Publications by authors named "José Luis Sandoval"

10 Publications

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Screening Status as a Determinant of Choice of Colorectal Cancer Screening Method: A Population-Based Informed Survey.

Gastrointest Tumors 2021 Apr 5;8(2):63-70. Epub 2021 Mar 5.

Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.

Objectives: Fecal blood testing is a noninvasive alternative to colonoscopy for colorectal cancer (CRC) screening and is preferred by a substantial proportion of individuals. However, participant-related determinants of the choice of screening method, particularly up-to-date screening status, remain less studied. We aimed to determine if up-to-date screening status was related to choosing a fecal blood test over colonoscopy.

Setting: Participants in the population-based cross-sectional survey study Bus Santé in Geneva, Switzerland - aged 50-69 years.

Design: Cross-sectional survey study using mailed questionnaires inquiring about CRC screening method of choice after providing information on advantages and disadvantages of both screening methods. We used multivariable logistic regression models to determine the association between up-to-date CRC screening status and choosing fecal blood testing.

Key Results: We included 1,227 participants. Thirty-eight percent of participants did not have up-to-date CRC screening. Overall, colonoscopy (54.9%) was preferred to fecal blood testing (45.1%) ( < 0.001) as screening method of choice. However, screening method choices differed between those with (65.6% colonoscopy and 34.4% fecal blood testing) and without up-to-date CRC screening (36.5% colonoscopy and 63.5% fecal blood testing). Not having up-to-date CRC screening was associated with a higher probability of choosing fecal blood testing as screening method (odds ratio = 2.6 [1.9; 3.7], < 0.001) after adjustment for the aforementioned confounders.

Conclusions: Not having up-to-date screening was independently associated with fecal blood testing as the preferred method for CRC screening. Proposing this method to this subpopulation, in a context of shared decision, could potentially increase screening uptake in settings where it is already high.
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http://dx.doi.org/10.1159/000512954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077459PMC
April 2021

Is clinical effectiveness in the eye of the beholder during the COVID-19 pandemic?

BMJ Evid Based Med 2020 Jul 9. Epub 2020 Jul 9.

Department of Oncology, Geneva University Hospitals, Geneva, Switzerland

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http://dx.doi.org/10.1136/bmjebm-2020-111423DOI Listing
July 2020

Amino acid changes in HA and determinants of pathogenicity associated with influenza virus A H1N1pdm09 during the winter seasons 2015-2016 and 2016-2017 in Mexico.

Virus Res 2019 10 21;272:197731. Epub 2019 Aug 21.

Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.

Biennial H1N1pdm09 influenza A virus (IAV) epidemics have been associated with major severity of respiratory disease in Mexico. Atypically and in contrast with what happened in USA, Canada and Europe during 2017, an increase of infections due to the H1N1pdm09 pandemic virus instead of H3N2 was observed. In order to determine the viral contribution to severe acute respiratory disease, we characterized the pathogenicity determinants of IAV in Mexico during the 2015-2016 and 2016-2017 seasons. The RNA segments of 20 IAV samples were sequenced by NGS platform and phylogenetic analysis was conducted. The analysis of the hemagglutinin (HA) sequences established that all virus samples, except one, belong to clade (6B.1). The IAVs presented the substitution S162 N, which introduces a new glycosylation site in the hemagglutinin. We also found the D222 G substitution, which has been associated with a higher tropism towards the lower respiratory tract, and a non-reported insertion of one Ile in NS1 (Ile113). The IAVs from 2016 to 2017 in Mexico belong to the new clade 6B.1. The new glycosylation site in HA (S162 N) is a major change that may affect the efficacy of the current vaccine. We detected in several patients pathogenicity determinants associated with the severity of the respiratory disease.
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http://dx.doi.org/10.1016/j.virusres.2019.197731DOI Listing
October 2019

Alcohol control policies and socioeconomic inequalities in hazardous alcohol consumption: a 22-year cross-sectional study in a Swiss urban population.

BMJ Open 2019 05 24;9(5):e028971. Epub 2019 May 24.

Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.

Objective: Harmful use of alcohol represents a large socioeconomic and disease burden and displays a socioeconomic status (SES) gradient. Several alcohol control laws were devised and implemented, but their equity impact remains undetermined.We ascertained if an SES gradient in hazardous alcohol consumption exists in Geneva (Switzerland) and assessed the equity impact of the alcohol control laws implemented during the last two decades.

Design: Repeated cross-sectional survey study.

Setting: We used data from non-abstinent participants, aged 35-74 years, from the population-based cross-sectional Bus Santé study (n=16 725), between 1993 and 2014.

Methods: SES indicators included educational attainment (primary, secondary and tertiary) and occupational level (high, medium and low). We defined four survey periods according to the implemented alcohol control laws and hazardous alcohol consumption (outcome variable) as >30 g/day for men and >20 g/day for women.The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were used to quantify absolute and relative inequalities, respectively, and were compared between legislative periods.

Results: Lower educated men had a higher frequency of hazardous alcohol consumption (RII=1.87 (1.57; 2.22) and SII=0.14 (0.11; 0.17)). Lower educated women had less hazardous consumption ((RII=0.76 (0.60; 0.97)and SII=-0.04 (-0.07;-0.01]). Over time, hazardous alcohol consumption decreased, except in lower educated men.Education-related inequalities were observed in men in all legislative periods and did not vary between them. Similar results were observed using the occupational level as SES indicator. In women, significant inverse SES gradients were observed using educational attainment but not for occupational level.

Conclusions: Population-wide alcohol control laws did not have a positive equity impact on hazardous alcohol consumption. Targeted interventions to disadvantaged groups may be needed to address the hazardous alcohol consumption inequality gap.
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http://dx.doi.org/10.1136/bmjopen-2019-028971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538024PMC
May 2019

Spatial distribution of mammography adherence in a Swiss urban population and its association with socioeconomic status.

Cancer Med 2018 12 25;7(12):6299-6307. Epub 2018 Oct 25.

Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.

Purpose: Local physical and social environment has a defining influence on individual behavior and health-related outcomes. However, it remains undetermined if its impact is independent of individual socioeconomic status. In this study, we evaluated the spatial distribution of mammography adherence in the state of Geneva (Switzerland) using individual-level data and assessed its independence from socioeconomic status (SES).

Methods: Georeferenced individual-level data from the population-based cross-sectional Bus Santé study (n = 5002) were used to calculate local indicators of spatial association (LISA) and investigate the spatial dependence of mammography adherence. Spatial clusters are reported without adjustment; adjusted for neighborhood income and individual educational attainment; and demographic factors (age and Swiss nationality). The association between adjusted clusters and the proximity to the nearest screening center was also evaluated.

Results: Mammography adherence was not randomly distributed throughout Geneva with clusters geographically coinciding with known SES distributions. After adjustment for SES indicators, clusters were reduced to 56.2% of their original size (n = 1033). Adjustment for age and nationality further reduced the number of individuals exhibiting spatially dependent behavior (36.5% of the initial size). The identified SES-independent hot spots and cold spots of mammography adherence were not explained by proximity to the nearest screening center.

Conclusions: SES and demographic factors play an important role in shaping the spatial distribution of mammography adherence. However, the spatial clusters persisted after confounder adjustment indicating that additional neighborhood-level determinants could influence mammography adherence and be the object of targeted public health interventions.
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http://dx.doi.org/10.1002/cam4.1829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6308042PMC
December 2018

Organised population-based programmes and change in socioeconomic inequalities in mammography screening: A 1992-2012 nationwide quasi-experimental study.

Prev Med 2018 11 24;116:19-26. Epub 2018 Aug 24.

Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Switzerland; Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland.

Organised mammography screening programmes may reduce socioeconomic inequalities in breast cancer screening, but evidence is contradictory. Switzerland has no national organised mammography screening programme, but regional programmes were progressively introduced since 1999, giving the opportunity to conduct a nationwide quasi-experimental study. We examined the evolution of socioeconomic inequalities in mammography screening in Switzerland and if exposure to regional organised programmes reduced socioeconomic inequalities. Data of 10,927 women aged 50 to 70 years old were collected from the Swiss Health Interview Survey, a nationally representative cross-sectional survey repeated 5 times (1992-2012). Socioeconomic characteristics were assessed using education, income, employment status, and occupational class. Adjusted prevalence ratios of up-to-date mammography screening were estimated with Poisson regressions and weighted for sampling strategy and non-participation bias. In the absence of organised screening programmes (1992-1997), prevalence of mammography screening increased by 23% and was associated with tertiary education and working part time. During the period of progressive introduction of regionally organised programmes (2002-2012), prevalence of mammography screening increased by 19% every 5 years and was associated with exposure to regional programmes and with independent/artisan occupations. Tertiary education and working part time were no longer associated. Exposure to organised programmes did not modify socioeconomic inequalities except for employment status: not employed women benefitted more from organised programmes compared to women working full time. In conclusion, socioeconomic inequalities in mammography screening decreased over time but organised programmes did not greatly modify them, except women not employed whose prevalence passed employed women.
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http://dx.doi.org/10.1016/j.ypmed.2018.08.012DOI Listing
November 2018

Public smoking ban and socioeconomic inequalities in smoking prevalence and cessation: a cross-sectional population-based study in Geneva, Switzerland (1995-2014).

Tob Control 2018 11 26;27(6):663-669. Epub 2018 Jan 26.

Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.

Introduction: Smoking bans were suggested to reduce smoking prevalence and increase quit ratio but their equity impact remains unclear. We aimed to characterise the socioeconomic status (SES)-related inequalities in smoking prevalence and quit ratio before and after the implementation of a public smoking ban.

Methods: We included data from 17 544 participants in the population-based cross-sectional Bus Santé study in Geneva, Switzerland, between 1995 and 2014. We considered educational attainment (primary, secondary and tertiary) as a SES indicator. Outcomes were smoking prevalence (proportion of current smokers) and quit ratio (ex-smokers to ever-smokers ratio). We used segmented linear regression to assess the overall impact of smoking ban on outcome trends. We calculated the relative (RII) and slope (SII, absolute difference) indexes of inequality, quantifying disparities between educational groups in outcomes overall (1995-2014), before and after ban implementation (November 2009).

Results: Least educated participants displayed higher smoking prevalence (RII=2.04, P<0.001; SII=0.15, P<0.001) and lower quit ratio (RII=0.73, P<0.001; SII=-0.18, P<0.001). As in other studies, smoking ban implementation coincided with a temporary reduction of smoking prevalence (P=0.003) and increase in quit ratio (P=0.02), with a progressive return to preban levels. Inequalities increased (P<0.05) in relative terms for smoking prevalence (RII=1.84, P<0.001 and RII=3.01, P<0.001) and absolute terms for both outcomes (smoking prevalence: SII=0.14, P<0.001 and SII=0.19, P<0.001; quit ratio: SII=-0.15, P<0.001 and SII=-0.27, P<0.001).

Conclusions: Implementation of a public smoking ban coincided with a short-lived decrease in smoking prevalence and increase in quit ratio but also with a widening in SES inequalities in smoking-related outcomes.
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http://dx.doi.org/10.1136/tobaccocontrol-2017-053986DOI Listing
November 2018

Maternal educational level and the risk of persistent post-partum glucose metabolism disorders in women with gestational diabetes mellitus.

Acta Diabetol 2018 Mar 29;55(3):243-251. Epub 2017 Dec 29.

Unit of Population Epidemiology, Department of Community Medicine, Primary Care, and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland.

Aims: Gestational diabetes mellitus (GDM) occurs in 5-15% of pregnancies, and lower maternal educational attainment has been associated with higher risk of GDM. We aimed to determine if maternal education level is associated with persistent post-partum glucose metabolism disorders in women with GDM.

Methods: Retrospective cohort study of women with GDM followed in 25 Portuguese health institutions between 2008 and 2012. Educational attainment was categorised into four levels. Prevalence of post-partum glucose metabolism disorders (type 2 diabetes mellitus, increased fasting plasma glucose or impaired glucose tolerance) was compared and adjusted odds ratios calculated controlling for confounders using logistic regression.

Results: We included 4490 women diagnosed with GDM. Educational level ranged as follows: 6.8% (n = 307) were at level 1 (≤ 6th grade), 34.6% (n = 1554) at level 2 (6-9th grade), 30.4% (n = 1364) at level 3 (10-12th grade) and 28.2% (n = 1265) at level 4 (≥ university degree). At 6 weeks post-partum re-evaluation, 10.9% (n = 491) had persistent glucose metabolism disorders. Educational levels 1 and 2 had a higher probability of persistent post-partum glucose metabolism disorders when compared to level 4 (OR = 2.37 [1.69;3.32], p < 0.001 and OR = 1.39 [1.09;1.76], p = 0.008, for level 1 and 2, respectively), an association that persisted in multivariable logistic regression adjusting for confounders (level 1 OR = 2.25 [1.53;3.33], p < 0.001; level 2 OR = 1.43 [1.09;1.89], p = 0.01).

Conclusions: Persistent post-partum glucose metabolism disorders are frequent in women with GDM and associated with lower maternal educational level. Interventions aimed at this risk group may contribute towards a decrease in prevalence of post-partum glucose metabolism disorders.
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http://dx.doi.org/10.1007/s00592-017-1090-yDOI Listing
March 2018

Introduction of an organised programme and social inequalities in mammography screening: A 22-year population-based study in Geneva, Switzerland.

Prev Med 2017 Oct 1;103:49-55. Epub 2017 Aug 1.

Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; Department of Epidemiology, Emory University, Atlanta, GA, United States; Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland. Electronic address:

In developed countries, breast cancer mortality has decreased during the last decades due to, at least partially, the advent of mammography screening. Organised programmes aim, among other objectives, to increase participation and decrease social inequalities in screening access. We aimed to characterise the evolution of socioeconomic disparities in mammography screening before and after the implementation of an organised programme in Geneva, Switzerland. We included 5345 women, aged 50-74years, without past history of breast cancer who participated in the cross-sectional Bus Santé study, between 1992 and 2014. Outcome measures were: 1) never had a mammography (1992-2014) and 2) never had a mammography or not screened in the two years before being surveyed (subgroup analysis, 2007-2014). Educational attainment was divided in three groups (primary, secondary and tertiary) and period in two (before/after introduction of a screening programme in 1999). We calculated measures of relative and absolute change, including the relative (RII) and slope (SII) indices of social inequality adjusted for age and nationality. We compared the prevalence of screening before and after screening programme implementation using Poisson models. The proportion of unscreened women decreased during the study period from 30.5% to 3.6%. Lower educated women were more frequently unscreened (RII=2.39, p<0.001; SII=0.10, p<0.001). Organised screening decreased the proportion of unscreened women independently of education (prevalence ratio=4.41, p<0.001), but absolute and relative inequalities persisted (RII=2.11, p=0.01; SII=0.04, p=0.01). Introduction of an organised programme increased women's adherence to mammography screening but did not eliminate social disparities in screening participation.
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http://dx.doi.org/10.1016/j.ypmed.2017.07.025DOI Listing
October 2017

[On the Future of Portuguese Physician-Scientists].

Acta Med Port 2016 12 30;29(12):793-795. Epub 2016 Dec 30.

Unidade de Epidemiologia Populacional. Hospitais Universitários de Genebra. Genebra. Suíça.; Departamento de Medicina Interna. Hospitais Universitários de Genebra. Genebra. Suíça.

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http://dx.doi.org/10.20344/amp.8388DOI Listing
December 2016