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Biomedical subjects

F Gutzwiller

Publications and source records attributed to F Gutzwiller.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Quality of dispensation of prescription medication from the patients' point of view].

A cross-sectional survey investigated quality relevant aspects of the most common distribution channels (pharmacies, self-dispensing physicians) for prescription drugs in Switzerland. A self-administered questionnaire focusing on consumers' behaviour, perception and priorities regarding the process of dispensation of prescriptive medication was mailed to a random sample of 3000 patients, aged 18 years or older, with regular intake of prescriptive medication. Chi-square analysis was performed on 1058 responses. 60% of the respondents received their medication mainly or exclusively from pharmacies and 40% from self-dispensing physicians. In German-speaking Switzerland 53% of participants received their prescription drugs exclusively or mainly from self-dispensing physicians, compared to only 10% in the French-speaking area (p = 0.00). This distribution confirms the existing differences in regulation of self-dispensation in these regions. Most of the patients took 2-4 prescriptive drugs a day. The French Swiss received slightly more prescriptive medication than the German Swiss (p = 0.05). 45% of the participants, especially women and people using a pharmacy, reported additional, usually occasional over-the-counter medication. Provision of technical information (41%), friendliness (19%), and the availability of drugs (19%) were valued most important when receiving prescription drugs and 96% of the participants were satisfied with the service. In consequence, the participants were strongly bound to their source of drug supply. Some 80% received instructions for use there. However, only half were informed about the purpose of the medication, drugs' side effects, or possible drug interactions. Physicians provided such information more often than pharmacy staff. This observation may be attributable to the double role played by the self-dispensers, who provide medical care and at the same time hand out the drug. In conclusion, patients' satisfaction is achieved equally by both medication channels. However, there is a need to improve counselling to ensure excellence in the supply of drugs.

Adult↗
PubMed2000

Health technology assessment in Switzerland.

Switzerland has a mixed public and private healthcare system. All citizens are enrolled in compulsory basic health insurance. A 1996 law allows people to choose among different sickness funds and managed care plans. The federal government is empowered to act on important health issues, but the 26 cantons have prime responsibility in health care and social welfare. They have their own laws on health care, hygiene, hospitals, and social welfare. These laws are not harmonized. The system is complex, with a mix of public (mainly hospitals) and private (mainly doctors' offices) providers. The health services are decentralized. Ambulatory care was traditionally provided in doctors' offices, but the last decade has seen the development of centers for day surgery, group practices, and managed care plans. Decisions on placement, location, and extension of services are decentralized. The payment system is very complex. Current trends include global budgets, cost analyses, and prices related to patient categories. However, coverage policy is developed centrally and includes both traditionally established services and new technologies. New technologies are added to the list only after evaluation by the Federal Coverage Committee. The coverage process integrates health technology assessment (HTA). Coverage can be granted in stages, including limited coverage and temporary coverage. Technologies and coverage can be reevaluated on the basis of registries or assessment information. The structure of the Swiss healthcare system does not lend itself to the establishment of a national HTA program. However, recent moves include the development of a coordinating mechanism for HTA in Switzerland.

Delivery of Health Care↗
PubMed2000

Association of low plasma cholesterol with mortality for cancer at various sites in men: 17-y follow-up of the prospective Basel study.

BACKGROUND: Low serum cholesterol has been associated with an increased risk of cancer mortality in various studies, which has led to uncertainty regarding the benefit of lower blood cholesterol. OBJECTIVE: The aim of our study was to evaluate the association between low blood cholesterol (<5.16 mmol/L) and cancer at sites that have rarely been evaluated. We placed special emphasis on the potential confounding effect of antioxidant vitamins. DESIGN: Plasma concentrations of cholesterol and antioxidant vitamins were measured in 1971-1973 in 2974 men working in Basel, Switzerland. In 1990, the vital status of all participants was assessed. RESULTS: Two hundred ninety of the participants had died from cancer, 87 from lung, 30 from prostate, 28 from stomach, and 22 from colon cancer. Group means for plasma cholesterol concentrations did not differ significantly between survivors and those who died from cancer at any of the studied sites. With plasma cholesterol, vitamins C and E, retinol, carotene, smoking, and age accounted for in a Cox model, an increase in total cancer mortality in lung, prostate, and colon but not in stomach cancer mortality was observed in men >60 y of age with low plasma cholesterol. When data from the first 2 y of follow-up were excluded from the analysis, the relative risk estimates remained practically unchanged with regard to lung cancer but decreased for colon, prostate, and overall cancer. CONCLUSIONS: Increased cancer mortality risks associated with low plasma cholesterol were not explained by the confounding effect of antioxidant vitamins, but were attributed in part to the effect of preexisting cancer.

Age Factors↗
PubMed2000

[Sexuality in the second half of the life span].

Compared to other research areas of sexology, the state of knowledge regarding sexual behavior and experiences in middle and older age is rather poor. This is due to not only the continuing taboo placed on questions regarding sexuality of elderly people, but also to limited understanding of factors influencing the sexual realm. The present review presents findings on sexuality in the second half of the life span from a number of differing disciplinary perspectives. Focus is on gender differences in sexual life and the influence of critical life events on sexuality in women in the second half of the life span. Apart from restrictive social norms and individual personality factors, physiological changes during the menopause can also have an effect on sexuality. The special situation of elderly women without partners and changes in partnership sexuality during this phase of the life span are discussed. Some recommendations for the field of gynecology are derived from a multidisciplinary approach.

Age Factors↗
PubMed2000

Appropriateness and necessity research on the Internet: using a "second opinion system".

Appropriateness and necessity research of various procedures in medicine may be the most complex field of innovation in healthcare and technology assessment. Nevertheless, the appropriateness of the indication of any medical intervention is probably more important than the outcome since even ideal quality components of structures, processes and outcomes become irrelevant without a proper indication. The first part of our appropriateness initiative in interventional cardiology and gynecology was to formulate guidelines. To define the appropriateness for coronary angiography, coronary revascularization and hysterectomy, literature-based consensus methods were used. The second part was to disseminate the guidelines in a user-friendly manner via the Internet. Therefore, we relied on a system-driven query facility for propositional (experts) rules. The next part of the appropriateness initiative may be a user-friendly Internet-based data collection system to validate the national accepted guidelines. Most important may be that only data that is needed can be collected using a refined database technology. The described Second Opinion System can be found under: http:sos.inf.ethz.ch. Research on indications with data on clinical outcome may open new opportunities to validate indication guidelines using Internet/database technology for data analysis and browsing of decision graphs concerning clinical decision-making. This new technology facilitates the evaluation of appropriateness and necessity criteria in combination with clinical outcomes.

Aged↗
PubMed1999

[Lipid-lowering therapy in patients with coronary disease: proportion of patients requiring treatment according to recommendations of the Swiss Society of Cardiology].

BACKGROUND: Recent studies have confirmed that treatment with lipid-lowering drugs decreases cardiovascular morbidity and mortality in primary as well as secondary prevention of cardiovascular diseases. In 1999, new Swiss recommendations for treatment with lipid-lowering drugs have been published. We therefore performed a study to estimate the proportion of patients with coronary artery disease requiring lipid-lowering drugs. METHODS: We included 637 patients with coronary heart disease who were referred for coronary angiography during 1991-1993. We calculated the proportion of patients requiring lipid-lowering drugs according to the new Swiss guidelines, and compared them with European and US guidelines. RESULTS: According to the 1999 Swiss recommendations, 79% of the study population would have qualified for lipid-lowering treatment (males 80%, females 78%; patients aged up to 69 years 80%, patients aged 70 years and over 73%). Agreement with both the Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention, and the ACC/AHA Guidelines for Management of Patients with Acute Myocardial Infarction, was 96% (Kappa 0.79 and 0.83 respectively). CONCLUSION: A large proportion of patients with coronary artery disease qualifies for treatment with lipid-lowering drugs. The new Swiss recommendations closely agree with European and US guidelines.

Aged↗
PubMed1999

[Hepatitis B and C in intravenous drug abusers in Switzerland].

Since the 1980s hepatitis B and C have spread greatly among intravenous drug consumers. This shows up today in a high prevalence for both pathogens. It is striking that many patients who have only consumed drugs intravenously for a few years have already been infected with hepatitis B or C. The clear reduction in the spread of HIV within the drug-using community achieved by targeted measures during recent years has not had a similar impact on hepatitis B and C. Given this background, optimising preventive efforts among intravenous drug users is of great importance. Structural steps for therapy and damage-reduction should be optimised even more. Moreover, individual protective behaviour among patients should be improved. Medical advice and care is of great importance in this case. New studies show that many intravenous drug consumers are insufficiently informed on the risks of infection from shared use of injection utensils (spoons, filters, etc.) or drug sharing with used needles. Moreover, many drug consumers are not vaccinated against hepatitis B. Medical advice on protective behaviour should address these problems more directly. In the future, other sustainable intervention programmes based on this approach will need to be developed.

Adolescent↗
PubMed1999

[Possible future of the project for quality assurance of indications and outcome in interventional cardiology and gynecology].

In the last few years the basis for national guidelines for the indications of coronary angiography, coronary revascularisation and hysterectomy has been established. The guidelines have been published and are accessible to medical doctors and patients on the Internet using a database system called "Second Opinion System": http:/(/)sos.inf.ethz.ch Dissemination, implementation and validation of the guidelines will be of major importance in the near future. With reference to validation, the question remains whether the established guidelines are correct for the everyday treatment of patients. A suitable method of answering this important question is comparison between the appropriateness and necessity rates of the various indication groups, combined with outcome measurements. The Internet-based second opinion system (SOS) may be used for data collection in order to verify hypotheses. Because of the database architecture, only relevant information about the patients is collected via Internet, independent of time and place. In addition, the system allows users to evaluate their individual data, and special attention is given to data protection. The discussion about priorities in health care (rationing) will be increasingly important in the near future. The present project may offer a way of maintaining adequate access to health care services for patients. Therefore, the participation of as many institutions as possible in the project "quality assurance of indication and outcome in interventional cardiology and in gynaecology" is of great importance.

Cardiology↗
PubMed1999

[Changes in mortality in Switzerland since 1950. II. Regional differences within Switzerland].

OBJECTIVES: To examine regional variations in all-cause mortality in Switzerland around 1990 and trends since 1950. Special emphasis is placed on unfavourable aspects that have been identified by comparisons with international trends. DATA AND METHODS: Descriptive analysis of Swiss mortality statistics taken from individual records (1969-94) and data published by the Swiss Federal Statistical Office (1949-68). RESULTS: Swiss citizens aged between 15 and 79 years often show mortality ratios of 1.5 and more between the best and the worst of the 106 regions of Switzerland. In subjects aged under 50 years, relative risk ranges are even larger. However, the regional mortality patterns before and after 50 rarely correspond. Generally, the relative risk difference between the best and the worst regions has not diminished since 1950, whereas the geographical patterns have completely changed. Instead of an obvious rural-urban gradient in 1950, mortality rates are now highest in the largest cities and, at least in men, are at their lowest in the wealthy suburbs. On a larger scale (division into 9 geographical units), central Switzerland has changed significantly from clearly elevated mortality rates in 1950 into a decidedly favourable position in 1990. A contrast between German and French Switzerland has existed for many decades: in the younger and middle age groups the francophone part of Switzerland has a higher mortality rate than the German-speaking part, whereas at ages over 70 French Switzerland has lower rates than German Switzerland. In some urban areas of Switzerland, the turning-point from a decreasing to an increasing trend in the mortality risks of subjects aged 15-49 years was reached around 1960, occasionally resulting in age-specific rates being higher in 1990 than in 1950. This unfavourable partial trend has spread over most, but not all, of Switzerland since 1970. Even in subjects aged 25-34 years, the age group for which Switzerland has the worst relative position on an international scale, some parts of the country do not have elevated all-cause mortality rates, whereas for men in the largest cities mortality risks are more than three times as high as in Japan. The deaths from "external" causes (mainly accidents and suicide) show marked geographical patterns within Switzerland; however, in all parts of the country, deaths from this group are much more frequent than, for example, in Italy or the Netherlands. CONCLUSION: Geographical differences in mortality risks within Switzerland, as well as international disparities, suggest that there is a need for preventive measures in Switzerland, first and foremost concerning males aged 15-49 years and deaths from "external" causes.

Adolescent↗
PubMed1999

[Development of mortality in Switzerland since 1950. I. International comparison and differences in sex, age and nationality].

BACKGROUND: All-cause mortality is an important criterion for assessing the health status and the living conditions of a population, thus indicating possible preventive measures. DATA AND METHODS: Descriptive analyses of Swiss mortality records and a comparison with the WHO mortality data bank for the period since 1950. RESULTS: Age-specific mortality trends in Switzerland are traced back to 1950 and compared with the situation in other European countries. At the beginning of the 1950s Swiss all-cause mortality rates were about the European average; now they are among the lowest worldwide. In most age classes, rates declined by more than one third between 1951/54 and 1990/94, in females even by more than 50%. This rather optimistic overall picture conceals less favourable partial trends. The decline in mortality rates in men aged 20-49 and women aged 20-34 years did not continue after 1970, and for males aged 20-44 and females aged 25-34 mortality risks have even increased in recent years. In both males and females, mortality rates from injury and poisoning (mainly accidents and suicide) exceed those of European low-incidence countries by 100%. On an international scale Swiss subjects aged between 15 and 44 years are at much higher risk, even when deaths from injury and poisoning, the most important cause of death in these ages, are excluded. When compared with their Swedish contemporaries, Swiss males aged 25-34 years have almost twice the risk of dying from a "natural" as well as from an "external" cause. As a rule, male/female sex ratios of mortality continued to increase, except in subjects aged 45-64 years. CONCLUSION: In spite of low overall mortality risks, international age-specific rates suggest considerable potential for preventive measures in Switzerland. There is some evidence of substantial under-registration of the mortality risks of foreigners living in Switzerland. As foreigners represent a substantial part of the total population--with a maximum of 30% of men aged 25-34 years--figures for Switzerland as a whole may be biased seriously. Therefore, for mortality analyses and comparisons with international data, we suggest the study be restricted to Swiss citizens. When assessing mortality risks for foreigners in Switzerland alternative data sources and methods should be taken into account.

Adolescent↗
PubMed1999

[New treatment concepts in smoking cessation].

Although the smoking rate in Switzerland had declined during the 1970s and 1980s, it has not continued to decrease during the 1990s. About one third of the population in Switzerland smoked in 1997. Striking is a sharp increase in young female smokers during recent years. The portion of 15- to 25-year-old female smokers rose from 26% (1992) to 41% (1997). This undesirable development calls for making the most of preventive initiatives to date. Beside primary prevention steps, the range of assistance for smokers also needs to be extended. In addition to the smoking withdrawal counselling introduced, development of a range of programmes should also be expanded to assist smokers who have currently been unable to quit. Reduction in the number of cigarettes smoked within the framework of intensive specialist care can make sense in this situation. In the near future, pharmacological aids (nicotine substitute preparations) are also anticipated for this purpose. The most important resources for such smoker counselling will be presented. Future studies should focus on optimising reduction treatment as a new approach toward treatment.

Adolescent↗
PubMed1999

[Epidemiology of overweight in Switzerland: results of the Swiss National Health Survey 1992-93].

UNLABELLED: In many western countries more than half of the population is considered overweight (BMI > or = 25). METHODS: Data from the first national representative health survey for Switzerland (conducted 1992/93), including 7930 men and 7358 women (response rate 71%) aged 15 and over, were used. Means and percentiles of body weight, body height and BMI were calculated for men and women of different age groups. Overweight was defined as a BMI > or = 25, graded as overweight grade I (25.00-29.99), grade II (30.00-39.99), and grade III (BMI > or = 40.00) and analyzed according to gender, age, etc. RESULTS: Mean values for height decreases with increasing age, and body weight increases up to the age of 55-64 years in men and women. BMI values of all percentiles and age groups are lower for women than for men with the exception of age groups of 55 years or older and the 90 percentile. The prevalence of grade I overweight is 33.1% for men and 17.1% for women, of grade II overweight 5.8% and 4.5%, and of grade III overweight 0.3% and 0.2% respectively. Overall prevalence of overweight is 21.8% for women and 39.2% for men. Increasing age is associated with a higher prevalence of overweight. The prevalence of overweight in men increases with age up to 55-64 years, then levels off. In women, prevalence continues to rise. Overweight is more common in men of all age groups than in women. CONCLUSIONS: Periodic studies of the national prevalence of overweight are essential for monitoring the magnitude, and changes in the magnitude, of this serious public health problem.

Adolescent↗
PubMed1999

[Epidemiological analysis of accidental falls by the elderly in Zurich and Geneva].

The purpose of the study was to determine the prevalence rate of fallers (PRF%) and fall-related consequences among the elderly according to age, gender and setting. Data derive from a cross-sectional study on dementia, depression and handicaps among the elderly, carried out between 1995 and 1996. Elderly people aged 65 and over living in Zurich or Geneva were considered eligible for the study. By means of the Canberra Interview for the Elderly, 921 subjects' and/or informants' interviews were completed. The subjects were classified as a faller if the subject and/or informant reported a fall in the year prior to the interview. Overall PRF% amounted to 27.8% and was higher to a statistically significant degree among females (30.9%) than males (22.5%). Gender difference in PRF was found only among the non-institutionalized elderly. Age-specific PRF increased significantly with the age of the elderly. However, this increase was observed only among male subjects. 143 subjects (PRF 17.1%) have fallen once and 101 (PRF 9.9%) two or more times. Females showed a substantially higher propensity to recurrent falls (age-adjusted OR 1.86; 95% confidence interval 1.11-3.10). While the risk of suffering two or more falls increased with age, it did not increase among one-time fallers. Residents of nursing homes had significantly higher risk of falling as compared with home-dwelling subjects (age-adjusted OR 2.46; 95% confidence interval 1.04-5.78). Every second fall caused fall-related consequences. 9.1% of all falls led to fall-related fracture. The risk of suffering fall-related consequences depended on neither age nor gender. One third of fallers reported fear of further falling. Falls among the elderly occur often and contribute substantially to morbidity.

Accidental Falls↗
PubMed1999

[Recording of multiple sclerosis in Swiss cause of death statistics. A 10-year mortality follow-up of the Bern prevalence study].

Based on data from a multiple sclerosis (MS) prevalence study which had been carried out in 1986 in the canton of Berne, Switzerland, a follow-up was performed 10 years later to gather information on mortality in the original study population. The authors used information on residency and death as gathered from municipal offices and, additionally, by record-linkage with the Swiss cause of death statistics. Slightly more than 80% of the cases were identified unequivocally as of January 1996. Among them, 21% of the cases died during the ten-year period; 70% of them have an MS entry in the cause of death statistics, mostly as the main cause of death. A large proportion of the non-identifiable cases appear to be related to mortality; thus, the findings here do not provide a promising basis for certain further analyses. In conclusion, continuous updating of personal data is the only way to avoid loss to follow-up in the carefully assembled prevalence database.

Cause of Death↗
PubMed1999

Swiss consensus guidelines for hysterectomy. Swiss Society of Gynecology and Obstetrics, Switzerland.

OBJECTIVE: The quality of the indication for hysterectomy is widely discussed at present. In early 1996, the committee for quality assurance of the Swiss Society of Gynecology and Obstetrics decided to set up nationally accepted guidelines for the indication of hysterectomy. METHODS: A modified Delphi approach was used. In a first step, general guidelines and actions prior to hysterectomy were defined. An expert panel of 17 Swiss gynecologists rated 74 frequent indications, twice for appropriateness (more benefits than risks for the patient), once for necessity (n = 34; procedure has to be offered or discussed with the patient), and outlined suggestions to be performed prior to hysterectomy. RESULTS: In a home rating round before the first panel met, there was an agreement rate of 48%. In 45% we observed neither agreement nor disagreement; in 7% we found disagreement. After the panel discussion 89% of experts agreed, 11% were indeterminate, and there was no disagreement. The necessity ratings showed agreement in 68% while 32% were indeterminate. The average median rating on a 1-9 point scale (1 = extremely inappropriate, 9 = extremely appropriate or necessary) was 5.4 over all single indications for appropriateness and 7.8 in single indications for necessity. After a second panel for consensus all panelists agreed on both appropriateness and necessity. CONCLUSION: The results of the appropriateness and necessity consensus presented in this paper reflect the findings of a 17 member Swiss panel. This joint effort by a medical society may be a step towards the direction of a peer controlled healthcare system.

Congresses as Topic↗