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PubMed2006

The timing of complementary feeding of infants in Switzerland: compliance with the Swiss and the WHO guidelines.

BACKGROUND: The importance of adequate complementary feeding of infants is increasingly acknowledged. Little is known of the actual complementary feeding practices in Switzerland. AIM: To report the prevalence of adequate timing of complementary feeding, comparing the compliance to Swiss and World Health Organization (WHO) guidelines, and to investigate factors influencing infant complementary feeding. METHODS: In 2003 a cross-sectional study was conducted of mother-and-infant pairs in Switzerland. The mothers, randomly chosen by local community mother-and-child health services, completed a 24-h dietary recall questionnaire and reported the infant's age at the first introduction of various foods. Descriptive analysis, group testing and regression analysis of data collected were conducted. RESULTS: Introduction of solids mainly occurred between the 5th and 6th months. Five per cent of the mothers introduced complementary food before the age of 4 mo. The main influencing factors for infant feeding were maternal age, language regions, mother's BMI and smoking status, the presence of siblings, and an allergic predisposition of the infant. CONCLUSION: The timing of the introduction of complementary foods meets with Swiss guidelines. WHO recommendations, however, are not met. This may be due to a misunderstanding of the Swiss Paediatric Association's age-range recommendations or insufficient promotion of the WHO recommendations.

Adult↗
PubMed2003

Nationwide surveillance of nasopharyngeal Streptococcus pneumoniae isolates from children with respiratory infection, Switzerland, 1998-1999.

The surveillance of pneumococcal antibiotic resistance and serotype distribution is hampered by the relatively low numbers of invasive pneumococcal infections. In Switzerland, a nationwide sentinel surveillance network was used to assess antibiotic resistance and serotype distribution among 1179 pneumococcal isolates cultured from 2769 nasopharyngeal swabs obtained from outpatients with acute otitis media or pneumonia during 1998 and 1999. The proportion of penicillin-susceptible pneumococcal isolates overall (87%) and among infants <2 years old (81%) was comparable to that of invasive isolates (90% and 81%, respectively). The high number of nasopharyngeal isolates allowed for the detection of a rapid increase in the number of penicillin-nonsusceptible pneumococcal (PNSP) strains in the West region of Switzerland, partly because of an epidemic caused by the 19F clone of Streptococcus pneumoniae. Clustering of risk factors for the carriage of PNSP isolates further explained the geographic variation in resistance rates. The nationwide sentinel surveillance of nasopharyngeal pneumococcus proved to be valuable for the monitoring of antibiotic resistance, risk factors for carriage of PNSP isolates, and serotype distribution and for the detection of the emergence of a new epidemic clone.

Acute Disease↗
PubMed1995

Infection control in Switzerland.

Infection control in hospitals is not mandatory in Switzerland as in the United States. There are more than 300 acute-care hospitals in Switzerland. Hospitals are reimbursed by patient-days rather than diagnosis-related group. However, all five Swiss university hospitals have developed an infection control program. The major criteria for setting up and running these programs are reviewed; data are based on a questionnaire and personal interviewing of each institution. Most of the major criteria exist in all five institutions. Resources allocated to infection control differ markedly. The number of infection control nurses per 250 beds varies between 0.2 and 0.75 for the five hospitals; the activity of those in charge of infection control differs between hospitals. A comparison is made between the Swiss and U.S. programs with regard to some aspects of healthcare and infection control.

Cross Infection↗
PubMed2005

Diverging trends in breast cancer mortality within Switzerland.

BACKGROUND: Substantial regional heterogeneity in the provision of cancer prevention and management services results from the decentralised Swiss healthcare system. MATERIALS AND METHODS: Breast cancer mortality trends between 1980 and 2002 were compared in two French- and in two German-speaking female populations of Switzerland, aged 55-74 years, characterised by different access to, and use of, mammography screening. RESULTS: Since the early 1990s, a 30% fall was observed in the French-speaking regions of Vaud and Geneva, where mammography screening is widespread, with no decline in the German-speaking areas of Basel and Zurich. CONCLUSION: Modification in breast cancer diagnosis and management in selected regions of Switzerland is urgently needed.

Aged↗
PubMed2005

Trends in primary care consultations for asthma in Switzerland, 1989-2002.

BACKGROUND: There is widespread debate about trends in the occurrence of asthma in industrialized countries. This study was conducted to investigate time trends in consultations for asthma in primary care in Switzerland. METHODS: Prospective observational study from 1989 to 2002 within the Swiss Sentinel Surveillance Network; a primary care surveillance system. We used time series analysis and non-parametric smoothing methods to investigate long-term and short-term trends in rates of asthma episodes per 1000 consultations. From 1994 to 2002 we compared rates of first episodes with all subsequent consultations for asthma. RESULTS: Overall consultation rates for asthma per 1000 primary care consultations increased from 1989 to 1994 then stabilized and have declined since 2000. Long-term trends showed a small decline in first consultations for asthma from an average of 0.78 (95% credibility intervals (CI) 0.74-0.81) in 1999 to 0.62 (95% CI 0.55-0.69) per 1000 consultations in 2002. Subsequent consultations for asthma have been declining since at least 1994, from an average of 1.5 (95% CI 1.40-1.61) per 1000 consultations in 1994 to 0.93 (95% CI 0.82-1.04) in 2002. In addition, the ratio of subsequent to first episodes of asthma fell in all age groups. CONCLUSIONS: In Switzerland, primary care consultations for asthma, subsequent to the initial diagnosis, have been declining since 1994. This is more likely to be owing to an increase in the use of home medication than to a shift in care to hospital settings. The incidence of diagnosed asthma might also be decreasing.

Adolescent↗
PubMed2001

Quality programmes, accreditation and certification in Switzerland.

PURPOSE: To report on current quality initiatives in health care in the context of accreditation and certification in Switzerland. SOURCE OF INFORMATION: A review from the Swiss Accreditation Service, the Swiss Medical Association and the University of Zurich. SETTING: In Switzerland, health care providers and health insurers are obliged by law to sign contracts on quality of care. The law texts and related ordinances do not state explicitly the content and format of quality contracts between providers and costs payers. Finding adequate practical solutions is the responsibility of the partners involved. Six different possibilities of quality initiatives are studied and discussed in this report. These include initiatives to create independent certification or inspection bodies for health care organizations accredited by the national accreditation body. FINDINGS: So far, there is only one established standardized system with clear requirements. This accreditation and certification model is an adaptation of the International Standards Organization but so far it has not been used often in the public domain. Each of the other five approaches are more frequently applied but none of them lead to full external peer review certification including medical outcome yet. CONCLUSIONS: A lot of harmonization work still has to be done and clear branch specific requirements need to be agreed upon. Practicability and validity of external peer review schemes may also need further evaluation and improvement to reach the goals of health care systems in the future.

Accreditation↗
PubMed2003

'Emerge': Benchmarking of clinical performance and patients' experiences with emergency care in Switzerland.

OBJECTIVE: To assess the effects of uniform indicator measurement and group benchmarking followed by hospital-specific activities on clinical performance measures and patients' experiences with emergency care in Switzerland. DESIGN: Data were collected in a pre-post design in two measurement cycles, before and after implementation of improvement activities. Trained hospital staff recorded patient characteristics and clinical performance data. Patients completed a questionnaire after discharge/transfer from the emergency unit. SETTING: Emergency departments of 12 community hospitals in Switzerland, participating in the 'Emerge' project. SUBJECTS: Eligible patients were entered into the study (18 544 in total: 9174 and 9370 in the first and second cycles, respectively), and 2916 and 3370 patients returned the questionnaire in the first and second measurement cycles, respectively (response rates 32% and 36%, respectively). MAIN OUTCOME MEASURES: Clinical performance measures (concordance of prospective and retrospective assessment of urgency of care needs, and time intervals between sequences of events) and patients' reports about care provision in emergency departments (EDs), measured by a 22-item, self-administered questionnaire. RESULTS: Concordance of prospective and retrospective assignments to one of three urgency categories improved significantly by 1%, and both under- and over-prioritization, were reduced. The median duration between ED admission and documentation of post-ED disposition fell from 137 minutes in 2001 to 130 minutes in 2002 (P < 0.001). Significant improvements in the reports provided by patients were achieved in 10 items, and were mainly demonstrated in structures of care provision and perceived humanity. CONCLUSION: Undertaken in a real-world setting, small but significant improvements in performance measures and patients' perceptions of emergency care could be achieved. Hospitals accomplished these improvements mainly by averting strong outliers, and were most successful in preventing series of negative events. Uniform outcomes measurement, group benchmarking, and data-driven hospital-specific strategies for change are suggested as valuable tools for continuous improvement. Several hospitals have already implemented the developed measures in their internal quality systems and subsequent measurements are projected.

Adolescent↗
PubMed1995

Changing pattern of primary hyperoxaluria in Switzerland.

BACKGROUND: The clinical course of primary hyperoxaluria (PH) is greatly variable and diagnosis is often delayed. Little is known about the overall occurrence and current prognosis. METHODS: We evaluated all known patients with PH residing and observed in Switzerland during the last 15 years with the help of a survey among Swiss nephrologists. RESULTS: Of the 25 patients observed between 7/79 and 6/94 in Switzerland, 18 were alive in 1994-14 on conservative therapy and four on renal replacement therapy (RRT). Twenty-two patients had PH type 1; the exact type was not determined in three. The estimated prevalence of PH (type 1) is 2 per million population; the minimal incidence is 1 per 100,000 live births. Diagnosis was delayed by 8 years (median) except in infants. Five patients were pyridoxine sensitive. According to life table analysis, 20% of patients were in end-stage renal failure (ESRF) and 10% had died by the age of 15 years, and 50% were in ESRF and 20% dead at 25 years. Prognosis has improved: Five of 13 patients died during the first half of the observation period as opposed to two of 20 in the second part. CONCLUSIONS: Overall prognosis appears better than hitherto believed considering the large clinical spectrum of PH. Greater awareness of PH is needed to improve further long-term prognosis.

Adolescent↗
PubMed2004

High prevalence in Switzerland of pure red-cell aplasia due to anti-erythropoietin antibodies in chronic dialysis patients: report of five cases.

BACKGROUND: Pure red-cell aplasia (PRCA) after erythropoietin (Epo) administration due to the appearance of neutralizing anti-Epo antibodies has been reported in over 200 cases between 1998 and 2002. However, large intercountry disparities were observed in the occurrence of this syndrome. METHODS: On behalf of the Swiss Society of Nephrology, a survey was conducted in all the dialysis units of Switzerland in order to collect information on the occurrence, diagnostic and evolution data of the cases observed. A questionnaire was send to the nephrologists in charge of each of the 69 dialysis units in January 2003. The clinical and biological data of the suspected cases were analysed and compared with the data provided to health authorities and pharmaceutical companies. RESULTS: A total of five cases were identified as true PRCA with demonstrated positive anti-Epo antibodies. They occurred between November 1998 and February 2002, were all treated by haemodialysis and had received Epo subcutaneously. The median appearance time of refractory anaemia after Epo initiation was 10 months (range: 7-54 months). Two cases had been treated exclusively with epoietin-alpha, one solely with epoietin-beta and the two others with a combination of both. With five cases out of a total of about 2500 dialysis patients and 2300 Epo-treated dialysis patients or an exposure rate to Epo of 9900 dialysis patient-years during a 4.3 year period, this prevalence is among the highest of those reported in European countries. CONCLUSIONS: The prevalence of PRCA after Epo administration in dialysis patients appears particularly high in Switzerland. Among the potential explanations, the most plausible are the high percentage of dialysis patients treated with Epo, the almost exclusive subcutaneous administration, the larger market distribution of the epoietin-alpha brand, the eventual disruption of the cold chain and the setting-up of a systematic national survey.

Aged↗
PubMed1995

Toxoplasma infection among pregnant women in Switzerland: a cross-sectional evaluation of regional and age-specific lifetime average annual incidence.

A simple generalized linear model of toxoplasmosis incidence has been applied to serologic data from more than 9,000 women who delivered babies in Switzerland. This model, based on an assumption of constant incidence of toxoplasmosis throughout time and ages, yields estimates of incidence rates that show marked contrasts between subgroups of women categorized on the basis of their geographic origin and duration of residence in Switzerland. The patterns observed are in agreement with previously reported data from specific areas. When applied to Swiss resident women of different age groups, the average incidence rate estimates obtained were remarkably similar. This was not the case among the subgroup of Portuguese immigrant women, nor when the model was applied to previously published data from Sweden where toxoplasmosis incidence has clearly decreased in the last 20 years. Although models for the analysis of cross-sectional data involve major simplifying assumptions, it appears that they can yield useful epidemiologic information and that departures from the assumed simplified structure of the data can sometimes be identified.

Adolescent↗
PubMed1994

HIV testing in Switzerland.

OBJECTIVES: To obtain information about the prevalence of, reasons for, and adequacy of HIV testing in the general population in Switzerland in 1992. DESIGN: Telephone survey (n = 2800). RESULTS: Some 47% of the sample underwent one HIV test performed through blood donation (24%), voluntary testing (17%) or both (6%). Of the sample, 46% considered themselves well or very well informed about the HIV test. Patients reported unsystematic pre-test screening by doctors for the main HIV risks. People having been in situations of potential exposure to risk were more likely to have had the test than others. Overall, 85% of those HIV-tested had a relevant, generally risk-related reason for having it performed. CONCLUSIONS: HIV testing is widespread in Switzerland. Testing is mostly performed for relevant reasons. Pre-test counselling is poor and an opportunity for prevention is thus lost.

Acquired Immunodeficiency Syndrome↗
PubMed1982

The blind in the economic structure of Switzerland: an analysis of some aspects of vocational integration.

This empirical investigation describes the present state of vocational integration of blind persons in Switzerland. The study is based on interviews of 215 blind persons--not multiply handicapped--who left a Swiss special school or rehabilitation center in the period 1960 to 1978. The study investigated the following dimensions: - vocational situation and opportunities in a horizontal comparison; - vocational situation and opportunities in a vertical comparison; - level of wage or salary; - subjective work satisfaction. The results of the investigation show that the degree of vocational integration attained by blind interviewees may be regarded as high. If, on the other hand, the forecast should prove correct that in the 80ies Switzerland, too, can expect a higher rate of unemployment, the efforts aimed at improving the qualification prerequisites for vocational integration of the blind deserve attention. Particular emphasis must be placed - in education, on the teaching of greater social competence; - in counseling and placement, on the provision of suitable measures for qualified training and/or retraining; - in further education, on the dynamic advancement of personal needs in regard to further training, the latter understood as "permanent training".

Blindness↗
PubMedDate not supplied

Medical engineering in Switzerland.

The clinical engineering or medical engineering departments in the hospitals in Switzerland are in a phase of rapid development. In particular, staffing, as well as official recognition by hospital management, needs improvement in many of the hospitals, as is also found in other countries. An overview is given of the current state of affairs in medical engineering in Switzerland, and of the amount of annual investment in medical equipment in the public hospitals. The activities of the Swiss Association of Hospital Engineers in this field are described. The main goals, responsibilities, and tasks of medical engineering departments are presented. The importance of the integration of the medical engineering operation in the management decision process is stressed.

Biomedical Engineering↗
PubMed2002

Could a regional trauma system in eastern Switzerland decrease the mortality of blunt polytrauma patients? A prospective cohort study.

BACKGROUND: In Europe and Switzerland, hardly any studies have been performed on regional trauma systems. We therefore decided to conduct a prospective study in our region to establish whether an organized trauma system derived from the American model would have a beneficial effect on the survival of blunt polytrauma patients. METHODS: In a prospective observational cohort study conducted between 1990 and 1996, we compared the actual mortality in 280 blunt polytrauma patients admitted directly to our trauma center with the predicted mortality using the A Severity Characterization of Trauma score. The same comparison was made for 190 transferred polytrauma admissions from regional hospitals. Our hypothesis was that for the transferred admissions, the actual mortality would be significantly higher than predicted, but that there would be no difference for the directly admitted patients. Inclusion criteria were blunt trauma of at least two body sites and an Injury Severity Score of 8 or more. RESULTS: Mortality in the patients admitted directly to the trauma center was 11.8% (33 of 280), which was not significantly lower than that for the transferred admissions at 14.2% (27 of 190). There were 10% (3 of 30) more deaths than predicted among the direct admissions (i.e., 3 more deaths; 95% confidence interval, -5.2-11.1; p = NS). Among the transferred admissions, there were 46% (8.6 of 18.4) more deaths than predicted (i.e., 8.6 more deaths; 95% confidence interval, 2.5-14.7; p < 0.05). CONCLUSION: It is likely that a regional trauma system in eastern Switzerland for polytrauma patients with an ISS of 8 or more would have a moderately positive effect on mortality. During the period of observation, transferred admissions from regional hospitals to our trauma center had a 46% higher mortality than predicted. In absolute terms, therefore, with a regional trauma system, it might have been possible to avoid between one death every 2 to 3 years and two to three deaths every year.

Adolescent↗
PubMed2002

National laboratory reports of Chlamydia trachomatis seriously underestimate the frequency of genital chlamydial infections among women in Switzerland.

BACKGROUND: Public health authorities want to evaluate their sexually transmitted disease (STD) surveillance systems to promote the most effective use of health resources. GOAL: The goal of this study was to estimate the sensitivity of national laboratory reports of in Switzerland (the proportion of cases detected by national laboratory reports). STUDY DESIGN: A cross sectional prevalence study was conducted by the Swiss Sentinel Surveillance Network of Gynecologists in 1998. Two groups of women aged less than 35 years were included in the study: those having a first consultation for pregnancy and those having a routine check-up. RESULTS: A total of 1589 women were tested for. The prevalence among pregnant women (n = 817) was 1.3%, and that among sexually active women (n = 772) was 2.8%. Using the prevalences observed among check-up women, we estimate that there were at least 24,400 infections in Switzerland among women aged 20 to 34 years in 1998 (95% CI: 14,300-34,300). The number of laboratory reports of in this age group was 1,150 in 1998. CONCLUSION: Our study suggests that the sensitivity of national laboratory reports of in 1998 was less than 5% for women aged 20 to 34 years.

Adult↗
PubMed1999

High frequency of non-B subtypes in newly diagnosed HIV-1 infections in Switzerland.

HIV-1 subtypes were determined in newly diagnosed residents of Switzerland. Blood was anonymously collected from patients with a first confirmed positive HIV-1 test result. Viral DNA from the env V3-V5 region was amplified by nested polymerase chain reaction (PCR) and screened for subtype B by heteroduplex mobility assay. All amplicons not identified as B were sequenced. From November 1996 to February 1998, 206 samples were analyzed. Main transmission risks were unprotected heterosexual (55.7%) or homosexual (27.1%) sexual contact or intravenous drug use (12.9%). Subtype B dominated in patients of Swiss, other European, American, or Asian citizenship; particularly high frequencies were found in homosexuals (97%) and drug users (94%). Non-B subtypes including A, C, D, E, F, G, H, a possible B/F recombinant, and a sequence related to J were present in 28.2% (95% confidence interval [CI], 22.9%-35.0%). Non-B were frequent in African citizens (95%), heterosexually infected individuals (44%), and women (43%). Heterosexually infected Swiss males harbored non-B strains in 18% and females in 33%. The results document a change in the epidemiology of newly diagnosed HIV-1 infections in Switzerland: predominance of heterosexual transmission and a high frequency of non-B subtypes.

Adult↗
PubMed2007

Cellular telephone use and time trends in brain tumour mortality in Switzerland from 1969 to 2002.

A rising concern exists that with the widespread use of mobile communication technologies, the incidence of brain tumours may increase. On the basis of data from the Swiss national mortality registry from 1969 to 2002, annual age-standardized brain tumour mortality rates per 100,000 person-years were calculated using the European standard population. Time trend analyses were performed by the Poisson regression for six different age groups in men and women separately. The study period was divided into two intervals: before and after 1987, when the analogue mobile technology was introduced in Switzerland. Age-standardized brain tumour mortality rates ranged between 3.7 and 6.7 for men and 2.5 and 4.4 for women per 100,000 person-years. For the whole study period, a significant increase in brain tumour mortality was observed for men and women in the older age groups (60-74 and 75+ years) but not in the younger ones in whom mobile phone use was more prevalent. Time trend analyses restricted to data from 1987 onwards revealed relatively stable brain tumour mortality rates in all age groups. For instance, the annual change in brain tumour mortality rate for the 45-59-year age group was -0.3% (95% confidence interval: -1.7; 1.1) for men and -0.4% (95% confidence interval:-2.2; 1.3) for women. We conclude that after the introduction of mobile phone technology in Switzerland, brain tumour mortality rates remained stable in all age groups. Our results suggest that mobile phone use is not a strong risk factor in the short term for mortality from brain tumours. Ecological analyses like this, however, are limited in their ability to reveal potentially small increases in risk for diseases with a long latency period.

Adolescent↗
PubMed2006

Cord blood screening for congenital toxoplasmosis in northwestern Switzerland, 1982-1999.

BACKGROUND: In the absence of mandatory nationwide toxoplasmosis screening during pregnancy in Switzerland, the Basel region introduced cord blood screening in 1982. METHODS: From 1982 to 1999, 64,622 cord blood samples (>90% of all neonates) collected in Basel region obstetric units were screened for toxoplasma specific immunoglobulin (Ig) G, M and A antibodies using commercial kits. Neonates with relevant results (IgG titers > or =300 IU/mL, or > or =200 IU/mL in the Abbott Toxo IMX system, and/or positive IgM or IgA antibodies) were monitored until clarification of infection status. From 1991 onward, retrospective maternal and follow-up data on these children were also collected by questionnaire. RESULTS: Despite increasing maternal age, seroprevalence for toxoplasmosis decreased steadily from 53% (1982-1985) to 35% (1999). During the same period, the prevalence of congenital toxoplasmosis declined from 0.08% to 0.012%. IgM and/or IgA antibodies were present with the Platelia Toxo test (enzyme-linked immunosorbent assay; sanofi pasteur; Bio-Rad) in the cord blood samples of 17 of 18 infected neonates born between 1986 and 1999, regardless of maternal treatment in pregnancy. Vertical transmission rates in 69 women with proven or suspected primary infection between 1991 and 1999 were 3.9% with, compared to 27.7% without, antiparasitic treatment during pregnancy. CONCLUSION: Toxoplasma seroprevalence and congenital toxoplasmosis incidence declined markedly in northwestern Switzerland from 1982 to 1999. Our data provide no conclusive evidence that maternal antiparasitic therapy in pregnancy affects vertical transmission because the treatment group also included women with suspected but unproven primary infection during pregnancy. Because toxoplasma specific IgA/IgM antibodies in cord blood identified almost all infected children, screening at birth may be more cost effective than during pregnancy.

Adolescent↗