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PubMed2000

Clinical epidemiology and research on HIV infection in Switzerland: the Swiss HIV Cohort Study 1988-2000.

BACKGROUND AND OBJECTIVES: The Swiss HIV Cohort Study (SHCS) was initiated in 1988 and represented the main scientific component of the comprehensive response to the AIDS epidemic in Switzerland. It brought together physicians and scientists from five university hospitals (Basel, Berne, Geneva, Lausanne and Zurich) and two Cantonal hospitals (Lugano and St. Gallen). The objective of SHCS was, and still is, to produce rapid, high quality patient-oriented medical research in the field of HIV infection. METHODS: SHCS is a prospective population-based cohort study. Any HIV-infected person aged > or = 16 years is eligible to participate. Data collection and study procedures are standardised. Data quality and protocol monitoring are conducted at the coordination and data centre in Lausanne. Detailed information on demographics, income, mode of HIV acquisition, risk behaviours, clinical events, laboratory results, treatment and treatment tolerance is collected at registration and at 6-monthly intervals. RESULTS: Since 1996, 10,600 persons have been enrolled and the SHCS study population is considered fairly representative of the HIV-infected population in Switzerland, at least in terms of gender and mode of HIV acquisition. In 1999, 4600 patients were actively followed up and more than 70% of patients were receiving highly active antiretroviral therapy (HAART). As a consequence, mortality and the incidence of HIV-related opportunistic infections have decreased significantly in the recent past. Between 1996 and 2000, 91 original manuscripts have been published by SHCS scientists and physicians, almost exclusively in peer-reviewed journals. A wide range of scientific questions have been addressed, including HIV primary infection, the natural history of HIV infection, the clinical and biological impact of HAART, drug resistance, risk factors for disease evolution including the timing of treatment initiation, the role of CD4 receptors, the validity of HIV surveillance reports, determinants of treatment access and tolerance, clinical trials of new drug combinations, the interruption of prophylaxis following a favourable response to HAART and issues relating to quality of life and interaction between income, social level and disease evolution. CONCLUSION: The SHCS has had, and continues to have, a significant impact on medical practice, public health and research in Switzerland and beyond. It represents a network of excellence which has brought together and fostered intensive collaboration between physicians and institutions throughout this country and beyond. This was possible thanks to the support of the Federal Office of Public Health and the commitment of primary care physicians, researchers and patients. This project may be model for focused and prioritised multicentre and transdisciplinary research programmes.

AIDS-Related Opportunistic Infections↗
PubMed2000

[Ten years of BSE in Switzerland. The development of an extraordinary disease].

The first case of bovine spongiform encephalopathy (BSE) in Switzerland was diagnosed in November 1990. BSE is--in particular considering its eradication--different from many other livestock diseases. Strict disease control measures were taken from the very beginning by the Swiss authorities in order to protect public as well as animal health. In addition, BSE has stimulated enormous media interest and public concern. The occurrence of the born after the ban (BAB) cases, increasing questions about the zoonotic potential of the disease and trade restrictions against Switzerland led to the "BSE-crisis". In 1999, Switzerland internationally took a leading role in the surveillance of BSE by active investigation of targeted risk population.

Animals↗
PubMed2006

[Evidence of new foci of tick-borne encephalitis in the French speaking part of Switzerland].

The incidence of tick-borne encephalitis (TBE) has more than doubled in Switzerland in recent years. In the French part of Switzerland several patients seem to have acquired the infection outside of known endemic foci. Thirty patients with TBE living or having acquired the infection in the French speaking part of Switzerland between 2000 and 2005 were identified. For one patient it wasn't possible to obtain precise information about the place of acquisition of the infection and 16 patients were infected in known endemic foci. Among the 13 remaining patients, 6 were infected on the southern shores of the lake of Neuchâtel and 7 in the plaine of Orbe. We conclude that there are new foci of TBE in the northern regions of the canton of Vaud. Vaccination should be proposed to the population at risk of these regions. In addition it is important that persons with outdoor activities in this regions respect the preventive

Adolescent↗
PubMed1991

[The epidemiology of gasterophilosis of horses in Switzerland].

Between March 1988 and December 1989, 198 gastrointestinal tracts from slaughtered horses from different areas of Switzerland have been analysed for the presence and the frequency of Gasterophilus spp. During the same period--always between July and November--200 horses from selected areas of Western Switzerland have been checked for the presence of eggs and their subsequent developmental stages in order to investigate further clinical and biological aspects of this infection. The evaluation has been performed according to origin, age, sex, colour of the horse and seasonal pattern of the cases and the various larval stages, respectively. The prevalence of Gasterophilus spp. amounts to 64.6%, showing a marked seasonal distribution. Only Gasterophilus intestinalis has been detected and the Western part of Switzerland appears to be considerably more contaminated than the other areas of the country. The reasons are discussed. It is possible that an intensive horse-traffic at the border is partly responsible. Horses with a dark coat are more often parasitized whereas no difference occurs with regard to age and sex. The observed high prevalence of this parasite infection in the Swiss horse population confirms that gasterophilosis has to be taken into serious consideration and prophylactic measures might be indicated.

Animals↗
PubMed1991

[Is iodination of cooking salt still necessary? Current studies on iodine supply in Switzerland].

Salt with 3.75 mg iodide per kg was introduced in Switzerland stepwise in the individual cantons between 1922 and 1952. The iodide content was raised to 7.5 mg in 1962 and to 15 mg per kg in 1980. 92% of retail salt and 78% of all salt for human consumption (including salt used in industrial food processing) was iodized in 1989. Under this measure, prevalence of grade 1b or larger goiter dropped continuously to a present value of 1.3% in school-children and 0.3% in male army recruits. Endemic cretinism has disappeared completely. Urinary iodine has reached the desired range of 150 +/- 77 (SD) micrograms per g creatinine. The following facts prove that iodization of salt (and not other changes of food habits) have corrected the iodine deficiency in Switzerland: 1. Urinary iodine is highly correlated with urinary sodium. Backward extrapolation yields a theoretical urinary iodine of 30 micrograms per g creatinine in the absence of iodized salt, a value typical of severe deficiency. 2. Goiter prevalence declined later in those cantons which introduced iodized salt last. 3. Surrounding countries without iodized salt (France, Italy, Federal Republic of Germany, Spain) suffer from considerable iodine deficiency with areas of high goiter prevalence and even endemic cretinism. The new data underscore the absolute and continued need for iodized salt in Switzerland.

Adolescent↗
PubMed1990

[Cardiopulmonary resuscitation in Switzerland: time to act!].

Cardiovascular related deaths still represent about 50% of all demises despite their decreasing incidence in the United States and in Switzerland. About two thirds of these deaths are due to ischemic heart disease in which half of the patients die outside hospital, the majority of them two hours after the first symptoms. Moreover, sudden death is the first symptom of coronary artery disease in 25% of cases. In this country few of these persons receive adequate basic life support (BLS) at the scene because a coordinated plan to teach BLS to the citizen does not yet exist in Switzerland. With the aid of specialized medical societies, the Swiss Red Cross and affiliated organizations, it is proposed to elaborate a plan to teach BLS to the general public in Switzerland on the basis of the future European guidelines for BLS.

Death, Sudden↗
PubMed1990

[The current status of cardiac rehabilitation in Switzerland].

The aim of this study was to investigate the present situation of institutionalized cardiac rehabilitation in Switzerland. In 1989, there were 21 rehabilitation clinics and 21 ambulatory cardiac rehabilitation programs in Switzerland. All programs include physical activity and risk factor intervention. There is a wide variety of program selection and intensity. The medical care, the physical activity program, the strategy for risk factor intervention, the technical equipment and the emergency concept can be regarded as good in most rehabilitation clinics and in the ambulatory rehabilitation programs. However, a search for quality criteria for further activities in cardiac rehabilitation in Switzerland seems desirable.

Cardiac Rehabilitation↗
PubMed1990

[Epidemiology of alcohol and its sequelae in Switzerland].

5 to 7% of adults in Switzerland are consumers of health damaging quantities of alcohol, and some 10% are drinkers at elevated risk of becoming alcoholics. The 7% of the adults who are the heaviest drinkers account for about half of the total alcohol consumed in Switzerland. Among middle-aged men and women, alcohol-related diseases are among the leading causes of hospitalisation in medical departments. About 100 deaths per year are due to causes related to alcoholism. Alcohol consumption at all levels is markedly elevated in the French- and Italian-speaking parts of Switzerland. These observations lead to a preventive strategy, in which preventive support of at-risk drinkers at the worksite and by the personal physician plays an important role; special efforts are indicated in the western and the southern part of the country.

Alcoholism↗
PubMed1989

Haplotype distribution of the human phenylalanine hydroxylase locus in Scotland and Switzerland.

RFLP haplotypes at the phenylalanine hydroxylase (PAH) locus were determined in 45 nuclear Caucasian families from Switzerland and Scotland. The RFLPs at the PAH locus are highly informative, and prenatal diagnosis is possible in 85% of the families studied. The data were combined with the profiles previously observed in the Danish population, in order to study the variation in RFLP haplotype distribution among European populations. A total of 22 different haplotypes were observed in Denmark, Switzerland, and Scotland. Fifteen and 19 haplotypes are associated with the normal (non-PKU) and with the mutant chromosomes, respectively. The haplotype distribution and the allele frequency of normal chromosomes remain constant between Denmark, Switzerland, and Scotland. However, both the haplotype distribution and allele frequencies of mutant chromosomes show significant variation between the three countries. Our results suggest there may be additional mutations in the PAH gene that cause PKU.

Alleles↗
PubMed1989

[The control of infectious bovine rhinotracheitis (IBR) in Switzerland from 1978 to 1988].

The eradication of Infectious bovine rhinotracheitis/Infectious pustular vulvovaginitis (IBR/IPV) in Switzerland is reviewed. In 1978 IBR was reported in dairy cattle in the Eastern part of Switzerland. No preexisting eradication program was available at that time. In 1983, following a period of hesitation, the legal basis for the eradication of IBR was issued. This aim was achieved by: i) Controls and restrictions of the traffic of susceptible animals in order to prevent further transmission of IBR. ii) Slaughter of seropositive cattle, based on the assumption that animals with antibodies to BHV 1 were virus carriers and therefore an IBR-virus-reservoir. iii) The fact that besides the cattle population no BHV 1 reservoir existed in Switzerland. iv) Never licensing IBR-vaccines because they were not able to prevent the infection and the establishment of latency. The costs of the eradication program amounted to approx. SFr. 114,000,000. A total of 51,911 animals were slaughtered in order to eradicate IBR. An amount of SFr. 5,000,000 per annum is estimated to be necessary in order to maintain the favourable situation concerning IBR. In the future, the experience concerning IBR is applied for the prevention and control of other infectious diseases in the Swiss cattle population.

Animals↗
PubMed1989

[Melanoma mortality in switzerland 1970-1986].

Time trends of mortality from malignant melanoma in Switzerland are presented. The death rates are based on the death certificates routinely collected by the Federal Office of Statistics and are age-adjusted (standard Europe). Mortality rates in Switzerland are the highest of any country in central Europe. Time trends in mortality show a significant increase in the elderly (aged over 64 years), whereas in the younger age group (30-64 years), the trend remains constant (no significant increase). For all age groups there is a significant increase in mortality (26% for men and 20% for women). Risk factors are presented. A higher risk of mortality from malignant melanoma among upper socioeconomic strata also applies to Switzerland. In view of the reported time trend in mortality, it is suggested that elderly people be addressed more specifically in future melanoma education campaigns.

Adult↗
PubMed1986

[Incidence of pollinosis in Switzerland. Results of a representative demographic survey with consideration of other allergic disorders].

In a survey carried out between January and April 1985 covering all of Switzerland except the Canton of Ticino and including 2524 males and females (49% and 51% respectively) aged 15 to 74 years, the subjects were interviewed regarding pollinosis symptoms during the pollen season of 1984 and in previous years, and questioned about other allergic symptoms. Individuals with pollinosis or with family members suffering from pollinosis received an additional questionnaire. This first extraterritorial survey of Switzerland showed that every tenth Swiss aged 15 or over suffers from hay fever (incidence 9.6%). In addition, 3% had suffered from pollinosis previously. In the 15-24 age group the incidence was 16%. It fell with advancing age and was only 4.2% in the over-60 age group. No statistically significant differences were found between incidences in town (9%) and country (10%) and between the sexes. Hay fever morbidity in individuals with higher education (14.5%) and in certain occupations (student, apprentice - 21%) and among job levels "manager, senior civil servant, senior employee" (13.8%) was higher than in other categories. This representative survey confirmed that in Switzerland hay fever is commoner than in 1926 and 1958. The symptoms of pollen allergy are known: symptoms predominate in May (53%) and June (62%) including rhinitis in 94%, conjunctivitis in 82% and asthma in 24%. In 11% pollen allergy was already manifest in the first four years of life, in 62% before puberty and in 80% before the age of 20.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1979

[Prescription profile in French speaking Switzerland and in the Tessin. Analysis of 2006 medical prescriptions].

Analysis of 2006 prescriptions given to 641 unselected patients by 360 doctors in the French- and Italian-speaking parts of Switzerland provides a wealth of information on prescription trends and the cost of medicine. The patients ordinarily received medication belonging to several therapeutic groups, usually 2 or 3 but up to 9 different groups. Each prescription averaged 2.08 drugs with a mean cost of 18.90 Swiss francs. The price varied considerably according to the group of drugs. Those related to the cardiovascular system were the most expensive closely followed by antibiotics, while the ophthalmological prescriptions were the least expensive. Hydergine is the most-sold drug in Switzerland, followed by Bactrim; however, if the various benzodiazepines were grouped together their sale would exceed the others. There are 62 different drugs for rheumatic conditions and 47 penicillins in Switzerland. The abundance of drugs and the prescription of medication with dubious action contribute to the inflationary cost of illness. For any given drug there is a striking parallelism between the number of pages publicizing it in 4 medical journals and total sales. This clearly demonstrates the influence of advertising on prescription trends. Doctors should be aware of this fact and rely on more objective sources of their information about drugs.

Drug Prescriptions↗
PubMed1983

[Silicosis in Switzerland. A half century of observation. The physician's viewpoint].

In Switzerland, the first cases of silicosis were recorded by Zangger in 1900. Since 1930, patients with silicosis have been provided with certain services by the "Caisse Nationale Suisse d'Assurances" (i.e. Swiss National Insurance Fund), an organization enforcing the Occupational Accidents and Diseases Bill. However, it took another two years before an effectively organized struggle against silicosis was started. Eventually, by 1938, this specific pneumoconiosis was acknowledged as an occupational disease under Swiss Law. Thus, the CNSA has been concerned with this disease for half a century, and it seems relevant now to take stock of the situation. From 1930 to late 1980, 9690 cases of silicosis were accepted by the CNSA. Nearly one half (46%) of these silicotic patients were still alive on December 31, 1980; another third had died of silicosis and the rest of other affections not related The origin of cases has remained remarkably constant over the course of time. Underground working and the stone-working industry account for the majority of cases (70%), followed by smelting works (16%) and the ceramic industry (5%). The remaining 9% are due to various causes. Silicosis hazards have declined but still remain real. In late 1980, 1287 companies in Switzerland were being monitored from this standpoint. More than two-thirds (67%) belong to the stone-working industry (even though only 30% of hazard-exposed workers are employed in this sector), 10% are involved in underground work (10% of hazard-exposed workers), 10% are smelting industries (36% exposed) and 6% belong to the ceramic industry (17% exposed). Since 1950, the number of hazard-exposed people has fluctuated between relatively narrow limits (i.e. 15,000 and 20,000). Corresponding figures for previous periods are not known. Some facts indicate that silicosis is becoming less problematic: a) The annual incidence rate of silicosis in Switzerland has evolved in three distinct phases. From 1930 to 1940 the number of new cases recorded each year rose regularly. From 1940 to the late 1960s, the incidence levelled off (200-300 cases yearly); then, from 1974, it dropped rather sharply and less than 100 new cases have been recorded yearly since 1978 (97 in 1978, 69 in 1979 and 68 in 1980). b) The average age at diagnosis of silicosis has regularly increased. Until 1940, the average age of recorded silicotic patients was about 40. The threshold of 50 years was reached between 1953 and 1957. More recently (between 1978 and 1980) the corresponding figure was 68.2.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1983

[Epidemiology of Neisseria gonorrhoeae isolated in Switzerland: sensitivity to antibiotics and auxotyping].

In a study to determine the epidemiological situation of N. gonorrhoeae (NG) in Switzerland, 149 strains isolated from different regions over the period September 1981 to February 1982 were analyzed for sensitivity to various antibiotics (minimum inhibitory concentration [MIC] for penicillin G, ampicillin, cefuroxime, tetracycline, thiamphenicol, and spectinomycin) and for their auxotype. From the results obtained it can be concluded that (1) the PPNG (penicillinase producing NG) strains are not a problem at present in Switzerland; (2) 15% of the non-penicillinase producing NG strains are "less sensitive" to penicillin G (MIC equal to or greater than 0.5 micrograms/ml); (3) sensitivity level of the NG strains to the various antibiotics assayed and the auxotypes do not show any significant peculiarity when compared to the data reported in other countries; (4) penicillin G should still be used as the first choice antibiotic at present in Switzerland, with spectinomycin, thiamphenicol and cefuroxime as second choice antibiotics; (5) when compared according to the geographical origin of their isolation, the NG strains show specific peculiarities, a fact which could lead to an antibiotic therapy policy more suited to specific regions.

Anti-Bacterial Agents↗
PubMed1983

[Standardization problems in the monitoring of oral anticoagulants by Quick's thromboplastin time: an attempt to determine the state of the problem in Switzerland].

In comparison with British Comparative Thromboplastin, we examined 11 different reagents which are presently available in Switzerland for surveillance of oral anticoagulation. Frozen plasma samples obtained from 50 patients under oral anticoagulation for at least 6 weeks were used for comparison of the various reagents. From our results the following conclusions emerge: Our present results largely concur with those of a similar study which compared the therapeutic range of thromboplastin reagents available in Switzerland 6 years earlier; therefore, we assume that the reagents which were sold at that time and are now available in Switzerland have remained fairly constant. In contrast to this apparent agreement, the therapeutic ranges indicated by the producers of reagents are, at least in part, comparable neither with the therapeutic range established for the British Comparative Reagent nor among themselves. Thus, the intensity of the induced coagulation defect is obviously variable, depending on a given test system. The calculated "therapeutic range" for a given test system traditionally corresponds to an average risk of thrombosis or bleeding; this range is not of necessity identical with a target zone that has to be established either individually or for certain diseases. Once established, a target value defining the intensity of oral anticoagulation can be more conveniently reproduced by use of suitable control plasmas rather than with reference thromboplastins, at any rate by practitioners or non specialised hospital laboratories.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1995

[Immunological aspects of kidney transplantation in Switzerland 1981-1992. Swiss Transplant Work Group Kidney Transplantation].

Every year some 200-260 kidney transplants are performed in Switzerland, improving the quality of life of patients with end stage renal disease. The current organ shortage is delaying transplantation of the 400 patients on the waiting list, a situation which calls for optimal utilization of the available donor kidneys. It is well established that AB0-compatibility, negative cytotoxic crossmatch, and optimal immunosuppressive therapy including cyclosporin A are important for a favorable clinical outcome. To identify further factors influencing transplant outcome, we undertook a retrospective study of all 1656 transplants to which the above criteria applied. We defined transplants matched for at least 1A, 1B, and 1DR HLA antigen as the better matched, and the remainder as the less well matched grafts. In patients who were not or only weakly immunized to alloantigens, the 5-year graft survival probability was 0.78 versus 0.69 for the better versus the less well matched transplants (p < 0.005). The strongly immunized patients did not, however, show a significant association between the degree of HLA matching and graft survival, presumably because there were more immunized patients in the HLA matched group. As expected, the patients previously immunized to alloantigens showed significantly reduced graft survival early after transplantation. Positive CMV serology, sex mismatch, and cold ischemia time did not correlate with graft survival. Compared to results obtained in the USA or Germany, the survival time of donor kidneys transplanted in Switzerland was significantly increased. Factors contributing to the good results in Switzerland are discussed. Future goals are reduction of alloimmunization and optimized HLA compatibility.

Cyclosporine↗
PubMed1994

[Geographic aspects in the allocation of kidney transplants in Switzerland].

By tradition kidney transplants in Switzerland are allocated to recipients on a regional basis. Since multi-organ donation became routine, teams traveling all over Switzerland have been accused of harvesting not only the livers but at the same time kidneys, thus withholding such kidneys from regional recipients. In order to investigate this suspicion, we analyzed the place of residence of all kidney donors and recipients during a twelve months' period. Shipping for reasons of matching was not analyzed. We found only minor imbalances between the six transplant centers. We conclude that the allocation of kidney transplants in Switzerland is satisfactory from a geographical point of view. The analysis of donor hospitals, however, shows intense organ recruitment in the referred area of Zurich. In other regions, abstinence from organ recruitment outside the transplant centers is evident. To increase organ availability, the motivation and collaboration of hospitals outside transplant centers needs to be improved.

Health Care Rationing↗