Luc Raymond

Diagnostic changes as a reason for the increase in papillary thyroid cancer incidence in Geneva, Switzerland

Objective: Several studies have reported upward incidence trends of papillary thyroid cancer. It is unclear whether these trends reflect a real risk increase, by some attributed to iodine supplementation, or an artificial one, due to increased diagnostic activity or changed histological criteria. This study examines if these artificial factors explain the increased papillary thyroid cancer incidence in the Swiss canton of Geneva. Methods: All thyroid carcinomas (n = 436) recorded between 1970 and 1998 at the Geneva Cancer Registry were considered. European age-adjusted incidence trends were estimated using linear regression analysis. For papillary cancers we evaluated diagnostic modalities and way of presentation (in particular microcarcinoma < 1 cm or silent carcinoma). In addition, we reviewed the histological slides of follicular carcinomas. Results: Papillary thyroid cancer incidence increased significantly from 0.7 to 1.8/100,000 for men and from 3.1 to 4.3/100,000 for women between 1970–74 and 1995–98. The proportion of microcarcinomas and silent carcinomas increased from 17% to 24% between 1970–79 and 1990–98. At histological review, follicular cancers were more often reclassified as papillary cancer for cases diagnosed between 1970 and 1979 than for cases diagnosed between 1990 and 1998 (45% vs 25%, p = n.s.). Conclusions: The increasing papillary thyroid cancer incidence seems mainly due to changes in histological diagnostic criteria and, to a lesser extent, to increased diagnostic activity. If confirmed, the results of this study indicate that fears of increasing incidence rates of papillary thyroid cancer should not prevent implementation of adequate programs of iodine supplementation in the many areas where iodine deficiency still prevails.

Diet and cancers of the larynx and hypopharynx: the IARC multi-center study in southwestern Europe

The main causes of cancer of the larynx and hypopharynx are smoking cigarettes and drinking alcohol. However, for these as well as for other cancers of the upper aerodigestive tract, some dietary components, mainly low consumption of fruit and vegetables, have been observed to be associated with increased cancer risk. We report results from a multicenter case-control study carried out in six regions of Europe located in northern Spain, northern Italy, Switzerland, and France. A total of 1,147 males with cancer (cases) and 3,057 population controls were interviewed on usual diet, lifelong drinking and smoking habits, and occupational history. Cancer cases had histologically verified epidermoid carcinomas. The cancers were classified in two anatomic sub-entities: the epilarynx (hypopharynx and upper part of the larynx), which enters into contact with the bolus and the air; and the endolarynx, through which air and tobacco smoke pass, but not the bolus. A previous report from this study found that alcohol drinking presents a greater risk factor for cancer of the epilarynx than for cancer of the endolarynx. The main results regarding diet indicate that high intake of fruit, vegetables, vegetable oil, fish, and low intake of butter and preserved meats were associated with reduced risk of both epilaryngeal and endolaryngeal cancers, after adjustment for alcohol, tobacco, socioeconomic status, and non-alcohol energy intake. Among nutrients, a reduced risk was found for high intake of vitamins C and E and for a high polyunsaturated/saturated fatty acids (P/S) ratio. While these variables are relevant in scoring nutritional behaviour, it remains unresolved whether the biologic properties of these nutrients play a role in the apparent protective effect.

Occupation and larynx and hypopharynx cancer: a job-exposure matrix approach in an international case-control study in France, Italy, Spain and Switzerland

Objective: To investigate the effect of exposure to occupational agents on the risk of hypopharyngeal/laryngeal cancer. Methods: Case-control study conducted during 1979–1982 in six centres in South Europe. An occupational history and information on exposure to non-occupational factors were collected for 1010 male cases of hypopharyngeal/laryngeal cancer as well as for 2176 population controls. The exposure to 10 occupational agents was assessed through a job-exposure matrix. As occupational histories had been collected since 1945 major analyses were restricted to subjects aged less than 55 years (315 cases and 819 controls). Results: Significant elevated risks adjusted for non-occupational variables (smoking, alcohol consumption and diet) and other occupational exposures were consistently found for organic solvents (odds ratio (OR) for ever-exposure: 1.7, 95% confidence interval: 1.1–2.5) and asbestos (OR: 1.6, 1.0–2.5). A significant positive trend for both probability of exposure and duration was found for exposure to solvents. A positive association between exposure to formaldehyde and laryngeal cancer was also suggested. No association was found for exposure to arsenic and compounds, chromium and compounds, and polycyclic aromatic hydrocarbons. Analyses restricted to subjects aged 55 or more did not show elevated risks, with the exception of wood dust (OR: 1.8, 1.3-2.7). Conclusions: In our study occupational exposure to solvents was associated with an increased risk of hypopharyngeal/laryngeal cancer. Results also provide additional evidence of an excess of risk for exposure to asbestos.

Occupation and larynx and hypopharynx cancer: an international case–control study in France, Italy, Spain, and Switzerland

Objective: To estimate risks for laryngeal/hypopharyngeal cancer associated with occupational titles and industrial activities. Methods: A multicentre population-based case-control study was conducted in the early 1980s in six southern European areas. Analyses included 1010 male cases and 2176 controls. Odds ratios (ORs) (adjusted for age, study area, tobacco consumption, and alcohol consumption) were estimated for 156 occupations and 70 industrial activities. Results: An excess risk has been confirmed for categories of construction workers, potters (OR: 5.91, 95% confidence intervals 1.46-24.0), butchers (2.53, 1.22–5.22), barbers (2.33, 1.00–5.40), laborers not otherwise specified (1.52, 1.12–2.06), as well as for men who had been employed in railway transport (1.52, 0.97–2.39), shipbuilding (2.05, 0.89–4.94), and hotels (2.06, 0.89–4.75). An association was also found for shoe finishers (3.23, 0.75–13.9), loggers (2.07, 0.87–4.90), and some groups of metal workers. ORs for loggers, butchers, railway transport workers, laborers, and reinforced concreters increased with duration of employment. The suggestion of a risk for machine operators among woodworkers (3.10, 0.92–10.5) conflicts with previous findings. No significant excess of risk was found for categories previously reported to be associated with laryngeal and hypopharyngeal cancer, such as drivers, mechanics, welders, machinists, and painters. Conclusions: The present study provides additional evidence to the hypothesis of a risk of cancer of the larynx/hypopharynx for workers engaged in jobs in the construction, metal, textile, ceramic, and food industries and in railway transport. Loggers were also found at risk; a previously unreported finding.

Decreased HDL cholesterol in prepubertal and pubertal children of CHD patients

Prepubertal boys and pubertal girls and boys selected because of the occurrence of acute myocardial infarction in their father or mother were characterized by a low HDL cholesterol when compared to healthy controls. This observation extends our previous observations of low HDL cholesterol in adult relatives of CHD patients to the children of the same patients. The occurrence of an HDL abnormality in young children demonstrates that the low HDL cholesterol precedes the occurrence of cardiovascular disease. Low HDL cholesterol was associated with increased VLDL cholesterol in prepubertal children and pubertal boys without significant increase in VLDL triglycerides. Smoking and drinking habits, and physical activity which are environmental factors known to affect HDL did not differ between these children and the controls and cannot account for the observed differences. The results show that the low HDL cholesterol is detectable early in life in close relatives of CHD patients, persists throughout the lifespan and is possibly genetically determined.

Prévention cardio-vasculaire: Limites de la pharmacothérapie de l'hypertension artérielle

SummaryThe efficiency of drug therapy diminishes strongly for low values of blood pressure. From the point of vue of prevention the attributable risk in the population can not be significantly reduced by drug treatment, when one takes into account the distribution of blood pressure values.ZusammenfassungMit fallendem Blutdruck nimmt die pharmacotherapeutische Effizienz ab. Unter dem Gesichtspunkt der Vorbeugung kann wegen der Verteilung der Blutdruckwerte durch dieses Vorgehen das Populationrisiko (attributable risk) käum vermindert werden).

Degré d'incapacité fonctionnelle selon l'échelle de Guttman et auto-évaluation de la santé, au 3e âge

ZusammenfassungDer globale Behinderungsscore nach Guttman und die Beurteilung des eigenen Gesundheitszustandes sind korreliert. Wenn diese Beurteilung im Vergleich mit anderen erfolgt, wird sie oft als besser eingeschätzt und entspricht in diesem Falle einem niedrigen Behinderungsgrad.AbstractThe global score of disability according to Guttman and the assessment of ones own health are correlated. Whenever this assessment is compared by reference to other peoples state of health, it often appears better and it corresponds then to a lower level of disability.

Evaluation des apports nutritionnels en protides, lipides, glucides de la population adulte résidente à Genève

ResumePar rapport aux apports nutritionnels conseillés, la population adulte résidente à Genève semble consommer trop de lipides et insuffisamment de glucides. Le phénomène est plus important chez les jeunes adultes que chez les personnes âgées.SummaryCompared with the dietary recommendations, the adult population of Geneva seems to have an excessive lipid intake and an insufficient intake of carbo-hydrates. This phenomenon is more conspicious in younger adults than in the elderly.ZusammenfassungVerglichen mit den Ernährungsempfehlungen enthält scheinbar die Nahrungsmittelzufuhr genfer Erwachsenen einen Ueberschuss an Fettstoffen und einen Mangel von Kohlenhydraten. Diese Erscheinung tritt bei jungen Erwachsenen mehr zum Vorschein als im höheren Alter.

Effets de l'incapacité, de la dépression et des troubles somatiques sur la santé auto-évaluée

SummaryPersons over 65 years of age were questionned on their state of health, in Geneva and the central part of canton of Wallis. The self-assessment of the state of health is only partially accounted for by the functional disability.ZusammenfassungBehinderung, Depression und körperliche Beschwerden: Auswirkung auf die Selbsteinschätzung der Gesundheit im dritten Alter. In Genf und im Mittelwallis sind 1522 65-jährigen oder ältere Personen bezüglich ihrer Gesundheit befragt worden. In dieser Hinsicht kann ihre Gesamteinschätzung nur teilweise der funktionalen Behinderung zugeschrieben werden.Persons over 65 years of age were questionned on their state of health, in Geneva and the central part of canton of Wallis. The self-assessment of the state of health is only partially accounted for by the functional disability.

Plan d'une étude d'évaluation randomisée de l'entraînement de la mémoire chez les personnes âgées

ZusammenfassungDie genannte Gedächtnisschulung umfasst Kursausbildung sowie Hausübungen. Mittel psychometrischer Tests (vorher/nachher) und auch Selbsteinstufung (nachher) wird die Wirksamkeit dieser Schulung beurteilt. Zwei Gruppen (Geschulte/Kontrollgruppe) wurden durch zufällige Auswahl aus eine Kollektiv von 100 freiwilligen Versuchspersonen gebildet. Die Kontrollgruppe soll erst nachträglich den Schulungskurs besuchen.SummaryThe training is realised through exercices carried out during courses and at home. The effectiveness of this training is assed 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.