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PubMed2004

Radiation exposure in dental radiology: a 1998 nationwide survey in Switzerland.

OBJECTIVES: To measure the frequencies of dental radiological examinations in Switzerland and to determine the associated collective radiation doses. METHODS: To evaluate the frequencies, a sample of 376 dental practitioners and other institutions performing dental radiology were requested to fill in questionnaires designed to measure, amongst others, frequencies of dental radiodiagnoses according to type of examination, patient age and gender, dental specialty and type of surgery. The associated collective radiation doses were determined by multiplying the relevant frequencies with dose estimates obtained from recent measurements and calculations. RESULTS: The total number of dental examinations performed in Switzerland in 1998 was 4.1 million (581 per 1000 population). Periapical, bitewing and panoramic radiographs were the most frequent types of dental examinations. The collective dose associated with dental radiology was 71 person.Sv. This amounts to an annual average effective dose to the population of 10 muSv per caput, which is in agreement with the figures reported for countries of similar healthcare level. Various features such as the age distribution of the radiographed patients, the forms of collimators used, film consumption and the use of digital imaging systems are presented. CONCLUSIONS: Several recommendations for dose reduction are made. These include the re-evaluation of the patterns and justification for prescribing some particular types of dental examinations as well as the avoidance of unnecessary irradiation by the use of rectangular collimation and high sensitivity F-speed films.

Adolescent↗
PubMed2006

Pharmaceutical care in community pharmacies: practice and research in Switzerland.

OBJECTIVE: To describe the current situation and prospects for community pharmacy practice in Switzerland, a confederation of 26 cantons with a population of approximately 7 million, located in the center of Europe. FINDINGS: For the past 10 years, the Swiss Association of Pharmacists has directed an in-depth reform of the profession, with measures such as a system of remuneration based on pharmaceutical cognitive services, a quality care program named QMS-Pharmacy, a postgraduate education program (including specific titles and certificates) and obligatory continuous education, programs of public relations and health promotion, innovative services of managed care, generics substitution, and others. DISCUSSION: The implemented changes in management represent a pharmaceutical care solution for Swiss community pharmacies, which face intense competition and a very liberal policy regarding healthcare organization, relating in particular to the important cantonal autonomy, free establishment of ownership of pharmacies, pharmacy chains, dispensing physicians, chemist shops, mail order, and others. CONCLUSIONS: Community pharmacy in Switzerland is making modernization of its role in public health policy a clear orientation. Priorities for the future include reinforcement of education and academic research in pharmacy practice, demonstration of the added value of pharmacists, integration of new information technologies with pharmacies, and development of new pharmaceutical services for managed care network in collaboration with physicians and other healthcare professionals.

Community Pharmacy Services↗
PubMed2003

Triplets and quadruplets in Switzerland: comparison with singletons, and evolution over the last decade.

AIMS: Main objectives were 1) to determine the incidence of higher multiple births from 1995 to 1998 in Switzerland, and 2) to evaluate neonatal mortality and morbidity. Secondary objectives were 3) to compare the results with those of matched singletons, and 4) to compare the present data to the first Swiss study (1985-1988). METHODS: Retrospective analysis of maternal and neonatal data obtained from all Swiss hospitals. RESULTS: The incidence of triplet births was 1/3247 and that of quadruplet births 1/81,186. The median gestational age was 32 5/7 weeks for triplets, and 28 6/7 weeks for quadruplets. The median birth weight was 1665 g for triplets and 1076 g for quadruplets. Perinatal mortality was 6% for triplets and 19% for quadruplets. Respiratory distress syndrome was the major morbidity as diagnosed in 52% of triplets and 81% of quadruplets. A comparison of triplets with matched singletons showed no significant differences in morbidity and mortality. Compared with the first Swiss study, the mortality rate decreased, while the incidence of triplets increased but decreased for quadruplets. CONCLUSION: The incidence of higher-order multiple births in Switzerland dropped for quadruplets in the last decade but has increased for triplets. The mortality and morbidity of triplets is comparable to that of singletons with a similar gestational age.

Cesarean Section↗
PubMed2005

Historical change of suicide seasonality in the canton of zurich, Switzerland.

Current research is yielding an increasingly heterogeneous picture of suicide seasonalities: They seem to depend on methods and, moreover, they seem to have smoothed in recent decades. This work examines the latter issue by comparing suicide seasonalities in the canton of Zurich, Switzerland, in the 16 th -18 th centuries, 1901-1920 and 1969-94. The results indicate shifts of peaks and lows on suicide seasonalities over the centuries, with a smoothing of seasonalities toward the 21 th century. The recent period does not show any suicide seasonality at all. The canton of Zurich seems to be ahead of the general trend found in other regions of Switzerland.

History, 16th Century↗
PubMed2004

Decreased taxation, spirits consumption and alcohol-related problems in Switzerland.

OBJECTIVE: The spirits market in Switzerland was reformed in 1999 in accordance with the World Trade Organization agreement. The resulting tax reform and increased competition have resulted in markedly reduced prices for foreign spirits, and a previous study showed that spirits consumption increased significantly after the tax reform. The present study examined whether alcohol-related problems also increased at follow-up and if they did, whether the increase was the result of increased spirits consumption. Further correlates of alcohol-related problems were also explored. METHOD: Data were obtained from a longitudinal study on changes in alcohol consumption in Switzerland. The baseline survey was conducted 3 months before the tax reform, and the follow-up was conducted 28 months after the tax reform. A randomly selected sample of 4,007 residents aged 15 years or older participated in the baseline survey, and 73% of this sample participated in the follow-up survey. Alcohol consumption was measured on the basis of a graduated frequency, and alcohol-related problems were measured by items taken from the Alcohol Use Disorder Identification Test (AUDIT). RESULTS: Findings indicate that alcohol-related problems increased significantly at follow-up. The significance disappeared, however, after controlling for spirits consumption, indicating that the increase of alcohol-related problems at follow-up was mainly mediated through increased consumption of spirits. The multiple regression models showed that spirits, beer and wine consumption, gender, Age*Spirits Consumption interaction, region, smoking status, heavy-drinking frequency and average number of drinks were significant correlates of alcohol-related problems. CONCLUSIONS: Alcohol-related problems increased at the follow-up, particularly among younger age groups who consumed more spirits. Prevention programs on alcohol-related problems should target young people.

Adolescent↗
PubMed1990

Iodine deficiency diseases in Switzerland one hundred years after Theodor Kocher's survey: a historical review with some new goitre prevalence data.

In certain regions of Switzerland, before prophylaxis, 0.5% of the inhabitants were cretins, almost 100% of schoolchildren had large goitres and up to 30% of young men were unfit for military service owing to a large goitre. Iodization of salt was introduced in 1922 at 3.75 mg I per kg and the iodine content was doubled twice, in 1962 and 1980, to the present 15 mg I per kg. In 1988, 92% of retail salt and 76% of all salt for human consumption (including food industry) was iodized, even though its use is voluntary. Urinary iodine excretion, previously between 18 and 64 micrograms per per day, has now risen to 150 micrograms per day. No new endemic cretins born after 1930 have been identified. Goitre disappeared rapidly in newborns and schoolchildren, more slowly in army recruits, and incompletely in elderly adults. In some Cantons (by constitution in charge of health matters and the salt monopoly) which allowed iodized salt only in 1952, disappearance of goitre lagged behind accordingly, proof that iodized salt was the cause of regression. The Swiss data provide evidence that isolated deafness, mental deficiency, and short stature, each without the other attributes of cretinism have also decreased. Adverse effects of iodized salt were minimal, possibly because the initial iodine content of salt was chosen very low. Iodization of salt has proved a highly cost-effective preventive measure in Switzerland.

Adult↗
PubMed1995

Surveillance of contagious bovine pleuropneumonia in Switzerland.

An active surveillance system for contagious bovine pleuropneumonia (CBPP) has been established in Switzerland. The system is based on the detection of typical gross pathological lesions in the lungs of slaughtered cattle, followed by microbiological analysis of the sampled organs and sero-epidemiological investigation of the herd of origin for each suspect case. The programme was tested over six months. The prevalence of lung lesions detected in carcasses during this period in the 108 participating abattoirs was 0.04%, but Mycoplasma mycoides subsp. mycoides SC was not isolated from any of these organs. On the basis of the results presented, there is no evidence of CBPP in Switzerland. The surveillance programme will continue, however, in order to document the situation and eventually obtain a disease-free status in accordance with international standards.

Abattoirs↗
PubMed2001

Economic evaluation of celecoxib, a new cyclo-oxygenase 2 specific inhibitor, in Switzerland.

OBJECTIVE: The aim of this study was to predict the cost effectiveness of celecoxib, a cyclo-oxygenase 2 (COX-2) specific inhibitor, in the treatment of arthritis patients in Switzerland. METHODS: We applied a decision analytical model to compare the effects of 6 months' treatment with the following: (i) celecoxib; (ii) nonsteroidal anti-inflammatory drug (NSAID) alone; NSAID protected with (iii) proton pump inhibitor (PPI), (iv) histamine H2 receptor antagonist (H2RA), or (v) misoprostol; and (vi) diclofenac/misoprostol. Treatment costs included drug acquisition and the management of gastrointestinal (GI) adverse effects, classified as GI discomfort, symptomatic ulcer, anaemia and serious GI events (requiring hospitalisation). Probabilities were derived from celecoxib clinical trials and the literature. Drug utilisation patterns and treatment costs reflecting Swiss practice were obtained from local sources. Analysis was from the public health insurers' perspective. A range of sensitivity analyses was performed. RESULTS: For the base case of patients at typical risk (0.56% per 6 months) of serious GI events, the total expected costs of 6 months' treatment were as follows: celecoxib 435 Swiss francs (SwF); NSAID alone SwF510; diclofenac/misoprostol SwF522; and other protected NSAID regimens between SwF1034 and SwF1415. Celecoxib remained the lowest costing treatment over all categories of GI risk. Celecoxib generated 115 expected adverse events per 1000 patients per 6 months, followed by NSAID + PPI (119), NSAID + H2RA (154), NSAID + misoprostol (202), diclofenac/misoprostol (203), and NSAID alone (220), again for the base case. The cost per adverse event averted for celecoxib compared with NSAIDs alone was estimated in a stochastic version of the model using Monte Carlo simulation. In 95% of 500 iterations, celecoxib was predicted to save both costs and adverse events, thus dominating NSAIDs alone; the maximum cost per adverse event averted was SwF440. CONCLUSIONS: Celecoxib is predicted to be the most cost effective of the treatments considered for managing arthritis patients in Switzerland. A policy of switching patients from NSAIDs to celecoxib is predicted to be cost saving for public health insurers, while reducing the burden of iatrogenic GI side effects. Greater cost savings would be realised when patients are switched from NSAIDs used with gastroprotective agents. Models such as this can provide a useful but simplified view of treatment outcomes and predicted results require prospective validation in clinical practice.

Anemia↗
PubMed2005

Tobacco and alcohol tax relationships with suicide in Switzerland.

Previous research has shown an empirical link between tobacco and alcohol use and suicide. If tobacco and alcohol use contribute to suicidal behaviors, then policies designed to reduce the tobacco and alcohol consumption may succeed in reducing suicides as well. To test this hypothesis, correlations for suicide rates with alcohol consumption, taxes on alcohol and tobacco in Switzerland were examined using sets of time-series data from Switzerland in 1965-1994. The tax on tobacco correlated significantly negatively with male standardized suicide rate. The tax on alcohol also correlated significantly with male standardized suicide rate in an autoregressive model. On the other hand, significant relationships with female suicide rate were not found. Policies designed to reduce tobacco consumption are consistent with a benefit of reducing suicides, particularly for men in this sample.

Adolescent↗
PubMed1997

Incidence and prevalence of illegal drug use in Switzerland in the 1980s and early 1990s: an analytical study.

The Swiss registry of charges concerning illegal trade and consumption of narcotics offers the possibility of monitoring the incidence and prevalence of illegal drug use in Switzerland. Of course, the relation between the number of charges against users of illegal drugs and the number of users is unknown and may vary in time and space. This makes it difficult to estimate the prevalence of consumption from law enforcement data, but it does not hinder the estimation of incidence if the numbers of first and subsequent charges are known. This is demonstrated by employing a dynamic model with two compartments which represent the not yet charged and the charged users. In contrast to methods which rely on treatment admission data, the new method can detect changes of incidence without time lag. Prevalence estimates can be obtained if the charge frequency distribution is known, as it is for Switzerland from 1990 to 1994. A theoretical distribution is fitted to the data which are available for all illegal drugs as well as for heroin and/or cocaine. This leads to estimates of the populations of users of illegal drugs in general and of heroin and/or cocaine.

Cocaine↗
PubMed2003

Microbiological quality of raw goat's and ewe's bulk-tank milk in Switzerland.

A total of 407 samples of bulk-tank milk (344 of goat's milk and 63 of ewe's milk) collected from 403 different farms throughout Switzerland, was examined. The number of farms investigated in this study represents 8% of the country's dairy-goat and 15% of its dairy-sheep farms. Standard plate counts and Enterobacteriaceae counts were performed on each sample. Furthermore, the prevalence of Staphylococcus aureus, Campylobacter spp., Shiga toxin-producing Escherichia coli, Salmonella spp., and Mycobacterium avium ssp. paratuberculosis was studied. The median standard plate count for bulk-tank milk from small ruminants was 4.70 log cfu/ml (4.69 log cfu/ml for goat's milk and 4.78 log cfu/ml for ewe's milk), with a minimum of 2.00 log cfu/ml and a maximum of 8.64 log cfu/ml. Enterobacteriaceae were detected in 212 (61.6%) goat's milk and 45 (71.4%) ewe's milk samples, whereas S. aureus was detected in 109 (31.7%) samples of goat's milk and 21 (33.3%) samples of ewe's milk. Campylobacter spp. and Salmonella spp. were not isolated from any of the samples. However, 16.3% of the goat's milk and 12.7% of the ewe's milk samples were polymerase chain reaction (PCR)-positive for Shiga toxin-producing E. coli. Seventy-nine (23.0%) goat's tank-milk and 15 (23.8%) ewe's tank-milk samples were PCR-positive for insertion sequence 900, providing presumptive evidence for the presence of M. avium ssp. paratuberculosis. These results form the basis for determining the microbiological quality standards for goat's and ewe's milk. Moreover, the data presented form part of the risk assessment program for raw milk from small ruminants in Switzerland.

Animals↗
PubMed2003

Evaluation of the safety assurance level for Salmonella spp. throughout the food production chain in Switzerland.

In Switzerland. the safeguarding of food is the responsibility of industry, organizations, and governmental authorities. The dispersion of the tasks and the diversity of implemented safety measures among involved stakeholders do not allow a general overview of the national safety assurance level provided. A comprehensive evaluation of the level of safety assurance provided for foodborne pathogens such as Salmonella spp. is therefore lacking, and the prevalence of Salmonella spp. at various points in the food production chain is not known. The objectives of this study were to (i) collect data on safety measures implemented throughout the food production chain in Switzerland regarding Salmonella spp.; (ii) evaluate the safety assurance level for Salmonella spp. at each step of the production chain for chicken meat, pork, beef, and milk and dairy products (bovine origin); and (iii) gather data on the prevalence of the pathogen at each step. Data on implemented safety assurance measures for Salmonella spp. were gathered from the various stakeholders in the food production chain. The data were analyzed by a semiquantitative method that considered the quality and relevance of the implemented safety measures for Salmonella spp. The safety assurance level for Salmonella spp. was evaluated from "no safety assurance" to "very good safety assurance." Available results of testing for Salmonella spp. from 1998 to 2000 were used for calculating the prevalence of the pathogen throughout the food production chain. The results showed a varying safety assurance level for Salmonella spp. throughout the food production chain. Strengths (e.g., feed production for chickens) and weaknesses (e.g., pork production) were observed. These results serve as a basis for a rational optimization of the system.

Animals↗
PubMed2002

Prevalence of asymptomatic celiac disease in adolescents of eastern Switzerland.

BACKGROUND: The prevalence of symptomatic CD in Switzerland is thought to be 1 in 1,000 inhabitants. As in other countries, oligo- and asymptomatic CD is being diagnosed with increasing frequency in all age groups. AIM: To assess the prevalence of asymptomatic CD in adolescents in eastern Switzerland. METHOD: Between September 1999 and July 2000 total serum IgA titres, anti-endomysium IgA (EMA) titres and anti-human tissue transglutaminase IgA (hTTG) titres were measured in the serum of healthy 11- to 18-year-old Swiss lower and upper secondary school students. RESULTS: Of the 1,450 students (871 f = 60.1%, CI 95%) tested, 11 (10 f) had elevated levels of both EMA and TTG. The diagnosis of CD was confirmed in eight of these students by mucosal jejunal morphology (Marsh III); one exhibited normal histology. Two of the 11 students refused to undergo mucosal biopsy. None of the students, however, had symptoms suggestive of CD, nor were they stunted or underweight, and none of them had family members with known CD. All of the eight students with enteropathy went on a glutenfree diet and felt subjectively better than on a normal diet. Of the remaining students, 38 (2.6%) had family members with known CD. None of those with the relevant family history had elevated EMA or TTG levels. CONCLUSION: Asymptomatic CD is common. It occurs in 1 in 132 (0.75%) Swiss adolescents. The absence of subjectively recognisable symptoms suggestive of family history or other risk factors makes it difficult to diagnose this type of CD.

Adolescent↗
PubMed2003

Two years outcome of very pre-term and very low birthweight infants in Switzerland.

BACKGROUND: There are only few reports worldwide on the outcome of very pre-term infants and very low birthweight infants for a whole country. In Switzerland official population statistics are based on birthweight only, gestational age not yet being documented. AIM: The aim of the present study was to assess the outcome at two years of age for a geographically defined high-risk neonatal population based on both birthweight and gestational age. METHODS: All infants born in 1996 included in the Swiss Neonatal Network (a national anonymous registry established by the Swiss Society of Neonatology for liveborn infants before 32 completed gestational weeks or weighing less than 1500 g) were divided into three groups according to gestational age and birth weight: Group 1: born <32 completed gestational weeks and weighing =1500 g; group 2: born after 32 completed gestational weeks and weighing <1500 g; group 3: born <32 gestational weeks and weighing <1500 g. Information at 24 months corrected age about growth, neurological outcome, frequency of respiratory infections, prescription of antibiotics and medical consultations during this period was obtained from the paediatricians caring for the infants. Fair outcome was defined as survival without serious neonatal complications or abnormal neurological findings at 24 months corrected for prematurity. RESULTS: 723 infants were born alive in Switzerland between 1.1. and 31.12.1996 before 32 completed weeks or weighing less than 1500 g at birth. Mortality was 4.3% for a total of 163 infants in group 1 (<32 weeks, =1500 g), 4.6% for 108 infants in group 2 (>32 weeks, <1500 g) and 18.6% for 452 infants in group 3 (<32 weeks, <1500 g). 6.5% of group 1 survivors followed up to 24 months corrected age had a poor neurological outcome as compared to 9.3% in group 2 and 10.9% in group 3. Infants in group 1 needed antibiotics less often after hospital discharge (interquartile range IQR: 0-2 courses) than infants in group 2 (0-3 courses) and 3 (0-3 courses). Infants in group 2 suffered from fewer airway infections (interquartile range 2-5 times) than in group 1 (2-6 times) and 3 (1-7 times). Infants in group 3 needed more medical consultations (IQR 12-21) than those in group 1 (10-16) and 2 (11-16). The overall fair outcome at 24 months corrected age was 85.3% in group 1, 80.7% in group 2 and 59.6% in group 3. A close correlation between overall fair outcome and gestational age at birth on the one hand and with birthweight on the other can be observed. CONCLUSIONS: This study gives estimates for mortality, poor and fair outcome at 24 months corrected age for very low birth weight infants (<1500 g) and for very pre-term infants (<32 completed gestational weeks). Gestational age is as important for predicting outcome as birthweight and should therefore be integrated into national statistics.

Anti-Bacterial Agents↗
PubMed2003

Use of alternative medicine by patients with cancer in a rural area of Switzerland.

BACKGROUND: Many cancer patients use alternative therapies in addition to conventional treatment. In a survey among such patients, we assessed the prevalence of and the motivation for alternative therapy use in a rural area of Switzerland. METHODS: From 1st February to 30th November 2001, we interviewed 108 patients treated in the oncology outpatient clinic of the Langenthal District General Hospital, Switzerland, using a structured questionnaire. 77% of the patients were female. 49% of the patients (i.e., 64% of the female patients) suffered from breast cancer. RESULTS: 42 (39%) of all patients had used an alternative therapy in addition to conventional treatment at least once. Mistletoe preparations were by far the most popular with a prevalence of 74%. Homeopathy (24%) and cancer diets (12%) were used less often. 79% of the patients seeking help from alternative treatment informed their treating oncologist and/or medical practitioner accordingly. 57% of the doctors encouraged their patients to continue the alternative treatment, none discouraged the patient to do so. The main reasons for the use of alternative therapy were: the desire to feel more hopeful (83%); "to do as much as possible myself to cure the disease" (83%); and to harness mental energy (62%). Only 19% of the patients hoped to be cured of cancer by alternative therapy. CONCLUSIONS: The motivation to seek help from alternative treatment is not based on a distrust of conventional care. Maintaining hope and taking an active role in self-care are the main stimuli for using alternative medicine.

Adjuvants, Immunologic↗
PubMed2004

Preimplantation diagnosis in Switzerland--birth of a healthy child after polar body biopsy.

In Switzerland preimplantation genetic diagnosis is limited by law to polar body biopsy (PBB). The indications for PBB include unexplained recurrent miscarriage and improvement of the outcome of in vitro fertilisation (IVF) cycles in women at an advanced reproductive age. In this article we report the first birth of a healthy child after polar body biopsy in Switzerland in a case of unexplained miscarriage after IVF.

Abortion, Habitual↗
PubMed2004

Decompressive craniotomy after middle cerebral artery infarction. Retrospective analysis of patients treated in three centres in Switzerland.

QUESTIONS UNDER STUDY / PRINCIPLES: Several studies have reported an improved outcome in patients presenting with complete middle cerebral artery (MCA) infarction treated by decompressive hemicraniectomy. Although this palliative treatment form has gained popularity in Switzerland since 2000, the results of these series have not been reported. The aim of this study is, firstly, to report factors influencing the outcome of our patients, in order to create awareness of the indications and decision-making processes in our departments, and, secondly, to analyse therapeutic strategies which are open to improvement and standardisation. METHODS: This retrospective study included a total of 28 patients (age 51 +/- 12 years) who underwent decompressive craniectomy after MCA between January 2000 and May 2002 at the Departments of Neurosurgery of Aarau (n: 6), Bern (n: 10), and Zurich (n: 12). Demographic characteristics included preoperative clinical condition (NIHSS and GCS), timing of surgery, cause, location, and extension of infarction. Additionally, the time delay from the onset of symptoms to surgery and preoperative signs of herniation and their relation to final outcome was analysed. The final outcome was assessed in terms of mortality and scores such as modified Rankin scale and Barthel index. RESULTS: The preoperative clinical condition according to NIHSS was 20.2 +/- 4.7 and GCS was 10.6 +/- 3.6. The mean time in hours to surgery after onset of symptoms was 35 +/- 24. Twelve patients (42.8%) underwent "early" surgery (within 24 hours) and 21 (75%) suffered non-dominant stroke. The follow-up period was 22 +/- 13 months and 17% of the patients died within this period. Outcome did not differ significantly between institutions. The overall mean Barthel index was 47 +/- 25 and modified Rankin scale was 4 +/- 1.3. CONCLUSIONS: The outcome in patients undergoing decompressive craniectomy after MCA infarction in Switzerland is less favourable than in other series recently reported. Less favourable preoperative clinical condition, inclusion of dominant hemispheric infarction, poorly defined protocols and late involvement of neurosurgeons on these patients' admission may explain the results.

Adult↗
PubMed2005

Homelessness among people with severe mental illness in Switzerland.

QUESTIONS UNDER STUDY: This study addresses socio-demographic and clinical characteristics among homeless people in Switzerland admitted to inpatient care, the use of and pathways to inpatient care by this group and, the extent to which psychiatric disorders contribute to the risk of homelessness. METHODS: Based on data of a psychiatric case register we analysed 16247 people consecutively referred to psychiatric hospitals of a catchment area in Switzerland between 1998 and 2001. RESULTS: 1.6% of all admitted patients (N = 257) were homeless (mean age: 34.4 years; women: 30.0%). The homeless as compared to other psychiatric inpatients had higher rates of substance use disorders, equal rates of psychotic and personality disorders, but lower rates of organic and affective disorders. Homeless people were more often compulsorily or as an emergency admitted. General practitioners (GPs) were less involved in the admission. The homeless had a shorter inpatient stay and their health status did not equally improve like in other patients. Risk factors of being homeless at psychiatric admission were: young age, male gender, single, low education level, urban residence, abuse of illicit drugs, especially multiple substance use, and having a dual diagnosis. CONCLUSIONS: Social factors and psychopathology are independently contributing to the risk of homelessness. Health care inequalities were found with regard to pathways to inpatient care (high rate of compulsory and emergency admissions, low involvement of GPs) and hospital stay (shorter stay, less improvement). Compared to other countries, disproportionate use of inpatient resources by homeless people could not be confirmed.

Adult↗