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PubMed1996

Trends in mortality from bronchial asthma in Switzerland, 1969-1993.

Several unfavourable trends and epidemics of fatal asthma have been registered in various developed countries of Europe, the United States and New Zealand over the last three decades. These have been related to problems in the treatment of the disease, following the introduction and/or inappropriate utilization of selected beta-agonist treatments. Thus, trends in mortality rates from bronchial asthma have been analyzed in Switzerland, where the Eighth Revision of the International Classification of Diseases has been in operation from 1969 to 1993. Overall age-standardized mortality rates (world standard) declined, from 4.3/100,000 males in 1969-73 to 2.8 in 1989-93, and from 2.0 to 1.5/100,000 females. The declines were consistent in both sexes for the age group 35 to 64 years, and some downward trend was observed also above age 65, particularly in males. Asthma mortality trends were inconsistent in children and young adults ( < 35 years), with some increase in males aged 15 to 34 after 1983, in the absence however of any significant linear trend in rates. Thus, trends in asthma mortality in Switzerland showed a moderate and steady decline in rates, particularly in middle aged males, in the absence of any systematic upward trend or epidemic peak. Still, the trends were only moderately favourable, and in the early 1990's about 250 deaths per year were attributed in Switzerland to bronchial asthma, i.e. an avoidable, in principle, cause of death.

Adolescent↗
PubMed1996

[Trends in alcohol consumption in Switzerland from 1975-1992].

Based on four representative surveys independently conducted at 6-year intervals, the study presented here delineates the development of alcohol consumption in the general population of Switzerland between 1975 and 1992. A description of changes in the frequency and quantity of alcohol consumption by sex is presented, as well as specific changes by beverage type. Even though Switzerland remains one of the high consumption countries, a marked decline can be observed. Compared to 1975 when 28% of respondents reported daily alcohol consumption, this figure dropped to 20% in 1992. Although 10% consumed more than 60 grams of pure alcohol in the 1975 sample, this proportion fell to only 3% in 1992. This downward trend, which is also reflected in secondary statistics such as sales and mortality figures, can be mainly attributed to male consumers. In contrast to international trends, which in general demonstrate converging drinking patterns, reduced consumption in Switzerland, a wine-producing country, is mainly due to a decline in beer consumption and not in wine consumption.

Adolescent↗
PubMed1997

[Small intestine graft in Switzerland: indications and potential recipients].

Small bowel transplantation is theoretically the best treatment for patients with short bowel syndrome and receiving total parenteral nutrition (TPN). The aim of our study was to determine the number of potential candidates for small bowel transplantation in Switzerland. We analyzed the clinical parameters of patients treated by TPN for short bowel syndrome obtained from university pediatric clinics, the SVK (Schweizerischer Verband für Gemeinschaftsaufgaben der Krankenkassen) and referring physicians. In 1995, 7 adults and 2 children were under TPN for short bowel syndrome. In the adult group (mean age 57), the causes of short bowel syndrome were 3 cases of mesenteric infarct, 2 cases of mechanical ileus, one Gardner syndrome and one inflammatory bowel disease. In the pediatric group, the causes of intestinal insufficiency were in one chronic enteropathy with malabsorption and in one congenital malformation. The average duration of TPN was 4.4 (1-10) years for the adults and 13 months for the children. The various complications related to TPN were repeated catheter sepsis in 5 patients, 2 cases of catheter thrombotic occlusion and 3 cases of cholestatic hepatopathy. The contraindications to small bowel transplantation were age, a history of malignant tumor, pulmonary hypertension and a psychiatric disorder. 4 patients were considered potential candidates for transplantation: 2 adults and 2 children, corresponding to an incidence of 0.5/million inhabitants. Considering that the prevalence and incidence of short bowel syndrome in Switzerland are comparable to those in other western countries, we think it should be possible to initiate a small bowel transplantation program in Switzerland.

Adult↗
PubMed1997

[Mumps epidemic in vaccinated children in West Switzerland].

Since 1991, 6 years after the recommendation of universal childhood vaccination against measles, mumps, and rubella (MMR triple vaccine), Switzerland is confronted with a large number of mumps cases affecting both vaccinated and unvaccinated children. Up to 80% of the children suffering from mumps between 1991 and 1995 had previously been vaccinated, the majority with the Rubini vaccine strain. On the basis of a case-control study including 102 patients and 92 controls from the same pediatric population, a study of the humoral immune-response following vaccination with the Rubini vaccine in 6 young adult volunteers, and two different genetic studies, we investigated the complex problem of large scale vaccine failure in Switzerland. We conclude that the recently reported large number of Swiss mumps cases was caused by at least four interacting factors: 1. A vaccine coverage of 90-95% at the age of 2 years is necessary to interrupt mumps wild virus circulation. The nationwide vaccine coverage in Switzerland of some 80% in 27-36 month-old children is too low. 2. Primary vaccine failures (absence of seroconversion or unprotective low levels of neutralizing antibodies), as well as secondary vaccine failures due to the rapid decline of antibodies to mumps virus in our volunteers and controls, seem to be frequent after vaccination with the Rubini strain. 3. Despite its reported Swiss origin, the Rubini strain does not belong to the mumps virus lineages recently circulating in this area but is closely related to American mumps virus strains. 4. Differences in protein structure between the vaccine strain and the circulating wild type strains, and in particular a different neutralization epitope in the hemagglutinin neuraminidase protein, may additionally contribute to the lack of protection in vaccinated individuals.

Adolescent↗
PubMed1997

[The nutritional status in Switzerland--consequences for prevention].

Diet is of importance in the prevention of most chronic diseases. Dietary habits are measured regularly in most countries. In Switzerland data on groups and individuals are available, but a comprehensive dietary survey is still lacking. Since World War II an overall decrease in foods rich in complex carbohydrates and an increase in foods rich in fat available per capita of the population has been observed. Data on individuals show that 30%, i.e. 39% of men and 22% of women, in Switzerland are over-weight (BMI < or = 25). The percentages of energy intake as fat and sugar are higher, and the percentage of energy intake as complex carbohydrates lower than recommended. 7% of women and 6% of men consume hazardous amounts of alcohol (men > or = 60 g/day, women > or = 20 g/day). Marginal vitamin deficiencies are observed in various population groups for the vitamins B1, B2, B6, folic acid and vitamin C. Due to the fortification of salt and the widespread use of American wheat rich in selenium, iodine and selenium intake can be considered adequate. An insufficient intake of calcium is demonstrated in the elderly and an insufficient intake of calcium and iron in women. As a consequence of this nutritional situation, the first national nutritional guidelines have recently been published in Switzerland.

Adult↗
PubMed1989

The spatial distribution of different elements in and on the foliage of Norway spruce growing in Switzerland.

This study centres around the question of how far the analysis of spruce needles (Picea abies L.) provides a suitable tool for detecting and describing large-scale air pollution, primarily by heavy metals, in Switzerland. For that reason 1637 spruce shoots from 833 sites were analysed, relationships between the different elements were calculated and maps of their spatial distribution drawn. The results show that needle analysis is a valid instrument for the identification of various air pollutants in Switzerland. The element best suited is Pb, followed by some others like Mo, Fe, Cd or S. The most heavily polluted areas in Switzerland are the midlands, and in the north and north-west. Their spatial distribution suggests that in these areas the indicator elements are derived from local sources.

Journal Article↗
PubMed2005

Variability in quality of care among dialysis units in western Switzerland.

BACKGROUND: Quality indicators for dialysis care vary across countries and regions, but regional variability across centres has received little attention. We analysed variations in quality indicators among dialysis facilities in western Switzerland to identify opportunities for improving care for patients with end-stage kidney disease. METHODS: A cross-sectional study of 617 dialysis patients treated at 19 facilities examined the distribution of indicators of quality of care addressing: adequacy of dialysis (Kt/V > or =1.2 for haemodialysis, Kt/V > or =2 for peritoneal dialysis), anaemia control (haemoglobin > or =110 g/l), calcium and phosphate control (product < or =4.4 mmol2/l2), adequate nutrition (serum albumin >35 g/l), hypertension control (pre-dialysis blood pressure <140/90 mmHg) and type of vascular access. Centre quality targets were the following: achievement of quality criteria for 80% of their patients, except 85% for anaemia control and 60% for arterio-venous fistulae. RESULTS: Most centres fulfilled quality targets for dialysis adequacy, but substantial variations existed among centres (haemodialysis, 76%, range 36-100; peritoneal dialysis, 76%, range 33-100). Results were similar for anaemia (77%, range 35-100), calcium x phosphate product (69%, range 29-92), albumin (63%, range 26-95), hypertension control (33%, range 13-54) and arterio-venous fistula (61%, range 49-92). The between-centre variability was significantly greater than would be expected by chance, for all indicators. Dialysis facilities with >40 patients better fulfilled quality targets than university-based centres. Adjustment for patient characteristics did not modify these results. CONCLUSIONS: Substantial variations in quality indicators existed between dialysis centres in western Switzerland, which could not be attributed to different centre policies, or to differences in available measures of patient case mix. These findings indicate opportunities for improvement in dialysis practice which may translate into improved clinical outcomes.

Aged↗
PubMed2002

Medical genetics and scientific expertise in Switzerland in the 1940s.

In Switzerland, the first course in human genetics for physicians was organized during World War II. The topic had less to do with human genetics than with eugenics, however. After this course, bitter opposition was forthcoming from physicians. The second course was held in quite a different context. The war was almost over and the Swiss authorities had to prove that they were on the side of the Allies. As eugenics was deemed to be a Nazi science, opposition to it became stronger. Given this context, the proponents of human genetics changed their discourse. This article explores how this debate on human genetics influenced not only the discourse on this science, but also human genetics practices in postwar Switzerland.

Biomedical Research↗
PubMed2001

Gross anatomy in the surgical curriculum in Switzerland: improved cadaver preservation, anatomical models, and course development.

The invention of new techniques for surgery and interventional radiology demand improved training for ongoing specialists. The Anatomical Institutes in Switzerland support these requirements by establishing hands-on practical training courses by using new procedures for cadaver embalming and model construction. Improvements allow courses to provide students with more realistic simulations of both established and experimental surgical methods. Through these changes, the value of in-depth gross anatomy is enhanced as a topic of fundamental importance for the postgraduate medical and surgical curriculum. The web site http://www.unifr.ch/sgahe/snga.html contains information on courses using the Thiel embalming solution. Details about training courses in Switzerland using anatomical models are available at http://www.heartlab.org, http://www.vascular-international.org, and http://www.elastrat.com.

Anatomy↗
PubMed1997

Available iron and zinc in major lean meat cuts and their contribution to the recommended trace element supply in Switzerland.

The objective of the present study was to analyze iron and zinc in major lean meat cuts in order to estimate the contribution of the average lean meat consumption in Switzerland (1995) for these trace elements. Iron, heme iron and zinc contents were analyzed in following muscles: pork (longissimus dorsi muscle and shoulder), beef (longissimus dorsi muscle and shoulder), veal (longissimus dorsi muscle) and chicken (breast and thigh). Beef and pork shoulder were the best sources of iron, heme iron and zinc. Pork and veal longissimus dorsi muscle and chicken were relatively poor in these trace elements. With an average daily lean meat consumption of 105 g, iron and zinc intake were about 1.1 mg/d and 3.8 mg/d, respectively. Recommendations for daily iron intake were met to 11% (men) and 7% (women) and for zinc to 25% (men) and 32% (women). Applying a modified Monsen model, the requirements for absorbed iron were met in the range of 10-30% and 7-20% for men and women, respectively. Taking into account a zinc absorption rate from meat of about 20-36%, the daily requirements for absorbed zinc were covered to 32-56%. In conclusion, the average amount of lean meat as consumed in Switzerland was high enough to be an important source of available iron and zinc, particularly for people with low iron and zinc status.

Adult↗
PubMed2004

Phylogenetic analysis of clinical mumps virus isolates from vaccinated and non-vaccinated patients with mumps during an outbreak, Switzerland 1998-2000.

During the past decade mumps outbreaks have occurred in several European countries with universal vaccination programs probably due to poor efficacy of the Rubini vaccine strain. However, the evolution of vaccine escape mutants has also been considered. A phylogenetic analysis was undertaken on 69 clinical mumps isolates obtained from 39 vaccinated and 22 non-vaccinated mumps cases (and six cases with unknown vaccination status) during an outbreak in 1998-2000. Two major strain clusters (SWI-H, SWI-C) with two subgroups each (SWI-H1/2, SWI-C1/2) were identified, which belonged to genotypes C and H. No association between viral clusters and vaccination status or a specific vaccine strain (Jeryl-Lynn or Rubini) was found. Cluster SWI-C1 occurred more frequently in the Western part of Switzerland (P < 0.001). Isolates causing complicated disease tended to cluster more frequently with SWI-H1 (P = 0.11). Wild-type strains homologous or similar to the Rubini vaccine strain (isolated in Switzerland in 1974) were no longer circulating. Therefore, there was no evidence for vaccine escape mutants. Strain redistribution may have occurred during the past decades. Continuous monitoring of circulating mumps virus populations is needed.

Adolescent↗
PubMed1995

Incidence of childhood acute lymphoblastic leukemia (ALL) and population-based treatment results in Switzerland: experiences with 507 study and 149 nonstudy patients.

Of 656 patients with ALL (all types) diagnosed in Switzerland during 4 consecutive 4-year periods (1976-1979, 1980-1983, 1984-1987, 1988-1991), 507 were officially registered on protocols ("study" patients) while 149 were not ("nonstudy" patients). The mean incidence of 3.8/100,000 children < 15 years/year is higher than reported for other Western countries. Evidence is presented suggesting that the 656 patients represent only approximately 90% of all children with ALL residing in Switzerland, indicating that the true incidence of ALL might even be higher. The fraction of "nonstudy" patients fell from 40% (1976-1979) to 15% (1984-1987). The rate of survival at 4 years of all patients with ALL ("study" and "nonstudy") increased by 17% during the three consecutive periods 1976-1979, 1980-1983, and 1984-1987. As expected, a higher increase (20%) was observed in "study" patients and a statistically nonsignificant lower one (10%) in "nonstudy" patients.

Adolescent↗
PubMed2008

Incidence of childhood cancer in Switzerland: the Swiss Childhood Cancer Registry.

BACKGROUND: This report describes the incidence of childhood cancer in Switzerland, based on the data from the Swiss Childhood Cancer Registry (SCCR), a national hospital-based cancer registry with very high coverage, founded in 1976 by the Swiss Paediatric Oncology Group (SPOG). PROCEDURE: Malignancies were coded according to the International Classification of Childhood Cancer (ICCC-3). Incidence rates per 100,000 person-years were calculated for all malignancies and groups of malignancies in Swiss residents less than 15 years of age for the decade 1995-2004. RESULTS: The SCCR annually registered on average 174 new cases of cancer in Swiss residents aged <15 years, with a median age at diagnosis of 5.6 years. The crude incidence of childhood cancer in children aged <15 years was 13.5, higher for boys (15.0 per 100,000) than for girls (12.1 per 100,000), and was nearly twice as high in the first 5 years of life (19.3 per 100,000) than in the age group 5 to 14 years (10.8 per 100,000). CONCLUSION: Incidence of childhood cancers in the SCCR was similar to neighbouring countries and to data published by regional cancer registries in Switzerland for the same period, suggesting good completeness of registration. This makes the SCCR a valuable resource for national and international research on childhood cancer.

Adolescent↗
PubMed1997

Surveillance of sexually transmitted diseases in Switzerland, 1973-1994: evidence of declining trends in gonorrhoea and syphilis.

The HIV/AIDS epidemic has led to growing interest in the epidemiology of sexually transmitted diseases (STDs) in Switzerland. STD surveillance data from three sources are presented: reports from six policlinics of dermatovenereology since 1973, laboratory reports of Neisseria gonorrhoeae, Treponema pallidum and Chlamydia trachomatis since 1988, and reports by the Swiss Sentinel Network between June 1991 and December 1993. The data indicate that there has been a decline in the number of cases of syphilis and, in particular, gonorrhoea since the early 1980s in Switzerland. Since many factors could explain the declines (e.g. more effective treatments, more widespread use of antibiotics, marked changes in behaviour such as increased levels of condom use) it is difficult to identify their exact causes. Evidence for two of the before-mentioned factors exists and these probably played important roles in the declines. Firstly, as a result of the emergence of penicillinase producing strains of N. gonorrhoeae, the introduction of new treatments for gonorrhoea in the early 1980s which were simpler to administer and more effective (in particular the use of spectinomycin). Secondly, the national AIDS prevention campaign which began in 1987 and has been associated with major increases in condom use in the Swiss population.

Adolescent↗
PubMed1997

Cancer mortality in Switzerland, 1990-1994.

Data and statistics are presented on cancer death certification in Switzerland in 1990-1994, updating previous publications covering the period 1951-1989. Data for 1990-1994, grouped into 30 categories, are presented in 10 tables as 5-years age- and sex-specific absolute and percentage frequencies of deaths, and average annual crude, age-specific and age-standardized rates, at all ages and truncated for the 35-64 years age group. Male-to-female ratios of mortality rates, and ranks of the ten most frequent cancer sites have also been tabulated, and all-ages and truncated age-standardized rates for most cancer sites plotted for 9 calendar quinquennia. Total cancer mortality rates decreased in both sexes (from 268.7 in 1985-1989 to 251.8/100,000 males in 1990-1994, and from 201.5 to 190.6/100,000 females; age-standardized rates on the 1980 Swiss population), particularly at younger ages and in males. Decreases in rates were observed in males for lung (from 68.7 to 62.7/100,000), oesophagus, larynx and prostate (at younger middle age), in females, for breast and genital sites and, in both sexes, for stomach, colorectum, gall-bladder, pancreas, skin, bladder, kidney, brain and most lymphohaemopoietic neoplasms. Increases were observed for pleura in males, and for larynx and lung (from 11.9 to 14.8/100,000) in females. Thus, with the major exception of lung cancers and a few other tobacco-related neoplasms in females, cancer mortality rates in Switzerland over the period 1990-1994 were generally favourable.

Adolescent↗
PubMed1994

[Effects of the 1987 revision of the definition for an AIDS case in Switzerland].

AIDS cases diagnosed in Switzerland after the revision of 1987 and reported to the Swiss Federal Office of Public Health until 31.12.1992 were categorised according to whether they conformed to the diagnostic criteria valid before the revision (= "pre-87"-group) or only to the new criteria introduced with the revision (= "post-87"-group). Compared to the "pre-87"-group, the proportion of injecting drug users was higher, the proportion of homosexual men was lower, the patients were younger and Pneumocystis carinii pneumonia (PCP) and Kaposi-sarcoma were diagnosed less frequently in the "post-87"-group. The revision of the AIDS case-definition affected the proportion of Aids-diagnoses with PCP over time. It improved the surveillance of AIDS morbidity in Switzerland but its effects must be distinguished from true phenomena of the AIDS-epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Practice and complications of liver biopsy. Results of a nationwide survey in Switzerland.

Studies on the complication rate of liver biopsy have hitherto been conducted in referral hospital centers. They are therefore not representative for general practice where liver biopsy is performed by specialists and nonspecialists. In a postal nationwide survey, we approached all gastroenterologists and hospital internists to assess the complication rate and practice (setting, needle type, use of ultrasonography) of percutaneous liver biopsy performed in 1989 in Switzerland for diffuse liver disease. Two hundred eighty questionnaires were mailed and 252 were returned (response rate 90.0%) 165 respondents (65.5%) performed 3501 biopsies while 87 respondents (34.5%) did not practice liver biopsy; 67.7% of biopsies were executed blindly and 32.3% were guided. Eight nonfatal and three fatal complications occurred. Hemorrhage was the most frequent complication (five cases) and was responsible for all three fatal outcomes. The overall complication rate was 0.31%, being distinctly lower in the group of gastroenterologists (0.11%) as compared to the group of internists (0.55%; P = 0.031). The complication rate was 1.68% in the group of internists performing fewer than 12 biopsies per year, while there was no complication in the group of internists performing more than 50 biopsies per year (P = 0.036). Complications were not related to the needle diameter or to the absence of ultrasonography before biopsy. In conclusion, this representative survey in Switzerland shows that the complication rate of liver biopsy is mainly related to the experience and training of the operator.

Biopsy, Needle↗
PubMed1993

[Evaluation of AIDS-related knowledge and behavior among seasonal workers in Switzerland].

Although an increasing number of AIDS prevention programmes are addressing migrants and ethnic minorities, few are either solidly research-based or adequately evaluated. Reported on here is a baseline evaluation of a marginal foreign population, Spanish and Portuguese seasonal workers in Switzerland. AIDS-related knowledge, attitudes and behaviours were assessed with both qualitative and quantitative methods during the winter of 1989-1990. The seasonal workers studied had been reached by prevention programmes both in the host country and in the country of origin, and knowledge was better than expected. Zones of ambiguity, such as confusion between AIDS and treatable STDs, persist however. Legal restrictions which prohibit family reunification affect sexual behavior: respondents report both more abstinence and more transitory sexual relations than the comparison Swiss population. Only about one in five report always using condoms during transitory relations. Qualitative material is used to suggest a relation between attitudes and protective behaviors. HIV/AIDS prevention programmes for Spanish and Portuguese populations in Switzerland are being established on the basis of the research findings.

Acquired Immunodeficiency Syndrome↗