Paul Sebo

Reliability of doctors' anthropometric measurements to detect obesity

OBJECTIVE To evaluate the reliability of anthropometric measurements (weight, height, Body Mass Index (BMI), waist and hip circumferences (WC; HC) and waist-to-hip ratio (WHR)) performed by doctors to assess obesity. METHOD Repeated anthropometric measurements were performed by 12 primary care physicians on 24 adult volunteers in Geneva, Switzerland, 2006. Volunteers (54% women, mean age 41) had a mean BMI of 28.1 (respective mean values for WC, HC and WHR: 91.4, 108.3, 0.84). Inter-observer reliability coefficient (R) and percent disagreement in categorisation of volunteers (normal weight, overweight, obesity, abdominal obesity) were computed according to these measurements. RESULTS The inter-observer reliability for weight, height, and derived BMI were excellent (R>0.99), but unsatisfactory for WC (R=0.92), HC (R=0.76) and WHR (R=0.51). Based on the BMI, only 1% of the volunteers were misclassified as overweight or obese, whereas the use of WC and WHR lead to misclassification in 6% and 23% respectively. Reliability for the measurements improved after a one-hour training in anthropometric measurements (R=0.97 for WC, 0.92 for HC and 0.89 for WHR), but the proportion who were misclassified remained high despite the training session for WC (5%) and WHR (9%). CONCLUSIONS BMI remains the most reliable measure to detect obesity in medical practice, whereas WC, HC and WHR are less reliable. These results challenge current recommendations on obesity-related cardio-vascular risk management based on WC and WHR and underline the need for further research to improve the reliability of anthropometric measurements by doctors.

Blood pressure measurements are unreliable to diagnose hypertension in primary care

Objectives: To evaluate the accuracy of blood pressure (BP) measurements performed by primary care physicians (PCPs), and to assess whether it improves following a short theoretical training. Methods: Observational study in 26 primary care practices in Geneva, Switzerland. The PCPs were asked to measure BP on 10 volunteers, within the usual context of their practice. Two trained research assistants repeated the measures immediately after the PCPs. The PCPs were then randomized to receive detailed training documentation on standardized BP measurement (group I: 14 doctors) or information about high BP (group II: 12 doctors). Measures were repeated a few weeks later. We computed accuracy and diagnostic categorization of high BP comparing the PCPs’ measurements to the average value of four measurements by the research assistants (gold standard). T-tests were used to compare measurements between the two educational groups, both at baseline and following exposure to the educational material. Results: BP measurements were performed on 257 volunteers at baseline and 251 after training. At baseline, the mean BP difference between PCPs and the gold standard were 23.0 mmHg (21.3–24.6) for systolic and 15.3 mmHg (14.3–16.3) for DBP. Following training, the mean difference remained high [group I: 22.3 mmHg (20.4–24.2) and 14.4 mmHg (12.6–16.2); group II: 25.3 mmHg (22.7–27.9) and 17.0 mmHg (15.3–18.7)]. As a result, 24–32% volunteers were misdiagnosed as having systolic hypertension and 15–21% as having diastolic hypertension. Conclusion: Though widely used in the assessment of hypertension in ambulatory settings, in-office BP measurements are highly inaccurate, even following training.

Psychiatric symptoms, psychological distress and somatic comorbidity among remand prisoners in Switzerland

OBJECTIVE The aims of this study were to determine the prevalence of psychiatric symptoms and complaints among remand prisoners in Switzerland and to analyze the relationships between psychiatric symptoms, physical health and substance abuse problems in this population. METHOD The medical files of all detainees attending the prison health service in 2007 were reviewed. Identified health problems were coded using the International Classification of Primary Care (ICPC-2). Descriptive statistics and measures of association were computed. RESULTS A total of 1510 files were analyzed. Several associations between psychological symptoms (anxiety and insomnia) and physical health problems (skin, respiratory and circulatory) were observed. Substance abuse was also frequently associated with somatic health problems. CONCLUSIONS These data provide the first comprehensive description of the mental health of detainees in Switzerlands largest remand prison. Our findings emphasize the need for coordinated health care services in detention settings.

Health problems among detainees in Switzerland: a study using the ICPC-2 classification

BackgroundLittle is known about the health status of prisoners in Switzerland. The aim of this study was to provide a detailed description of the health problems presented by detainees in Switzerlands largest remand prison.MethodsIn this retrospective cross-sectional study we reviewed the health records of all detainees leaving Switzerlands largest remand prison in 2007. The health problems were coded using the International Classification for Primary Care (ICPC-2). Analyses were descriptive, stratified by gender.ResultsA total of 2195 health records were reviewed. Mean age was 29.5 years (SD 9.5); 95% were male; 87.8% were migrants. Mean length of stay was 80 days (SD 160). Illicit drug use (40.2%) and mental health problems (32.6%) were frequent, but most of these detainees (57.6%) had more generic primary care problems, such as skin (27.0%), infectious diseases (23.5%), musculoskeletal (19.2%), injury related (18.3%), digestive (15.0%) or respiratory problems (14.0%). Furthermore, 7.9% reported exposure to violence during arrest by the police.ConclusionMorbidity is high in this young, predominantly male population of detainees, in particular in relation to substance abuse. Other health problems more commonly seen in general practice are also frequent. These findings support the further development of coordinated primary care and mental health services within detention centers.

Sexual and reproductive health behaviors of undocumented migrants in Geneva: a cross sectional study.

Undocumented migrants face major barriers in accessing prevention and health care. Whereas the association between low socioeconomic status and poor health is well documented only few studies have addressed specific health issues in undocumented migrants. The aim of the present study is to describe sexual and reproductive health behaviors of undocumented migrants in Geneva. This descriptive cross sectional study included consecutive undocumented migrants presenting from November 2007 to February 2008 to a health facility offering free access to health care to this population. Following informed consent, they completed a self administered questionnaire about their socio-demographic profile and sexual and reproductive health behaviors. A total of 384 patients were eligible for the study. 313 (82%) agreed to participate of which 77% (241 patients) completed the survey. Participants were mainly young, Latino-American, single, well-educated and currently working women. They had multiple partners and reported frequently engaging in sexual intercourse. Use of contraceptive methods and strategies of prevention against sexually transmitted infections (STI) were rare. Nearly half of the women had had at least one induced abortion and 40% had had an unplanned pregnancy. One in four participants reported a current or past STI or other genital infection. The results of our study suggest that undocumented migrants engage in frequent and high risk sexual intercourse with insufficient use of contraceptive methods and suboptimal strategies of prevention against STI. Our study underlines the real need for specific sexual and reproductive educational programs targeting this hard to reach population.

Rates, Delays, and Completeness of General Practitioners’ Responses to a Postal Versus Web-Based Survey: A Randomized Trial

Background Web-based surveys have become a new and popular method for collecting data, but only a few studies have directly compared postal and Web-based surveys among physicians, and none to our knowledge among general practitioners (GPs). Objective Our aim is to compare two modes of survey delivery (postal and Web-based) in terms of participation rates, response times, and completeness of questionnaires in a study assessing GPs’ preventive practices. Methods This randomized study was conducted in Western Switzerland (Geneva and Vaud) and in France (Alsace and Pays de la Loire) in 2015. A random selection of community-based GPs (1000 GPs in Switzerland and 2400 GPs in France) were randomly allocated to receive a questionnaire about preventive care activities either by post (n=700 in Switzerland, n=400 in France) or by email (n=300 in Switzerland, n=2000 in France). Reminder messages were sent once in the postal group and twice in the Web-based group. Any GPs practicing only complementary and alternative medicine were excluded from the study. Results Among the 3400 contacted GPs, 764 (22.47%, 95% CI 21.07%-23.87%) returned the questionnaire. Compared to the postal group, the participation rate in the Web-based group was more than four times lower (246/2300, 10.70% vs 518/1100, 47.09%, P<.001), but median response time was much shorter (1 day vs 1-3 weeks, P<.001) and the number of GPs having fully completed the questionnaire was almost twice as high (157/246, 63.8% vs 179/518, 34.6%, P<.001). Conclusions Web-based surveys offer many advantages such as reduced response time, higher completeness of data, and large cost savings, but our findings suggest that postal surveys can be still considered for GP research. The use of mixed-mode approaches is probably a good strategy to increase GPs’ participation in surveys while reducing costs.

Effect of magnesium therapy on nocturnal leg cramps: a systematic review of randomized controlled trials with meta-analysis using simulations

BACKGROUND AND OBJECTIVE Nocturnal leg cramps (NLC) are common in primary care and may cause severe pain and sleep disturbance. We systematically reviewed the effectiveness of magnesium in treating NLC and the side-effect profile of magnesium compared to placebo. METHODS We searched Medline, Embase, Cochrane Library, ClinicalTrials.gov, the International Standard Randomised Controlled Trial Number and the International Clinical Trials Registry Platform registries until August 2012. All randomized controlled trials (RCTs) comparing magnesium therapy for NLC in adults with any other comparator were eligible. Two investigators independently selected, extracted data from and rated the risk of bias of relevant studies. To compensate for the heterogeneity in outcome measures, simulations were used to summarize the data. RESULTS Seven RCTs were included in the review (n = 361), all comparing magnesium to placebo. Three of these trials included only pregnant women. The difference in the median number of leg cramps per week between the placebo and the intervention groups was 0.345 (quantile 2.5%: -0.133, quantile 97.5%: 0.875). This difference was 0.807 (quantile 2.5%: 0.015, quantile 97.5%: 1.207) in the three studies involving only pregnant women and 0.362 (quantile 2.5%: -0.386, quantile 97.5%: 1.148) in the others. Overall gastrointestinal side effects were slightly more common with magnesium therapy than with placebo. The strength of this evidence was weak, mainly due to small study sizes and short follow-up. CONCLUSIONS Magnesium therapy does not appear to be effective in the treatment of NLC in the general population, but may have a small effect in pregnant women. Further research using better designed RCTs is necessary.

Prevalence and Associated Factors for Chlamydia trachomatis Infection Among Undocumented Immigrants in a Primary Care Facility in Geneva, Switzerland: A Cross-Sectional Study

Chlamydia trachomatis infection (CTI) is the most frequent sexually transmitted infection in western countries. Its prevalence in undocumented immigrants, a rapidly growing vulnerable population, remains unknown. We aimed to document the prevalence of CTI and associated factors at the primary health care level. This cross-sectional study included all undocumented immigrants attending a health care facility in Geneva, Switzerland. Participants completed a questionnaire and were tested for CTI by PCR assay. Three-hundred thirteen undocumented immigrants (68.4% female, mean age 32.4 (SD 8) years) agreed to participate. CTI prevalence was 5.8% (95% CI 3.3–8.4). Factors associated with higher prevalence were age ≤25 (OR 3.9, 95% CI 1.3–12.2) and having had two or more sexual partners during the precedent year (OR 4.5, 95% CI 1.5–13.7). Prevalence and associated factors for infection in this vulnerable population were comparable with other populations in Western countries. Our findings support the importance of facilitating access to existing screening opportunities in particular to individuals at higher risk.

Chlamydia trachomatis infection in a Swiss prison: a cross sectional study

BACKGROUND Chlamydia trachomatis infection (CTI) is the most frequent sexually transmitted infection in Switzerland and its prevalence in correctional settings is currently unknown. The aim of this study was to determine the prevalence of CTI and associated risk factors in a population of inmates aged 18-35 years. METHODS Inmates attending the health care unit of the largest Swiss remand prison from June 2008 to May 2009 were invited to participate in this cross-sectional study. All participants completed a questionnaire and provided a first-void urine specimen for CTI testing based on a PCR assay. Univariate and multivariate logistic regression analyses were used to assess risk factors associated with CTI. RESULTS 214 male and 20 female inmates agreed to participate. Overall CTI prevalence was 6.5% in men (95% CI 3.2; 9.9) and 10% (95%CI 0; 23.1) in women. None of the following possible risk factors analysed were significantly correlated to CTI: age, origin, education, religion, number of sexual partners, iv drug use, subjective health status and uro-genital symptoms. CONCLUSION CTI prevalence in the largest Swiss prison was two to six times higher than in the general population but similar to other European prison settings. This result should raise our awareness that this population is at particularly high risk for sexually transmitted infections and motivate a widespread surveillance of prison CT prevalence. We hesitate to consider systematic screening because evidence is still lacking in relation to the benefits of screening in males. Local cost effectiveness studies would highly contribute to a correct decision concerning implementation of screening.

Mental health of young offenders in Switzerland: Recognizing psychiatric symptoms during detention

We reviewed the medical records of the 118 adolescent detainees which had at least one consultation by a psychiatrist at the prison health facility during 2007. General practitioners used the International Classification of Primary Care (ICPC-2) for recording health problems. Psychiatrists used the International Classification of Diseases (ICD-10) for making psychiatric diagnoses. The concordance between the mental health assessment done by general practitioners using the ICPC-2 and the diagnoses proposed by psychiatrists was globally satisfying. The five most frequent ICD categories (conduct disorder, drug abuse, alcohol abuse, personality disorder, adjustment disorder) encompassed the most frequently reported ICPC-2 psychological symptoms. Several associations between psychological symptoms and socio-demographic characteristics were observed. Apart from providing a description of the mental health of adolescent detainees in one of Switzerlands largest detention centre for minors, results suggest that general practitioners can adequately identify frequent mental disorders in such contexts.