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PubMed2006

Haematopoietic stem cell transplantation in Switzerland. Report from the Swiss Transplant Working Group Blood and Marrow Transplantation (STABMT) Registry 1997-2003.

In 1997, the Swiss Transplant Working Group Blood and Marrow Transplantation (STABMT) initiated a mandatory national registry for all haematopoietic stem cell transplants (HSCT) in Switzerland. As of 2003, information was collected of 2010 patients with a first HSCT (577 allogeneic (29%) and 1433 autologous (71%) HSCT) and 616 additional re-transplants. This included 1167 male and 843 female patients with a median age of 42.4 years (range 0.2-76.6 years). Main indications were leukaemias (592; 29%) lymphoproliferative disorders (1,061; 53%), solid tumours (295; 15%) and non-malignant disorders (62; 3%). At the time of analysis 1,263 patients were alive (63%), 747 had died (37%). Probability of survival, transplant related mortality or relapse at 5 years was 52%, 21%, 36% for allogeneic and 54%, 5%, 60% for autologous HSCT. Outcome depended on indication, donor type, stem cell source and age of patient. HSCT is an established therapy in Switzerland. These data describe current practice and outcome.

Adolescent↗
PubMed2006

Educational inequalities in life expectancy in German speaking part of Switzerland 1990-1997: Swiss National Cohort.

STUDY OBJECTIVE: Switzerland belongs to the group of nations with the highest life expectancy. However, it is unclear to what extent life expectancy varies across socio-economic groups. We used data from a large longitudinal study to quantify differentials in life expectancy across educational groups for men and women of different ages. DESIGN: The Swiss National Cohort linked the records from the December 4th, 1990 census with death certificate data up to 1997, using a probabilistic record linkage method. The current analysis was restricted to Swiss nationals resident in the German speaking part of the country. Life expectancy was calculated for four educational categories ("compulsory schooling or less", "vocational training", "upper secondary education", "university education") by constructing abridged life tables for men and women aged 30 or older. RESULTS: The study was based on 3.06 million persons and 262,552 deaths recorded during 19.01 million person-years of follow up. The educational level was lower in women than in men. In most age groups vocational training was the dominant educational category. At ages 30, 50, 65 and 80 men with university education lived 7.1, 5.4, 3.5 and 1.6 years longer than their counterparts with compulsory education or less. In women the corresponding differences were 3.6, 3.1, 2.7 and 2.2 years. CONCLUSIONS: In Switzerland educational gradients in life expectancy are substantial, particularly among young and middle-aged men. Social policies and public health strategies should address this situation.

Adult↗
PubMed2006

Primary care in Switzerland--no longer attractive for young physicians?

BACKGROUND AND OBJECTIVES: A trend away from primary care (PC) to other specialties has been noted in Switzerland, as well as in the health-care systems of many other Western countries. The objective of the present study was to ascertain how many third-year residents graduating in 2001/02 from medical schools in German-speaking Switzerland wanted to become PC physicians (PCPs), whether this career goal was continuously followed, and how many subjects switched to or away from PC during residency. METHODS: Data reported are from the third assessment of the longitudinal Swiss physicians' career development study, begun in 2001. In 2005, at the third assessment, 515 residents (53.8% females, 46.2% males) were asked what specialty qualifications and career goals they aspired to. In addition, participants' socio-demographic, personality, and career-related characteristics as well as their life goals were addressed. RESULTS: Of n = 515 (total sample) third-year residents, 81 had not yet decided on the medical field in which they wished to specialise, while 434 had made this decision. Of the latter, only 42 (9.7%) aspired to become PCPs. Twelve of the 42 future PCPs consistently mentioned PC as a career goal from graduation throughout residency. The other 30 subjects only decided on PC during the course of their residencies. A switch away from PC was also noted in the case of 19 subjects who on graduation or after the first year of residency aspired to become PCPs, but abandoned this goal after three years of residency. Future PCPs differ from those pursuing other specialties in terms of personal and career-related characteristics, as well as in their life goals, insofar as they are less career-orientated and regard having more time outside work a priority. There are few gender-based differences between female and male future PCPs. CONCLUSION: Primary care seems to hold little attraction as a career goal for young physicians. Residency experiences would seem to have more of an effect on choice of specialty than teaching experiences during medical school. The percentage of subjects qualifying in PC is far too low to fill the need for the future generation of PCPs. In addition to efforts to incorporate PC issues into medical school curricula, structured residency programs should be established to promote PC.

Adult↗
PubMed2002

Notoedric and sarcoptic mange in free-ranging lynx from Switzerland.

Between March and December 1999, five free-ranging lynx (Lynx lynx) affected by mange were found dead or shot by game wardens in the Swiss Alps. In the first two cases, Notoedres cati was isolated from the skin; in the third and fourth case, Sarcoptes scabiei was the cause of the infection; and in the fifth case, a mixed infection was diagnosed. Red foxes (Vulpes vulpes) affected with sarcoptic mange and domestic cats infested with N. cati are likely to be the sources of infection. It seems improbable that mange will occur as an epidemic in lynx in Switzerland, but losses due to infections with N. cati and/or S. scabiei may have an impact on this small, geographically limited lynx population. This is the first report of notoedric mange in a free-ranging lynx and the first report of mange in lynx from Switzerland.

Animals↗
PubMed1976

[The relative therapeutic value of drugs in international comparison: differences between Switzerland and Canada].

In Switzerland the relative therapeutic value of various drugs (e.g. pyrazolone analgesics, phenacetin, clindamycine, clioquinol) is placed demonstrably higher than in Canada. In Canada, rare but possibly dangerous complications of drug therapy are considered to be of greater importance. Two factors might be responsible for these differences: 1. Compared with similar publications in Canada, drug advertisements in Swiss medical journals contain fewer warnings of untoward effects. This can be interpreted as an "information lag". 2. Since the link between an untoward effect and a drug is very difficult to establish with absolute certainty, it may be concluded that the drug is relatively inoffensive. This conclusion is drawn more often in Switzerland than in Canada. Uniformization of the way in which the physician is presented with information concerning untoward drug effects would be an important step towards the establishment of internationally accepted standards of drug therapeutic value.

Analgesics↗
PubMed1999

[Polyomavirus infections in exotic birds in Switzerland].

Polyomavirus infections in budgerigars, in other parrots as well as in passeriformes have been described in many countries, but not in Switzerland so far. This paper reports on cases of polyomavirus infections in three different bird collections in Switzerland. The first outbreak occurred in a mixed collection of passeriformes, the second in a collection of parrotlets (Genus Forpus), and the third in a large groups of parrots (Psittaciformes), of which only one recently acquired Kea (Nestor notabilis) was affected. The clinical symptoms, gross necropsy changes and histopathologic findings are described. The presence of avian polyomavirus was confirmed by the polymerase chain reaction (PCR).

Animals↗
PubMed1999

[UV exposure in Switzerland: time- and topography-associated factors important for the skin].

The intensity of UV-A and UV-B-radiation in Switzerland shows big differences that result from the various altitudes, the season and the time of the day. Additionally the intensity of UV-radiation is influenced by other factors like aerosols, cloudiness and ozone. In higher altitudes there is an additional enhancement by reflection of snow. The most important consequences of the UV-radiation for the population are, however, relevant in spring and summer time during the bathing season and during the late winter season for ski tourists. On a day with a clear sky in summer the UV-radiation can reach maximum values for UV-A of 45 W/m2 and for UV-B of 0.175 W/m2. The ratio of UV-A/UV-B shows an annual course with a maximum in winter of about 500 and a minimum of about 220 in summer. The possible effects on health by extensive UV-exposition are photoageing, skin cancer, inflammation processes and cataract. In Switzerland about 5000 new melanoma cases in men and about 4000 in women occur per year. In contrast to other environmental factors like pollen UV-radiation has the big advantage that the personal exposition can be controlled. Therefore, it is very essential that the general rules of a judicious behaviour such as avoiding the sun at noon, always wearing a hat, shirt and trousers as well as sunglasses with UV-filter are often reiterated.

Female↗
PubMed1999

[The relationship between intensive care medicine and pneumology in Switzerland. The situation in 1998].

We describe the relationships in Switzerland between two medical specialties, critical, or intensive, care and the respiratory medicine. To date, there are only few direct relationships between these medical fields, and very rarely a respirologist becomes the head of a critical, or an intensive care unit. There are two main reasons explaining this situation. First, internal medicine, or general internal medicine, is still a strong specialty in Switzerland, and the patients are frequently under the direct responsibility of an internist, whereas the pneumologists remain consultants. Second, intensive care medicine is a full specialty, distinct from anaesthesiology, with a strong structure. However, things are moving, and the general tendency now is to reduce the total number of beds in the Swiss hospitals, and to open some specialised wards under the direct supervision of specialists, including pneumologists. Nevetherless, due to the small size of the country and the important number of decentralised hospital structures, specialised intensive care units, as respiratory intensive care units, are unlikely to be open in the future.

Cardiopulmonary Resuscitation↗
PubMed1999

[Chlamydia abortion in sheep: possibilities for serological diagnosis using a competitive ELISA and insight into the epidemiologic situation in Switzerland].

466 sheep sera out of 19 flocks in Switzerland were examined by a competitive enzyme linked immunosorbent assay (cELISA) for antibodies against Chlamydia psittaci "serotype 1" ("ovine enzootic abortion"). Since numerous positive reactors were found in flocks without abortion history, 30 fecal samples out of two of these flocks were examined by PCR for evidence of chlamydial DNA. One of these samples turned out to contain DNA of Chlamydia psittaci "serotype 1". These results suggest, that in Switzerland "serotype 1" of Chlamydia psittaci is widespread not only as cause of chlamydial abortion but also as latent intestinal infection in sheep. The resulting difficulties for serological diagnosis of chlamydial abortion and possible solutions based on the cELISA are discussed. The complement fixation test (CFT), still considered as standard method for serological examination for Chlamydiae, has additionally been applied.

Abortion, Veterinary↗
PubMed2000

Prevalence of Helicobacter pylori and hepatitis C virus infections among non-Hodgkin's lymphoma patients in Southern Switzerland.

BACKGROUND AND OBJECTIVE: Several recent studies have reported a high rate of previous hepatitis C virus (HCV) infection in patients with non-Hodgkin's lymphoma (NHL). However, it appears that there are marked geographical differences in the prevalence of HCV among NHL patients. There is further controversy concerning a possible pathogenetic link between HCV and certain histologic lymphoma subtypes, in particular MALT lymphomas, and it has recently been speculated that HCV might be involved in the multistep process of gastric lymphoma genesis, in addition to the well established role of chronic Helicobacter pylori infection. The aim of this study was to investigate the prevalence of HCV and H. pylori infections in patients with B-cell NHL in Southern Switzerland. DESIGN AND METHODS: One hundred and eighty newly diagnosed HIV-negative B-cell NHL patients, consecutively seen at a referral oncology center in Southern Switzerland between 1990 and 1995 were prospectively studied. A microparticle enzyme immunoassay was used to detect antibodies to HCV. Serologic determination of HCV genotype was done by the Murex method. The quantitative detection of IgG anti-H. pylori was performed by the Biorad GAP test. RESULTS: Infection with HCV was detected in 17/180 patients (9.4%; 95% C.I., 6%-15%). This prevalence is significantly higher than that observed in a large survey of 5424 new blood donors from the same area tested in 1992-97 (0.9%; 95% C.I., 0.7-1.2). Neither histologic subtypes nor specific extranodal presentations of NHL were associated with a higher prevalence of HCV. HCV serotype 2 (corresponding to genotypes 2a-c) was the most common. HCV infection was significantly associated with a shorter progression-free survival at both univariate and multivariate analysis. Anti-Helicobacter antibodies were detected in 81/180 patients (45%; 95% C.I., 38%-53%) and H. pylori infection was significantly associated with the development of primary lymphomas of the stomach. INTERPRETATION AND CONCLUSIONS: A high prevalence of HCV infection was detected in NHL lymphoma patients and was associated with a shorter time to lymphoma progression. HCV infection was not correlated with primary gastric presentation or with MALT-type histology. Our findings further support the key role of H.pylori infection in the pathogenesis of primary gastric lymphoma of MALT-type. The possible role of HCV in the pathogenesis of NHL should be further investigated.

Aged↗
PubMed2000

[Herpes simplex virus type 1 and 2 in Switzerland].

A worldwide increase in the incidence of genital herpes infections has been described in recent years. Transmission of the herpes simplex virus type 2 (HSV-2) by asymptomatic seropositive subjects is considered to be a relevant mode of infection. The seroprevalence of HSV-2 varies considerably between different populations. In Europe, data are scarce and the epidemiological situation in Switzerland is unknown. In 1997 we performed serological examinations in 151 adult volunteers (87% between 20 and 49 years of age) of a low-risk population from the region of Basel with no history of genital herpes or any other sexually transmitted disease. The overall seroprevalence of HSV-1 was 77% and an annual seroconversion rate of 4.6% (95% CI: 3.8-5.6) was estimated for both sexes. Of the 51 subjects with no symptoms of orolabial herpes, 25 (49%) proved to be HSV-1 seropositive. In contrast, of 91 patients with symptoms of orolabial herpes, 90 (97%) had serum antibodies against HSV-1. The seroprevalence of HSV-2 was 14.6% for women (n = 89) and 8.1% for men (n = 62). The annual seroconversion rate was estimated to be 0.61% (95% CI: 0.14-1.4) for women and 0.49% (95% CI: 0.09-1.4) for men for the period after 1985 (when "safer sex" and the use of condoms were promoted). Our results indicate the significance of herpes simplex virus type 2 infections in Switzerland. More detailed studies are needed to describe the epidemiology of HSV-2 infections more reliably, especially in view of progress in the development of vaccines against HSV infections.

Adult↗
PubMed2000

Hereditary hyperferritinaemia cataract syndrome: does it exist in Switzerland?

Recent research in iron metabolism has revealed the existence of iron-responding elements in the 5'UTR of the mRNA of ferritin. Binding of these structures with iron-regulatory proteins regulates ferritin synthesis within the cell, according to the intracellular iron level. Several mutations of the iron-responding elements located at the 5'UTR of the L-ferritin subunit, which lead to the hereditary hyperferritinaemia cataract syndrome, an autosomal dominant hereditary disease, have been described. Patients with congenital bilateral nuclear cataract present high serum ferritin (360-2264 micrograms/l) in the absence of iron overload. The purpose of our study was to look for this syndrome in Switzerland and in particular in the Geneva population. About 3000 cases of cataract operated on during a 4-year period (1995-1998) in the University Clinic of Ophthalmology were screened. We found 135 patients operated on before the age of 51 years. However, only 19 had bilateral nuclear cataract. 15 patients agreed to undergo iron screening. In 2 of them, a slight elevation of ferritin (267 micrograms/l in a female, 416 micrograms/l in a male) was found in the absence of iron overload. In both cases there is a positive family history of cataract. DNA sequencing analysis in these patients showed a normal nucleotide sequence of the whole iron-responding elements region. One of them (male) was found to present the codon 63 mutation at HFE gene in the heterozygous state. Our local study indicates that hereditary hyperferritinaemia cataract syndrome is extremely rare in Switzerland. However, similar studies should be carried out in other regions of the country. Iron status evaluation and ferritin level monitoring should become routine examinations in all new cases presenting with bilateral nuclear cataract before the age of 50 years.

5' Untranslated Regions↗
PubMed2000

[Distribution of antigen types of canine parvovirus in Switzerland, Austria and Germany].

In this study the distribution of the various antigenic types of canine parvovirus in Switzerland, Austria, and Germany was investigated. From 14 samples from Switzerland, 35 samples from Austria, and 82 samples from Germany exclusively the new antigenic types CPV-2a and CPV-2b were isolated. Most of these isolates had a Ser-Val mutation at amino acid 297, which was shown to be prevalent in recent CPV isolates from various parts of the world. These findings are discussed with regard to the use of modified live virus vaccines.

Animals↗
PubMed2000

[Epidemiology of chronic hepatitis B and C among dialysis patients in Switzerland].

BACKGROUND: Among patients with renal insufficiency undergoing chronic dialysis treatment, chronic hepatitis due to infection with viruses of the hepatitis B (HBV) or hepatitis C (HCV) type represents a serious medical problem. In contrast to other countries, detailed statistics on the prevalence of HBV and HCV infection are not available for dialysed patients in Switzerland. METHODS: The present study is based on a nationwide survey among the Swiss dialysis population which evaluated the prevalence of patients positive for either the HBs antigen (reflecting HBV infection) or anti-HCV antibodies (reflecting HCV infection) in 1999. From our survey we collected data on 1713 haemodialysis and 226 peritoneal dialysis patients, representing 92 and 65% of the respective dialysis populations in Switzerland. RESULTS: Of all patients (haemodialysis and peritoneal dialysis), 6.59% were HBV or HCV marker positive (HBV: 1.44%, HCV: 5.05%). In haemodialysis patients the prevalence was clearly higher for HBV (1.63%) and HCV (5.72%) compared to patients undergoing peritoneal dialysis (0.88 and 3.09% respectively). Laboratory parameters of hepatitis--as evidenced by an increase in liver transaminases--were present in 4% of the entire dialysis cohort, 0.6% having an increase in ALAT beyond 1.5 times the normal range. Patients undergoing treatment in haemodialysis units which do not implement additional precautions to prevent the spread of HCV among patients were more likely to be HCV marker positive with laboratory signs of hepatitis. A similar correlation was observed between HBV or HCV marker positivity and the number of patients treated per haemodialysis unit. Finally, the percentage of HBV/HCV marker positive patients on the Swiss kidney transplant list is comparable with that of HBV/HCV marker positive patients in the entire dialysis population.

Hepatitis B Surface Antigens↗
PubMed2000

Haematopoietic stem cell transplant activity in Switzerland 1997/1998: a report by the STABMT. Swisstransplant Working Group Blood and Marrow Transplantation.

Data on haematopoietic stem cell transplants done in Switzerland in 1997 and 1998 are reported. A total number of 532 autologous and 150 allogeneic procedures were performed during this period. Detailed information on indications, use of transplant technology and short-term outcome is provided. These data reflect the current use of haematopoietic stem cell transplantation in Switzerland and may be used for patient counselling and health care planning.

Adolescent↗
PubMed2000

[Rabies-free status of Switzerland following 30 years of rabies in foxes].

The European fox rabies epizootic starting in 1939 at the eastern border of Poland reached Switzerland on March 3, 1967. Rabies spread over large parts of the country until 1977, the year it caused three human deaths. In 1978 the first field trial world-wide for the oral immunization of foxes against rabies was conducted in Switzerland. Initially, the expansion of the vaccination area led to a rapid reduction in rabies cases. However, the 1990s were characterized by a recrudescence of rabies in spite of regular oral immunization of foxes. The last endemic case of rabies was diagnosed in 1996 after an adaptation of the vaccination strategy. A total of 17,109 rabies cases, of which 73% in foxes and 14% in domestic animals were diagnosed, leading to an estimated number of some 25,000 postexposure treatments in humans. To eliminate rabies, a total of 2.8 million baits containing a modified live virus were distributed--mostly by hand--in the field.

Animals↗
PubMed2000

[The development of rabies in Switzerland--landscape determines the spread of a wildlife epidemic].

The rabies epidemic that reached Switzerland in 1967 developed in response to landscape factors as long as no efficient control strategies were available. The landscape acted either as barrier to the spread of rabies, or it influenced the density of red foxes and thus the habitat of the epidemic. Following the first cases in the canton of Schaffhausen, the whole northwestern Switzerland was infected followed by the eastern Alps, large parts of the Plateau and the Jura mountains. In 1978, in the canton of Valais, the first campaigns of oral immunization of foxes against rabies started. The design of vaccination campaigns during the next two decades was always closely linked to landscape features. Thus, it was possible to free first the Alps and then the Plateau from rabies and finally, at the end of the 1990s, to eliminate it completely within the country. We describe the entire development of the epidemic within the period of 30 years from the first infection up to the last registered case and the final vaccination campaign.

Animals↗
PubMed2000

[Medical treatment of heart failure: an analysis of actual treatment practices in outpatients in Switzerland. The Swiss "IMPROVEMENT of HF" Group].

BACKGROUND: From several studies in Europe and the USA there is evidence that drug treatment of patients with congestive heart failure (CHF) could be improved. There are only sparse data on the treatment of this population in Switzerland. METHODS: In the context of a European Study (IMPROVEMENT of HF Study), in 1999, the treatment of 474 patients with symptomatic CHF was recorded by chart review with primary care physicians throughout Switzerland. The effect of potential predictors of drug treatment was tested using multivariate logistic regression. RESULTS: Mean age of the study population was 75 +/- 12 years. Overall, angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) were prescribed to 65% of the study population. Beta-blockers, loop diuretics/thiazides, spironolactone and digitalis were prescribed to 25%, 73%, 13% and 31% respectively. Compared with CHF patients < 65 years of age, the odds ratio of ACE-I/ARB prescription in patients aged 65-74, 75-84, and > or = 85 years was 0.80, 0.58 and 0.40 respectively (p < 0.001). The respective odds ratios for beta blocker treatment were 0.37, 0.21 and 0.06 (p < 0.001). In addition, NYHA classification, comorbid conditions such as renal failure and contraindications strongly predicted drug prescription. Gender and geographical area were not associated with drug selection. CONCLUSIONS: Overall drug prescription among CHF patients in Swiss primary care appears to be satisfactory. However, prescription of ACE-I/ARB and beta-blockers falls steeply with increasing age, independent of measured comorbid conditions and contraindications. Thus, improvement of treatment should focus on a more consistent use of these drugs in the segment of elderly CHF patients.

Adrenergic beta-Antagonists↗