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"Getting Switzerland to move": evaluation of a new "Sport for All" programme.

OBJECTIVES: Even though sports participation in Switzerland appears to be quite elevated, recent research suggests that only about a third of the population are doing enough sports from a health perspective. METHODS: Against this background several Swiss health insurance companies together with the Swiss Olympic Association have recently developed a novel approach to get people to start physical exercise: Under the label of "Allez Hopl" sport clubs offer training and information courses aimed at motivating and helping previously inactive people to take on regular exercise. RESULTS: The paper presents results from an interdisciplinary evaluation of the first three years of the "Allez Hopl" campaign. Starting from an overview of the basic idea and features of the campaign it asks whether "Allez Hopl" has reached its self-declared goal of "getting Switzerland moving". Available evidence on the social background of participants and their further activities shows that by systematically avoiding any reference to conventional notions of sport and by stressing the health and fun aspect instead. "Allez Hopl" has indeed managed to mobilise an important group with under-average levels of activity (particularly middle-aged women). In addition, on average the level of physical exercise of participants appears to have increased. Yet, the number of participants is below the original target values and, contrary to the campaign's initial goal, participants are reluctant to leave the programme after one course to take up an independent activity or to join a club. CONCLUSIONS: The paper explores the achievements and problems of the campaign so far and offers an explanation of recent problems which can also serve as a basis for the implementation of similar programmes in other countries.

Attitude to Health↗

Alcohol consumption and gender in the 20th century: the case of Switzerland.

Given the changes of gender roles in this century it is hardly justified to assume constant proportions of alcohol consumption for males and females. The purpose of the study was to reconstruct the consumption trends of males and females in Switzerland since the beginning of the 20th century. Cirrhosis mortality and survey data were used to disaggregate by sex the per capita alcohol consumption derived from sales data. The disaggregation of the per capita alcohol consumption based on liver cirrhosis mortality suggests that the evolution of alcohol consumption in Switzerland followed a parallel course for both sexes only until the 1930s. The low consumption during World War II and the evident increase until the beginning of the '60s seem to have resulted above all from the variations in consumption of beer by men. The decrease in total alcohol consumption observed since the '70s is also most probably due only to men; there is no indication of a decreasing consumption by women. The tendency of male and female consumption patterns to become more similar should be taken into account in the prevention of alcohol misuse.

Adult↗

Dosimetric data on radiation workers in Switzerland: availability and limitations for epidemiological research.

In 1990 the Swiss National Dose Registry started a test phase of data collection and processing. The question has been raised whether this new, centralised database with its computerized, easily obtainable data on occupational radiation exposure in Switzerland can be used for radioepidemiological studies. This paper sketches the organisation of personal dosimetry in Switzerland, describes the dose registry and other dosimetric data sources and discusses their suitability and limitations for radio-epidemiological studies.

Epidemiologic Methods↗

[Average life expectancy in Switzerland--historic and international background and thoughts on future development].

Age-specific mortality rates are a sensitive measure for the conditions of life in a population. Life tables--in Switzerland calculated approximately all ten years since 1876/80--indicate for any age and any observation period the mean life expectancy as well as the probabilities of death and survival, respectively. In the past centuries survival curves developed more and more a rectangular shape, but mortality rates didn't decrease uniformly in all age groups: until the first part of the twentieth century, increases in mean life expectancy were predominantly due to a rapid decline of infant and children's mortality; since the 1930s decreasing adults' mortality gained more importance, and not until the 1960s lower death rates in the population aged over 60 became a major component of prolonging the mean span of life. The nowadays favourable mortality situation of Switzerland within Europe started to emerge in the 1950s, predominantly due to declining mortality rates in the uppermost age groups. For the decades to come, experts predict a further substantial increase of mean life expectancy, in spite of actually rather unfavourable trends in the mortality rates of young adults. Consequently, the number of those aged over 65 and particularly those over 80 years will considerably increase till 2020, even if the scenarios of 1995 would prove to be too optimistic.

Adult↗

Mortality from respiratory tuberculosis in Switzerland.

Since 1901, the Swiss Federal Office of Statistics has published at least each decade detailed mortality statistics from tuberculosis. These cross-sectional data on deaths from respiratory tuberculosis from 1901 to 1991 were utilized to analyse retrospectively tuberculosis death experience within each birth cohort. The cross-sectional data indicate that tuberculosis mortality increases with age in each successive decade. Nevertheless, the cohort-contour approach indicates that this phenomenon is the result of a much higher mortality that each cohort experienced in their early adulthood, and that mortality form respiratory tuberculosis in Switzerland always preferentially affected the young. The data also indicate that tuberculosis mortality in Switzerland has been decreasing for at least 160 years, and perhaps peaked as early as in the eighteenth century.

Adolescent↗

[Mumps epidemiology in Switzerland: results from the Sentinella surveillance system 1986-1993. Sentinella Work Group].

UNLABELLED: Since 1990, there have been reports of an increasing number of mumps cases in Switzerland, in particular among vaccinated children, and of local outbreaks of mumps. Using data from the Sentinella reporting system, a network of voluntary participating doctors (general practitioners, internists and paediatricians, yearly average: n = 141), trends and factors influencing mumps incidence in the general population were assessed during the last seven years. Following an initial decline in mumps reports, since 1990, there has been a continuous and marked increase in reports from a minimum of 0.7 cases per physician and year in 1989/90 to a near five-fold increase of 3.3 cases in the last reporting period from June-December 1993 (calculated for one year). Half of this increase, which is reflected in a doubling of the number of cases reported in 1986/87, is explained by an increase in cases among vaccinated children. The trend in mumps cases contrasts with that of measles and rubella, where there has been a clear decline in these reports since 1986 (approximately 70-80%). Complications were reported in 75 (4.0%) of the total number of mumps patients (n = 1894); in 2/5 of the cases this was a meningitis, in 1/3 an orchitis. Based on available data on vaccination coverage, the estimated efficacy of the mumps vaccines against parotitis is between 47-77%; this is clearly lower than the corresponding figure for measles (91-97%) and rubella (89-97%) vaccines. The relatively low efficacy against parotitis is mainly due to a protective level of 13-73% of the vaccines containing the Rubini strain. The estimated efficacy of the Rubini vaccines against complications is 50-81%; it is nearly 60-90% if a possible reporting bias is taken into consideration. CONCLUSIONS: 1. The Rubini strain vaccines, which are the most commonly used in Switzerland, seem to have played an important role in the clear increase in mumps cases since 1990. 2. The situation seems more favourable concerning the efficacy against complications of the vaccines used. 3. Our data support the high efficacy of all measles and rubella vaccines. 4. The surveillance of MMR by the Sentinella reporting system provides a useful and effective manner to evaluate the MMR vaccination programme.

Adolescent↗

Childhood leukaemia in Switzerland: comparison of different sources of data.

Since 1976 the Swiss Paediatric Oncology Groups (SPOG) has registered leukaemia cases occurring in Switzerland. The registration was set up for clinical research; however, since 1985 efforts have been made to complete the registers with cases not taking part in a clinical trial. The data of the SPOG register between 1976 and 1989 are compared to data from cancer registers and the mortality statistics of the Federal Office of Statistics. Between 1985 and 1988 the SPOG register included 91% of the cases recorded by the six cantonal registries. Compared to mortality data, registration was 100% in 1989. The SPOG data file can therefore be assumed to be complete enough to be used for epidemiological studies on incidence of leukaemias and on time trends of leukaemias in Switzerland.

Child↗

Seroprevalence of rubella among women of childbearing age in Switzerland.

A seroepidemiological study was carried out in Switzerland to define the population susceptible to rubella among women of childbearing age. IgG antibodies to rubella virus were determined in 9,046 women giving birth between 1 August 1990 and 30 September 1991 in 23 of 26 Swiss cantons. These sera represented 10-20% of the yearly total number of births in each Swiss canton. Anti-rubella IgG was measured by an automated enzyme-linked fluorescent assay for use with a commercial system (Vidas Rub IgG, bio-Mérieux, France). Before the study population was screened, the commercial system was compared to the traditional hemagglutination-inhibition (HAI) test using 500 consecutive samples from parturient women. The sensitivity was 97.7%, the specificity was 100%, and agreement between the two tests was 97.8%. The discrepancies corresponded to very low titres of antibodies as measured by HAI. The seroprevalence of rubella nationwide in women of childbearing age in Switzerland was 94.3%. The seroprevalence was higher (96.5%) in the 5,677 women of Swiss nationality than in the 3,090 women of a different nationality (90.4%) (p < 0.001). In Swiss women the seroprevalence of rubella did not increase significantly with age and was identical in primiparous and in multiparous women, thus indicating that women of childbearing age are probably not sufficiently immunised.

Adult↗

Serological evidence of human granulocytic ehrlichiosis in Switzerland.

To investigate whether human granulocytic ehrlichiosis (HGE) is prevalent in Switzerland, 1515 human serum samples from individuals with different risks for tick exposure were tested for antibodies to Ehrlichia phagocytophila, a surrogate marker of the agent of HGE. The distribution of titres showed marked differences between sera of individuals with no or low risk for tick exposure and those with a high risk. The results of serological testing provided evidence of HGE in Switzerland as well as evidence of two types of coinfections: those with the agent of HGE and Borrelia burgdorferi, and those with the agent of HGE and the central European tickborne encephalitis virus.

Antibodies, Bacterial↗

A new mumps virus lineage found in the 1995 mumps outbreak in western Switzerland identified by nucleotide sequence analysis of the SH gene.

We determined the nucleotide sequence of the SH gene its flanking regions over a range of 380 nucleotides for three distinct mumps virus (MUV) isolates. Two isolates from the 1992 mumps epidemic in Western Switzerland and one MUV isolated in 1995 in the same geographic area have been analyzed and compared to 16 recently published SH nucleotide sequences and their presumed amino acid sequences. The nucleotide sequences from the 1992 MUV isolates were identical and closely related to two MUV strains from Eastern Switzerland and strains from the U.K. The MUV isolated in 1995 is clearly different from all other strains.

Amino Acid Sequence↗

The incidence of rubella virus infections in Switzerland after the introduction of the MMR mass vaccination programme.

We have collected data on the incidence of rubella in Switzerland from 1987 to 1992 to help evaluating the impact of the measles, mumps and rubella (MMR) mass vaccination programme which started in 1985 in this country. We used detailed informations on samples submitted for diagnostic testing in conjunction with anonymous laboratory notifications to the Swiss Federal Office for Public Health, and data from the Swiss sentinel network of general practitioners to find trends in the incidence of rubella after the introduction of mass vaccination. We observed an unabated seasonal oscillation without decreasing trend during the observation period and were unable to detect a shift in the age distribution of cases. An important proportion of laboratory-confirmed rubella occurred in women of childbearing age. Immigrants from regions with low endemicity of rubella were at increased risk of contracting rubella and transmitting it to their offspring. We conclude, that MMR mass vaccination has not interrupted the circulation of rubella virus in Switzerland, and that improvements in the implementation and surveillance of the MMR vaccination campaign are necessary in order to avoid untoward effects of it.

Adolescent↗

[Alcohol and liver cirrhosis in Switzerland].

The question wheter in Switzerland, too, there exists an association between alcoholism and cirrhosis of the liver was examind by the use of Federal Statistics. E.M. Jellinek devised an internationally applicable formula which shows a linear relationship between these two conditions. Three hypotheses were tested to validate the assumption that there are no alternate causes of cirrhosis of the liver. The results show: a) that in Switzerland as elsewhere, a direct relationship exists only between alcoholism and cirrhosis of the liver; b) that, in consequence, other causes of the condition have only small significance; c) that mortality from cirrhosis shows a distinct sex difference, with a surprisingly great increase amongst women in recent years.

Adult↗

[Status of dental preventive efforts in Switzerland].

Regarding schools, the first endeavours of preventive dentistry based on the results of modern scientific results were made in the early fifties in the Canton of St. Gall. Great efforts have been made since then and it is impossible to keep track of all activities. At the schools it is the teachers on one hand and specialized or lay auxiliary personnel on the other who organize and perform supervised toothbrushing exercises with fluorides. In Switzerland there are now some 30 full-time positions for auxiliaries charged with preventive measures at Kindergarten or school. An estimate of the population reached by the various methods of prevention is presented. The costs of prevention are but a small fraction of the cost of conservative treatment. In the majority of the private dental offices prevention is part of the activity, but with varying intensity. As to public clinics, the preventive programm run by the Volkszahnklinik Basel is most advanced. It is important that prevention is introduced in all regions of Switzerland and that it reaches the children of all ages. The future depends strongly on the availability of auxiliary personnel working at the schools and in the dental offices.

Child↗

[Some aspects of early education of handicapped children in Switzerland].

Early education for young handicapped children is an aid both for the children and their parents. It has been propagated for centuries, and due to a serious research-programme it has also been developed and institutionalized in Switzerland during the last twelve years. The whole of Switzerland is included in this programme. The results of the investigation presented hereby are as follows: 65% of the children are reached after their third year of age only, and only 80% are referred by doctors. Of the 1.2% severely handicapped the 4- to 6-year-old children are well represented, the 0- to 3-year-old children as well as the 2.8% slightly handicapped 0- to 6-)ear-old children are badly represented. Combined methods are proposed for improving the early detection of the Mentally Handicapped. The fact that early education for young Mentally Handicapped is necessary and important has been proved by thorough scientific research. The aim and method of early education for young mentally handicapped children (diagnosis, education, councellinf for parents) are sketchily represented. The principal aim is: improvement of the parental competence concerning the education of mentally handicapped children.

Child↗

[Deaths caused by poisoining in Switzerland].

In order to assess the mortality from poisoning in Switzerland, the medical certificates of death from the years 1972 to 1976 were analyzed. A comparison with earlier work shows that the overall mortality remains constant, with an increase of suicidal and a decrease of accidental and chronic poisoning. Most suicides are committed with drugs (especially hypnotics) and, mainly by men, with carbon monoxide (exhaust gas). Chronic fatal poisoning from the abuse of analgesics is lessening, at length, whereas death from hard drugs is on the increase. Fatal accidental poisoining is relatively rare in Switzerland. Among the victims are children, but adults as well, and particularly old people. Involved agents (carbon monoxide, drugs and medicines, technical and agricultural poisons, mushrooms) are pointed out with regard to prevention.

Accidents, Home↗

[Elimination of measles, mumps and rubella in Switzerland].

The combined measles, mumps and rubella live vaccine nowadays available is very well tolerated and confers lifelong immunity. A complete immunization coverage among toddlers, schoolchildren and adolescents should nearly eliminate these three childhood diseases in a given population. The cost/benefit ratio of the immunization is for all three diseases rewarding in Switzerland. Reactions expected to the combined vaccine are mild and complications negligible in comparison to the diseases prevented. Starting in 1987 a nationwide campaign will begin in Switzerland; the aim is to vaccinate next to toddlers all so far non-vaccinated 6-7 years old and 14-15 years old schoolchildren respectively for a period of 8 years.

Adolescent↗

[Physiotherapists in French-speaking Switzerland--basic data].

In the framework of health services research sponsored by the Swiss National Science Foundation, a survey was made among the physiotherapists of the French-speaking part of Switzerland (six cantons), in order to gather information on --their personal and professional characteristics, --conditions of professional practice, --therapeutic methods used, medical indications of treatments and some data on the patients seen --the personnel, facilities and equipment of physiotherapy offices, institutes (several professionals) and services (in hospitals). Out of a total of 771 physiotherapists (i.e. 5.4 per 10,000 persons, in an area with 1.5 million population), 40% of them answered the questionnaire which was sent. They are a representative sample as regards region of practice, sex, age, employment status, and working environment. Physiotherapy is experiencing in Switzerland since the middle 1970's a quantitative increase and an accelerated diversification in the modes of practice. One observes in particular that many women enter the profession, working often part-time. According to the data gathered, it appears that, in spite of a marked differentiation in structural terms, physiotherapy is able to conserve its unity as regards therapeutic methods and types of care, thanks to keeping a practice of a generalist character. Thus, this discipline shows a potential for adaptation which could be of interest to other health professions. This paper introduces the main axes of a research in a yet largely undocumented field.

Adult↗

[The incidence of coronary disease in Switzerland compared to the rest of Europe].

Switzerland ranks low in ischaemic heart disease mortality amongst the European countries. Evidence from field studies, however, would suggest that mortality is underestimated. Nevertheless, in Switzerland, like in France, the disease is probably rather less common than in some other comparable countries. The difference seems unexplained by the major, known risk factors, indicating a need for further research.

Coronary Disease↗