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PubMed1996

[Serious plant poisonings in Switzerland 1966-1994. Case analysis from the Swiss Toxicology Information Center].

AIM: To analyze the types, frequency and severity of plant poisonings in Switzerland over 29 years. METHODS: Retrospective analysis of severe poisonings with toxic plants reported to the Swiss Toxicological Information Center (STIC). Assessment of the causality, severity of symptoms and the types of plants involved. RESULTS: During the period under review the STIC registered 24 950 cases of contact with or ingestion of toxic plant material. In 99.4% of all cases the clinical course was either unknown, asymptomatic or associated with only minor symptoms (no hospitalization). Severe plant poisonings occurred in 152 cases. Detailed analysis was possible in 135 cases (23 children, 112 adults) including 5 lethal cases (all adults). The 24 plants involved produced the following severe symptoms: Atropa belladonna (42 cases): anticholinergic syndrome (42), acute psychosis (33), convulsions (2), coma (2). Heracleum mantegazzianum (18): severe photodermatitis (18). Datura stramonium (17): anticholinergic syndrome (17), psychosis (12), coma (2). Dieffenbachia (11): severe stomatitis (8), corneal lesions (3). Colchicum autumnala (10): diarrhea (10), liver necrosis (9), fatal multiorgan failure (2). Veratrum album (8): bradycardia ( < or = 40/min) (6), shock (5). Aconitum napellus (4): tachyarrhythmia (2), AV-block II/III (2). Aesculus hippocastanum (3): allergy (3), anaphylactic shock (2). Hyoscyamus niger (3): anticholinergic syndrome (3). Ricinus communis (3): diarrhea (3), toxic megacolon (1). Oenanthe crocata (2): convulsions (1), lethal coma (1). Taxus baccata (2): tachyarrhythmia (1), fatal asystole (1). Further single cases with severe poisonings were observed with Arum maculatum, Asarum europaeum, Chrysanthemum vulgare, Cyclamen persicum, Datura suaveolens, Glycyrrhiza glabra, Laburnum anagyroides, Lycopodium, Narcissus pseudonarcissus (lethal aspiration), Nerium oleander, Senecio vulgaris and Vicia faba. CONCLUSIONS: Potential and real intoxications with plant materials occurred in 7.2% of all cases registered at the STIC. However, among all plant cases only 0.6% were severe intoxications requiring hospitalization. Although severe plant intoxications are rare events, a small number of specific plants appear to be mainly responsible for continued serious plant poisoning in Switzerland. The present study has identified the plants with the highest toxicological risks and provides a data base for more rational prevention, diagnosis and treatment of plant poisoning cases in the future.

Adult↗
PubMed1996

Surveillance of influenza in Switzerland between 1987 and 1995.

During 8 years of continuous influenza surveillance in Switzerland (1987 to 1995), influenza A viruses predominated during 5 seasons and influenza B viruses during 3. The most severe outbreaks occurred in the 1988/89 season (A/H1N1 subtype), in the 1989/90 season (A/H3N2 subtype) and in the 1994/95 season (simultaneous outbreak of influenza A/H3N2 and B). From 1987 to 1993, peak activity of influenza A viruses was observed during December and January (for 8 weeks on average) while influenza B viruses were most active between February and March (ordinarily for 6 weeks). During the 1994/95 season, however, simultaneously increased activity of both influenza A/H3N2 and B viruses was observed, peaking at the end of March and lasting for about 9 weeks. The variants predominant in Switzerland largely corresponded antigenically to those isolated elsewhere in Europe, but a delay of one year was often observed. New strains detected at the end of a season (herald viruses) made it possible to forecast the type or subtype of virus which would predominate the next season. Isolation rates for A/H3N2 viruses were significantly higher in the 10-19 years and 60-plus age groups, whereas there was no statistical difference between age groups for A/H1N1 viruses. A decreasing isolation rate, corresponding to increasing age, was found for influenza B viruses. Increased mortality was observed in patients over 65 during the period of high influenza A/H3N2 activity, as was especially evident during the 1989/90 season.

Adolescent↗
PubMed1996

[Systems for monitoring animal health in Switzerland].

Due to the changing conditions of animal production in Switzerland the demand for scientifically based animal health information has increased during the last years. It has become a central element in animal health policy making. National animal health surveillance systems include methods for data collection, analyses, interpretation and information distribution. The current Swiss surveillance systems are presented. In the future, these systems should be more integrated in order to make better use of the available data. The project "Systems for the recording of animal health in Switzerland" (SysET) is a proposal how a comprehensive animal data base could be developed.

Animal Husbandry↗
PubMed1997

[Attack of black flies (Diptera, Simuliidae) on horses in Basel (Switzerland)].

In April 1996 an attack of black flies (Diptera, Simuliidae) to horses was observed in the region of Basle, Switzerland. Females of Simulium erythrocephalum and Simulium ornatum were involved in this attack, part of them had taken a blood meal. For S. ornatum this is the first record in Switzerland that this species takes blood meals on horses.

Animals↗
PubMed1998

[Estimation of the efficacy of three strains of mumps vaccines during an epidemic of mumps in the Geneva canton (Switzerland)].

BACKGROUND: The number of mumps cases reported in Switzerland markedly increased from 1993 to 1995 although vaccination coverage against mumps had risen steadily since the national MMR immunization program was launched in 1987. In 1991, an estimated 80% of children 27 to 36 month-old were immunized against mumps. The purpose of the present study was to assess the hypothesis that the epidemic was the consequence of a low vaccine efficacy of the Rubini strain--a mumps vaccine strain that has been widely used in Switzerland. METHODS: Vaccine efficacy was assessed by measuring secondary attack rates among immunized and nonimmunized children 16 year-old or younger who wre family contacts of cases. RESULTS: From February 1993 to April 1996, Geneva pediatricians reported 283 primary cases of mumps and 63 secondary cases. Estimate of vaccine efficacy was equal to 6.3% (95% CI: -45.9; 39.8) for the Rubini strain, as compared to 73.1% (95% CI: 41.8; 87.6) for the Urabe Am 9 strain, and 61.6% (95% CI: 0.0; 85.4) for the Jeryl Lynn strain, two vaccine strains of mumps that had also been used in Geneva. CONCLUSION: Our study supports the hypothesis that the Rubini vaccine strain of mumps does not confer sufficient long-lasting protection against mumps.

Adolescent↗
PubMed1998

[Autoimmune hepatitis in Switzerland].

The incidence and course of autoimmune hepatitis in Switzerland are unknown. In an attempt to obtain an overview of all patients at present under treatment in Switzerland for autoimmune hepatitis, we circulated a questionnaire to all Swiss gastroenterologists. Eighteen patients were identified and their symptoms, course and treatment were evaluated. The majority were females, usually without liver cirrhosis at the time of diagnosis. The course of the disease was largely favourable.

Adult↗
PubMed1998

[Characteristics of attenders of low threshold syringe-exchange centers providing sterile syringes in Switzerland].

BACKGROUND: The objectives of the present study were to evaluate Aids prevention in drug users attending low threshold centres providing sterile injection equipment in Switzerland, to identify the characteristics of these users, and to monitor the progress of indicators of drug-related harm. METHODS: This paper presents results from a cross-sectional survey carried out in 1994. RESULTS: The mean age of attenders was 28 years, and women represented 27% of the sample. 75% of attenders used a combination of hard drugs (heroin and cocaine). Mean duration of heroin consumption was 8 years, and of cocaine 7 years; 76% of attenders had a fixed abode, but only 34% had stable employment; 45% were being treated with methadone; 9% had shared their injection material in the last 6 months; 24% always used condoms in the case of a stable relationship, and 71% in casual relationships. In a cluster analysis constructed on the basis of multiple correspondence analysis, two distinct profiles of users emerge: highly marginalised users with a high level of consumption (21%); irregular users, better integrated socially, of which the majority are under methadone treatment (79%). CONCLUSION: Theses centres play a major role in Aids prevention. Nevertheless, efforts to improve the hygiene conditions of drug injection in Switzerland should be pursued and extended. At the same time, prevention of HIV sexual transmissions should be reinforced.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Accidents related to sleepiness: review of medical causes and prevention with special reference to Switzerland.

Sleepiness is a major cause of traffic accidents. Our purpose was to review determinants of accidents related to sleepiness and measures to prevent them. We performed a systematic literature review on the topic and studied official accident statistics and legislation regarding medical driving ability in Switzerland. In 1997, 79,178 road traffic accidents, each causing bodily injury or property damage in excess of 500 Swiss francs, occurred in Switzerland. According to official statistics, sleepiness accounted for only 1% of identified causes. However, scientific studies performed in other countries suggest that sleepiness is a contributing factor in up to 30% of traffic accidents. Causes of hypersomnolence are sleep restriction, sleep disturbance by external environmental factors, inappropriate sleep hygiene, and sleep disorders. Several reports suggest an increased crash rate in patients with obstructive sleep apnoea syndrome. At our clinic, every sixth sleep apnoea patient reports sleepiness-related driving problems which resulted in traffic accidents in one third of them. Long monotonous motorway drives, late night, early morning and late afternoon hours are associated with an increased crash rate. Drivers with excessive sleepiness should not drive until the cause of hypersomnolence is determined and treated appropriately. Medical assessment of driving ability in patients with sleep disorders involves a specific history including standardised questionnaires, sleep studies and vigilance tests. Swiss legislation authorizes physicians to report sleepy drivers to the authorities if they are thought to represent an accident risk for themselves or others. We conclude that sleepiness is a common but under-recognised cause of traffic accidents. Enhancing awareness of the problem in the public, early recognition and treatment of sleep disorders, and counselling of drivers with excessive sleepiness may contribute to prevention.

Accident Prevention↗
PubMed1998

[The role of local health departments in reducing inequalities in health in Switzerland].

Examples from Switzerland: In Switzerland, as in other countries, several studies have demonstrated social inequality in health. The aim of this study is to demonstrate practical approaches to reducing these differences, as they offer themselves on the local level, and to analyse the implications for the functioning of local departments of Public Health. Case studies, mainly from the health department of the city of Bern, are used to demonstrate measures taken 1. to identify and correct unmet needs of the socially disadvantaged disabled elderly; 2. to find children from marginal groups who failed to be immunised before entering school age, and to arrange for them to be immunised; and 3. to include psychosocial measures when routine school health examinations have led to observations of a biomedical nature. Recent difficulties are pointed out which developed in this connection as a consequence of the privatisation of traditional Public Health functions. The examples show that considerable effort is needed if local health departments attempting to correct social inequalities try to solve individual problem cases. The task is often multidisciplinary. It involves other administrative sectors such as education, social services and housing construction, and is greatly influenced by measures taken on the Federal or Cantonal (Federal Provincial) level. Whereas demonstrating social inequalities through periodic health reporting can be seen as belonging to the traditional activities of health departments, eliminating or reducing the inequalities not only requires a far-reaching re-orientation of local Public Health services, but also a re-definition of the job description and training of Public Health physicians; and as this process continues, it appears that health departments in Continental Europe will increasingly be led to adopt approaches developed previously by Public Health departments in Anglo-Saxon countries.

Community Health Services↗
PubMed2006

Responders and non-responders in a study on medical end-of-life decisions in Denmark, the Netherlands, Sweden and Switzerland.

OBJECTIVES: To determine the direction and magnitude of participation bias in end-of-life research. METHODS: Within the framework of a European survey on medical end-of-life decisions, a non-response study was conducted among physicians in Denmark, the Netherlands, Sweden and Switzerland. People were asked about their attitudes and experiences in the area of medial end-of-life decision. The response rates ranged from 12.8% (Netherlands) to 39.4% (Switzerland). The responders (n = 5403) and the non-responders (n = 866) were compared regarding socio-demographic characteristics, experiences with terminal patients and agreement with attitudes towards "end-of-life decisions". The reasons for non-participation to the study were analyzed. RESULTS: Non-response did not cause socio-demographic distortion, but non-responders had statistically significantly fewer terminal patients than responders. Agreement rates were statistically significantly higher among responders than among non-responders for euthanasia, non-treatment decision and life-preserving statements. Neutral answers were statistically significantly more frequent among non-responders than among responders for life-preserving and euthanasia statements. The most commonly mentioned reason for non-participation was "lack of time". CONCLUSION: Non-participation does cause an overestimation of proponents of life-shortening, as well as of life-preserving end-of-life decisions. Non-responders more often have ambiguous attitudes towards end-of-life decisions than responders.

Adult↗
PubMed2002

Age and gender in the management of HIV-relevant sexual risks: theoretical background and first results of a population survey in the German speaking part of Switzerland.

OBJECTIVES: Health related lifestyles can be seen as resources for preventive behaviour in HIV-relevant situations. A concept was developed to analyse the management of HIV-relevant sexual risks and to uncover patterns of sexual lifestyles. In this paper first descriptive results will be presented focusing on gender and age. METHODS: 2,275 men and women between the ages of 19 and 65 from the German speaking part of Switzerland were interviewed in a computer-assisted telephone survey. Data were collected concerning attitudes, behaviours and resources, situational aspects and communication with regard to health and sexuality. Particularly, respondents were asked whether within the past 24 months they had had either first sexual contacts with new partners or casual sex, two forms of contacts which have special HIV relevance. RESULTS: 527 men and women reported having had first or casual sexual contacts. First results show a substantial lack of condom use among persons of both sexes in the age group older than 45. In general men showed more risk behaviour than women. CONCLUSIONS: For the first time in Switzerland, detailed data were collected from persons older than 45 years regarding sexual risk behaviour. Older, sexually active people are a vulnerable target group which has been neglected thus far in terms of research and preventive measures.

Adult↗
PubMed2006

Antimicrobial resistance of Yersinia enterocolitica strains from human patients, pigs and retail pork in Switzerland.

To obtain basic data for future resistance monitoring programs, 386 Yersinia enterocolitica strains from human patients, raw retail pork and pig feces were tested for their susceptibilities to 16 antimicrobial agents and two antimicrobial growth promoters (carbadox and olaquindox). No strains were resistant to ceftriaxone, cefuroxime, ciprofloxacine, gentamicin, kanamycin, neomycin or polymyxin. Although in Switzerland carbadox and olaquindox were used as growth promoters for pigs for over 25 years, all strains were susceptible to them. In contrast, there were high levels of resistance to ampicillin, cefalothin and amoxicillin/clavulanic acid. Less than 10% of clinical isolates and strains from pig feces were resistant to streptomycin, sulfonamide, trimethoprim/sulfamethoxazole, tetracyclin, trimethoprim and chloramphenicol, but strains from retail pork were all susceptible to these antimicrobial agents. This finding suggested that pork is probably not a major source of Y. enterocolitica that cause human infections in Switzerland. A difference between clinical isolates and strains from pork was also shown by serotyping. Clinical isolates frequently belonged to the O3 and O9 groups whereas these two serotypes were not found in strains from pork. Resistance to multiple antimicrobial agents was rare. When examined by pulsed field gel electrophoresis (PFGE), two strains of fecal origin with an identical pattern of resistance to six antimicrobial agents were shown to be unrelated. Of four clinical isolates with resistances to five antimicrobial agents, two were of the same pulsotype. Retrospectively, it was found that these strains came from two members of the same household and thus represented a mini-outbreak.

Animals↗
PubMed2004

Good outcomes of Lyme arthritis in 24 patients in an endemic area of Switzerland.

OBJECTIVE: To describe outcomes of treated Lyme arthritis in an endemic area of western Switzerland, where some of the first cases of Lyme disease outside the United States were reported. PATIENTS AND METHODS: We retrospectively studied 24 patients (15 males and nine females, mean age 38.7 years) managed by rheumatologists between 1994 and 1999 for Borrelia burgdorferi arthritis manifesting as monoarthritis (n = 20), oligoarthritis (n = 3), or polyarthritis (n = 1). The knee was affected in 20 (85%) patients. Nine patients reported a history of tick bite and four of erythema chronicum migrans. All the patients but one had a high titer of antibodies to B. burgdorferi by ELISA and all but two had a positive immunoblot test (22 positive for all three types of B. burgdorferi found in Switzerland and one positive only for B. burgdorferi sensu stricto). Joint fluid PCR for B. burgdorferi was done in nine patients and was positive in six. RESULTS: All 24 patients received antibiotic therapy, orally (n = 10) or parenterally (n = 14). A second course of antibiotic therapy was used in four patients with persistent arthritis. A rapid response was noted in 13 patients. Intraarticular glucocorticoid therapy or a synoviorthesis was required in nine patients. After a mean follow-up of 40 months (range, 6-84 months), none of the patients had chronic arthritis but two reported persistent muscle or joint pain. CONCLUSION: Recurrent or chronic arthritis, which has been reported in treated patients in the United States, did not occur in our series. This may be ascribable to differences in B. burgdorferi subtypes, as in the United States only B. burgdorferi sensu stricto is found.

Adolescent↗
PubMed2006

Peri-operative morbidity and changes in symptom scores after transurethral prostatectomy in Switzerland: results of an independent assessment of outcome.

OBJECTIVES: To assess, in a prospective study, the contemporary outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) in Switzerland, by evaluating peri-operative morbidity and changes in lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: Between January 2000 and January 2005, 11 hospitals in Switzerland participated in the study. The hospitals were required to inform Verein Outcome (VO), an independent institution specialising in outcome measurements in the Swiss healthcare system, about patients with BPH who were scheduled for TURP. Later, the hospitals provided data on peri-operative complications in these patients. The patients' Danish Prostate Symptom Score (DAN-PSS) was obtained by VO before and 4 months after TURP (via mailed questionnaires). RESULTS: Data on peri-operative complications from 1014 patients were included in this analysis. The mean (range) age of the patients was 69 (43-91) years. The most common complication after TURP was urinary retention, in 4.5% of the patients; the overall peri-operative complication rate was 9%. In all, 468 patients returned questionnaires both before and after TURP. The mean total DAN-PSS before and 4 months after surgery was 25.2 and 6.2, respectively (P < 0.001). CONCLUSIONS: The results of this prospective multicentre study showed that the current peri-operative morbidity of TURP is lower than that reported from older large-scale trials. The independent assessment of symptom scores confirms that TURP is highly effective in alleviating bothersome LUTS due to BPH.

Adult↗
PubMed1997

Association of distinct species of Borrelia burgdorferi sensu lato with neuroborreliosis in Switzerland.

OBJECTIVE: To evaluate by species-specific immunoblots the association of Borrelia burgdorferi sensu stricto, B. garinii and B. afzelii with neuroborreliosis in Switzerland. METHODS: Borrelia strains isolated from the cerebrospinal fluid (CSF) of three children with neuroborreliosis were typed by phenotypic and genotypic analysis. The serologic reactions (IgG) of these three patients as well as those of 28 patients, including one of these three children, with confirmed neuroborreliosis were characterized and scored by immunoblots on the three individual Borrelia species antigens. Twenty patients with typical erythema migrans served as a control group. RESULTS: Phenotypic and genotypic analysis confirmed that all three CSF isolates were B. garinii. In the 28 patients with neuroborreliosis, the comparatively strongest reactions were as follows: 18 to B. garinii, three to B. burgdorferi sensu stricto and two to B. afzelii; five were inconclusive. In the control group (erythema migrans), the comparatively strongest reactions were as follows: six B. garinii, one to B. burgdorferi sensu stricto and five to B. afzelii; eight were indeterminate. CONCLUSIONS: Typing of these three CSF isolates and characterization by immunoblots of the antibody reactions of patients with neuroborreliosis give additional evidence of the association of B. garinii and neuroborreliosis. Our serologic results suggest that B. burgdorferi sensu stricto and B. afzelii are also responsible for some neuroborreliosis cases in Switzerland. Our immunoblots and the scoring system proved particularly useful for the serologic typing of patients with late Lyme borreliosis.

Journal Article↗
PubMed1993

Cardiac rehabilitation in Switzerland. Efficacy of the residential approach following bypass surgery.

BACKGROUND: The traditional central European approach to cardiac rehabilitation involves sending patients to an idyllic setting, where they reside for a specified period following a cardiac event. Favorable results have been demonstrated using this approach in Germany, but to our knowledge no data have been reported from Switzerland, where these programs tend to be short (4 weeks) and exercise training is concentrated (2 h daily, 6 days per week). METHODS AND RESULTS: Seventeen patients (aged 58 +/- 6 years) who resided in a rehabilitation center for 4 weeks were compared with 11 patients (aged 54 +/- 7 years) given usual community care beginning approximately 6 weeks after coronary artery bypass surgery (CABS). Exercise training consisted of 1 h of group walking twice daily, with the intensity stratified into 4 levels based on clinical status and initial exercise capacity. All patients underwent pulmonary function testing and maximal ramp exercise testing on a cycle ergometer with continuous ventilatory gas exchange and lactate analysis before and after the study period. Patients receiving beta-blockers and those with cardiomyopathy or valvular heart disease were excluded. Medication status was not changed during the study period. Although maximal oxygen uptake increased by approximately 12 percent within both groups, the change was not significant between groups. Analysis of variance demonstrated that mean lactate levels were reduced throughout exercise within both groups (p < 0.001); however, there were no differences between groups. Oxygen uptake at the lactate threshold was not different in either group after the study period. CONCLUSIONS: Similar changes occur in the functional status of post-CABS patients regardless of their participation in the short but concentrated rehabilitation programs common in Switzerland, suggesting that these programs either begin too soon after CABS or are too short to achieve training benefits.

Coronary Artery Bypass↗
PubMed2001

Epidemiological and economical impact of tuberculosis in an adolescent girl in Lausanne (Switzerland).

UNLABELLED: Patients with pulmonary tuberculosis (TB) can infect people in their environment but children and adolescents are rarely contagious. A recent case of an adolescent girl in Lausanne, however, proved to be infectious and required extensive contact tracing. SUBJECTS AND METHODOLOGY: The source case was a 15-years-old adolescent girl of African origin. Upon her arrival in Switzerland in 1994 the tuberculin skin test was 14 mm. The patient did not receive preventive treatment. She developed smear-positive pulmonary tuberculosis in May 1999. Contact tracing identified contacts in the surrounding population. The contact persons were divided into 3 groups according to their proximity. The first group consisted of close family and friends, the second of classmates and teachers and the third of more distant contacts. Costs were also evaluated. RESULTS: Of the 53 people examined, 24 (45%) were infected and required treatment. Eight out of 9 cases (88%) were infected in the first group (including another case of culture-positive pulmonary tuberculosis). Fourteen out of 33 cases (42%) in the second group and 2 of 11 (18%) to the third group. Passing from one proximity group to the next decreased the relative risk of infection 4 fold. The costs of contact tracing and treatment are estimated at over CHF 24,000. CONCLUSIONS: (1) Pulmonary TB can be contagious even in adolescents. (2) Subdividing contacts into proximity groups allows for better targeting of the people to be screened. (3) Contact tracing and the high costs involved could have been avoided if the patient had received preventive chemotherapy upon her arrival in Switzerland.

Adolescent↗
PubMed2004

Consumer-driven health care: lessons from Switzerland.

Switzerland's consumer-driven health care system achieves universal insurance and high quality of care at significantly lower costs than the employer-based US system and without the constrained resources that can characterize government-controlled systems. Unlike other systems in which the choice and most of the funding for health insurance is provided by third parties, such as employers and governments, in the Swiss system, individuals are required to purchase their own health insurance. The positive results achieved by the Swiss system may be attributed to its consumer control, price transparency of the insurance plans, risk adjustment of insurers, and solidarity. However, the constraints the Swiss system places on hospitals and physicians and the paucity of provider quality information may unduly limit its impact. The Swiss health care system holds important lessons, including evidence about its feasibility and equity, for the United States, which is now embarking on its own consumer-driven health care system.

Consumer Behavior↗