem to be an interesting biomarker independently associated with cardiometabolic outcomes in the general population.

8.
Praxis (Bern 1994) ; 109(1): 23-26, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910756

RESUMO

Socio-Economic Differences in the Lausanne CoLaus Cohort Abstract. The CoLaus study allowed to highlight the existence of broad social inequalities in health among the population of the city of Lausanne. In fact, participants with low socioeconomic status had a higher prevalence of cardio-metabolic risk factors, risk behaviors, sleep disturbances, and higher inflammatory markers compared to the more socio-economically advantaged participants in the study. In most cases, these inequalities are similar to those found in the neighboring cantons and countries.


Assuntos
Doenças Cardiovasculares , Transtornos do Sono-Vigília , Fatores Socioeconômicos , Biomarcadores , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Humanos , Fatores de Risco , Transtornos do Sono-Vigília/epidemiologia
9.
Praxis (Bern 1994) ; 109(1): 27-30, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910758

RESUMO

GeoLaus, a Study on the Influence of Geo-Environmental Characteristics on Population Health Abstract. Geographic information on risk factors for health or disease is increasingly being used to understand the determinants of health. GeoLaus is a project initiated in 2015 that studies the impact of living spaces and socio-economic situation, on physical and mental health and on different lifestyle habits. This paper discusses and illustrates the use of spatial information in CoLaus to understand the determinants of obesity and daytime sleepiness. The first results of the GeoLaus study open new perspectives on population health.


Assuntos
Estilo de Vida , Saúde Mental , Obesidade , Geografia , Humanos , Fatores de Risco
10.
Praxis (Bern 1994) ; 109(1): 13-17, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910765

RESUMO

PneumoLaus: Prevalence of Lung Function Abnormalities in a Sample of the General Population of Lausanne Abstract. Reduced lung function predicts increased mortality. The prevalence of spirometric abnormalities depends on their definition, the references values used and the use or not of bronchodilation. In the PneumoLaus study, conducted between 2014 and 2017 in a sample of the general population of Lausanne, prevalence of chronic obstruction was 3,8 %, of reversible obstruction 2,5 % and of possible restriction 2,2 %. These numbers are lower than in other population studies. Men had more abnormal spirometry results than women, and ever-smokers more than never-smokers. Two thirds of participants with chronic obstruction, most of which without respiratory symptoms, were not aware of any lung disease.


Assuntos
Pneumopatias , Feminino , Humanos , Pneumopatias/epidemiologia , Masculino , Prevalência , Valores de Referência , Espirometria
11.
Praxis (Bern 1994) ; 109(1): 31-34, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910767

RESUMO

CoLaus: Diet, the Forgotten Key to Preventing Cardiovascular Diseases Abstract. Healthy eating is paramount for the prevention and management of cardiovascular diseases. Still, data from the CoLaus study show that dietary management of cardiovascular risk factors and cardiovascular disease is little implemented. Less than one fifth of participants with dyslipidemia reported being on a hypolipidemic diet, and only half of participants with diabetes reported being on an antidiabetic diet. Further, the occurrence of a myocardial infarction was not associated with an improvement in dietary quality.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Dieta , Dislipidemias , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/prevenção & controle , Dislipidemias/prevenção & controle , Humanos
12.
Int J Cardiol ; 302: 5-14, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31937454

RESUMO

OBJECTIVE: Assess the dietary recommendations provided to patients hospitalized for a coronary heart disease (CHD) event. DESIGN: Cross-sectional, multicentre observational study (ESC EORP Euroaspire V). METHODS: 8261 participants (25.8% women, 9.3% aged<50 years) from 27 countries, 6 to 24 months after hospitalization for a CHD event were included. Participants were asked if they had been advised to reduce salt, fat or sugar intake, change type of fat consumed, and increase consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish. Self-reported changes were recorded. RESULTS: Advice to reduce energy intake, salt, fat and sugar was provided to 64.5% [range: 9.2-90.5], 73.2% [38.6-95.2], 77.3% [42.3-95.6] and 67.0% [39.4-93.3] of patients, respectively. Advice to change fat type, increase consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish was provided to 68.3% [33.7-92.3], 36.7% [0.6-75.2], 73.2% [39.2-93.6], 66.5% [8.0-90.8] and 53.5% [3.7-83.3] of patients, respectively. Advices were more frequently provided to patients aged 50 to 69, with a high educational level, or obesity. One-eighth [0-55.0] of patients reported having consulted a dietician. Reductions in energy intake, salt, fat and sugar were reported by 57.7% [4.9-81.0], 69.9% [32.1-85.9], 71.8% [40.4-88.4] and 61.2% [29.0-84.0] of patients, respectively. Changes in fat type and increased consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish were reported by 60.9% [4.9-81.0], 25.8% [0.6-54.1], 69.2% [27.7-88.4], 54.8% [4.0-80.1] and 40.4% [2.0-66.8] of patients, respectively. CONCLUSION: Dietary advice is not systematically provided to patients with CHD, and considerable differences exist between European countries.

14.
Clin Nutr ; 2019 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-31806396

RESUMO

BACKGROUND: People report many barriers that prevent them from achieving a healthy diet. Whether perceived barriers are associated with dietary behavior remains unclear. OBJECTIVE: To assess the association between barriers to healthy eating and adherence to the Swiss dietary guidelines. METHODS: Cross-sectional data from the Swiss Health Survey 2012 (N = 15,450; 53% women). Barriers included price, daily habits, taste, gluttony, lack of time, lack of willpower, limited options in restaurants, in supermarkets, no social support, and social opposition. The associations between barriers and adherence to Swiss dietary guidelines were assessed using multivariable logistic regression. RESULTS: Daily habits (odds ratio; 95% confidence interval: 0.91; 0.85-0.98) and taste (0.85; 0.79-0.91) were associated with lower adherence to the guidelines for fruits, while price (1.13; 1.06-1.21) and limited options in restaurants (1.33; 1.23-1.45) and in supermarkets (1.18; 1.03-1.35) were associated with higher adherence. Taste was associated with lower adherence to the guidelines for vegetables (0.72; 0.66-0.78), while price (1.20; 1.11-1.30), gluttony (1.17; 1.04-1.31), social group opposition (1.48; 1.18-1.85) and limited options in restaurants (1.56; 1.42-1.72) and in supermarkets (1.25; 1.07-1.47) were associated with higher adherence. Daily habits (0.82; 0.75-0.90), time (0.86; 0.78-0.94), lack of willpower (0.78; 0.70-0.87), and gluttony (0.86; 0.76-0.98) were associated with lower adherence to the guidelines for fish, whereas price (1.09; 1.01-1.19), and limited options in restaurants (1.26; 1.14-1.39) and supermarkets (1.40; 1.20-1.63) were associated with higher adherence. Daily habits (0.89; 0.82-0.97), taste (0.66; 0.61-0.72), lack of willpower (0.84; 0.76-0.92) and gluttony (0.66; 0.58-0.75) were associated with lower adherence to the guidelines for meat. Time (0.88; 0.78-0.99) was associated with lower adherence to the guidelines for dairy, while gluttony (1.26; 1.09-1.46) was associated with higher adherence. Daily habits was associated with lower adherence (0.91; 0.85-0.97) to the guidelines for liquids, while limited options in restaurants was associated with higher adherence (1.12; 1.03-1.22). CONCLUSION: In the Swiss adult population, several self-reported barriers to healthy eating appear to hinder adherence to the dietary guidelines, while other commonly reported barriers are linked to higher adherence.

15.
Sleep Med ; 64: 56-61, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31670162

RESUMO

OBJECTIVE: The aim of this study was to assess the trends and determinants of sleeping pill consumption in the general population. METHODS: This was a prospective study that included 4329 participants (2379 women, 51.9 ± 10.4 years) living in the city of Lausanne, Switzerland, followed up for an average of 10.9 years. Benzodiazepines and benzodiazepine receptor agonists were considered as sleeping pills. RESULTS: The prevalence (95% confidence interval [CI]) of sleeping pills use was 8.0% (7.2-8.9) at baseline and 8.4 (7.6-9.3) after 10.9 years. Overall, sleeping pills use was higher among women, elderly individuals, and individuals reporting a history of anxiety and depression. During the 10.9-year follow-up, 85.8% of participants never used sleeping pills, 2.7% used the sleeping pills at all assessments, and 11.5% shifted from using to quitting (and vice versa). On multivariate analysis, the factors associated with "always" sleeping pills use were as follows: female gender (relative risk ratio and [95% CI] = 1.80 [1.14-2.85]); older age (7.05 [3.56-14.0] for 65 + vs < 45 years); lower educational level (2.06 [1.06-3.99] for mandatory vs university); anxiety (5.61 [3.61-8.71] for yes/no); and depression (3.75 [2.47-5.69] for yes/no). The same factors were also associated with occasional sleeping pills use (ie, shifters): relative risk ratios and 95% CI = 1.56 (1.26-1.94), 2.37 (1.72-3.26), 1.35 (0.98-1.87), 3.40 (2.59-4.45), and 2.50 (1.99-3.15) for female gender, older age, lower educational level, and anxiety and depression, respectively. CONCLUSION: During a 10.9-year follow-up, one out of seven participants (14.2%) used sleeping pills at least once during the study period. Sleeping pills use is more frequent among individuals with anxiety or depression, elderly individuals, and women.

16.
Nat Commun ; 10(1): 5121, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31719535

RESUMO

Both short and long sleep are associated with an adverse lipid profile, likely through different biological pathways. To elucidate the biology of sleep-associated adverse lipid profile, we conduct multi-ancestry genome-wide sleep-SNP interaction analyses on three lipid traits (HDL-c, LDL-c and triglycerides). In the total study sample (discovery + replication) of 126,926 individuals from 5 different ancestry groups, when considering either long or short total sleep time interactions in joint analyses, we identify 49 previously unreported lipid loci, and 10 additional previously unreported lipid loci in a restricted sample of European-ancestry cohorts. In addition, we identify new gene-sleep interactions for known lipid loci such as LPL and PCSK9. The previously unreported lipid loci have a modest explained variance in lipid levels: most notable, gene-short-sleep interactions explain 4.25% of the variance in triglyceride level. Collectively, these findings contribute to our understanding of the biological mechanisms involved in sleep-associated adverse lipid profiles.

17.
Nutr Diabetes ; 9(1): 35, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727876

RESUMO

BACKGROUND: Obesity and obesity-related diseases represent a major public health concern. Recently, studies have substantiated the role of sugar-sweetened beverages (SSBs) consumption in the development of these diseases. The fine identification of populations and areas in need for public health intervention remains challenging. This study investigates the existence of spatial clustering of SSB intake frequency (SSB-IF) and body mass index (BMI), and their potential spatial overlap in a population of adults of the state of Geneva using a fine-scale geospatial approach. METHODS: We used data on self-reported SSB-IF and measured BMI from residents aged between 20 and 74 years of the state of Geneva (Switzerland) that participated in the Bus Santé cross-sectional population-based study (n = 15,423). Getis-Ord Gi spatial indices were used to identify spatial clusters of SSB-IF and BMI in unadjusted models and models adjusted for individual covariates (education level, gender, age, nationality, and neighborhood-level median income). RESULTS: We identified a significant spatial clustering of BMI and SSB-IF. 13.2% (n = 2034) of the participants were within clusters of higher SSB-IF and 10.7% (n = 1651) were within clusters of lower SSB-IF. We identified overlapping clusters of SSB-IF and BMI in specific areas where 11.1% (n = 1719) of the participants resided. After adjustment, the identified clusters persisted and were only slightly attenuated indicating that additional neighborhood-level determinants influence the spatial distribution of SSB-IF and BMI. CONCLUSIONS: Our fine-scale spatial approach allowed to identify specific populations and areas presenting higher SSB-IF and highlighted the existence of an overlap between populations and areas of higher SSB-IF associated with higher BMI. These findings could guide policymakers to develop locally tailored interventions such as targeted prevention campaigns and pave the way for precision public health delivery.

18.
Rev Med Suisse ; 15(672): 2159-2163, 2019 Nov 20.
Artigo em Francês | MEDLINE | ID: mdl-31746573

RESUMO

The main aims of the CoLaus/PsyCoLaus cohort study are to better understand: 1) the personal, biologic, genetic end environmental determinants of cardiovascular risk factors and diseases, and 2) the existing association of mental disorders with cardiovascular diseases. The study was initiated in 2003 and over 6700 participants from the city of Lausanne were include and very rich phenotypic data were collected making the study unique worldwide. Numerous scientific articles were published in various fields such as epidemiology, public health, genetic, social and environmental determinants of cardiovascular diseases and their association with mental health. We briefly present here some key results obtained over the last 16 years.


Assuntos
Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/genética , Transtornos Mentais/complicações , Doenças Cardiovasculares/epidemiologia , Seguimentos , Humanos , Transtornos Mentais/epidemiologia , Fatores de Risco , Suíça/epidemiologia
19.
BMC Cardiovasc Disord ; 19(1): 240, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664920

RESUMO

BACKGROUND: We characterised the phenotypic consequence of genetic variation at the PCSK9 locus and compared findings with recent trials of pharmacological inhibitors of PCSK9. METHODS: Published and individual participant level data (300,000+ participants) were combined to construct a weighted PCSK9 gene-centric score (GS). Seventeen randomized placebo controlled PCSK9 inhibitor trials were included, providing data on 79,578 participants. Results were scaled to a one mmol/L lower LDL-C concentration. RESULTS: The PCSK9 GS (comprising 4 SNPs) associations with plasma lipid and apolipoprotein levels were consistent in direction with treatment effects. The GS odds ratio (OR) for myocardial infarction (MI) was 0.53 (95% CI 0.42; 0.68), compared to a PCSK9 inhibitor effect of 0.90 (95% CI 0.86; 0.93). For ischemic stroke ORs were 0.84 (95% CI 0.57; 1.22) for the GS, compared to 0.85 (95% CI 0.78; 0.93) in the drug trials. ORs with type 2 diabetes mellitus (T2DM) were 1.29 (95% CI 1.11; 1.50) for the GS, as compared to 1.00 (95% CI 0.96; 1.04) for incident T2DM in PCSK9 inhibitor trials. No genetic associations were observed for cancer, heart failure, atrial fibrillation, chronic obstructive pulmonary disease, or Alzheimer's disease - outcomes for which large-scale trial data were unavailable. CONCLUSIONS: Genetic variation at the PCSK9 locus recapitulates the effects of therapeutic inhibition of PCSK9 on major blood lipid fractions and MI. While indicating an increased risk of T2DM, no other possible safety concerns were shown; although precision was moderate.

20.
PLoS One ; 14(10): e0218933, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31596852

RESUMO

BACKGROUND AND AIMS: Many countries lack resources to identify patients at risk of developing Type 2 diabetes mellitus (diabetes). We aimed to develop and validate a diabetes risk score based on easily accessible clinical data. METHODS: Prospective study including 5277 participants (55.0% women, 51.8±10.5 years) free of diabetes at baseline. Comparison with two other published diabetes risk scores (Balkau and Kahn clinical, respectively 5 and 8 variables) and validation on three cohorts (Europe, Iran and Mexico) was performed. RESULTS: After a mean follow-up of 10.9 years, 405 participants (7.7%) developed diabetes. Our score was based on age, gender, waist circumference, diabetes family history, hypertension and physical activity. The area under the curve (AUC) was 0.772 for our score, vs. 0.748 (p<0.001) and 0.774 (p = 0.668) for the other two. Using a 13-point threshold, sensitivity, specificity, positive and negative predictive values (95% CI) of our score were 60.5 (55.5-65.3), 77.1 (75.8-78.2), 18.0 (16.0-20.1) and 95.9 (95.2-96.5) percent, respectively. Our score performed equally well or better than the other two in the Iranian [AUC 0.542 vs. 0.564 (p = 0.476) and 0.513 (p = 0.300)] and Mexican [AUC 0.791 vs. 0.672 (p<0.001) and 0.778 (p = 0.575)] cohorts. In the European cohort, it performed similarly to the Balkau score but worse than the Kahn clinical [AUC 0.788 vs. 0.793 (p = 0.091) and 0.816 (p<0.001)]. Diagnostic capacity of our score was better than the Balkau score and comparable to the Kahn clinical one. CONCLUSION: Our clinically-based score shows encouraging results compared to other scores and can be used in populations with differing diabetes prevalence.

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