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PubMed1998

Eating disorders among female adolescents in Switzerland: prevalence and associations with mental and behavioral disorders.

OBJECTIVES: To measure the prevalence of eating disorders in a national representative sample of adolescent girls and association of eating disorders with other behavioral/mental problems in Switzerland. METHODS: As part of a national health survey, a subsample of 1,084 15 to 20-year-old female students attending school aged filled in a self-administered anonymous questionnaire focusing on eating behavior and body image. Factor analysis made on these specific questions reveals two major dimensions: weight and image concern (WIC) and problematic eating conduct (PEC). The correlates of these two dimensions were measured using bivariate analyses. RESULTS: Among girls, 62% say they want to lose weight, 36% feel too fat, 37% report fasting episodes, 18.9% fear not to be able to stop eating, 9.1% engage in binge eating at least once a week (1.9% daily), 1.6% self-induced vomit at least once a week (0.2% daily). Girls who exhibit high WIC (N = 198) or high PEC (N = 75) scores report significantly more mood problems (p < .05), suicidal conducts (p < .05), or violent and aggressive behaviors (p < .05). No association is found with substance use. Associations with acting-out behavior are stronger among high PEC subjects, whereas those with mood disorders are stronger among high WIC subjects. CONCLUSION: A large proportion of adolescent girls show concerns regarding their weight and body image whereas a less important proportion exhibit dysfunctional eating behavior. The results confirm the associations between eating disorder and mood, suicide, and conduct problems but infirm the association with substance use. Girls who exhibit problematic conducts appear to require more attention from health resources.

Adolescent↗
PubMedDate not supplied

Decentralization and central and regional coordination of health services: the case of Switzerland.

As part of reforms in the health care delivery sector, decentralization is currently promoted in many countries as a means to improve performance and outcomes of national health care systems. Switzerland is an example of a country with a long-standing tradition of decentralized organization for many purposes, including health care delivery. Apart from the few aspects where the responsibility is at the federal level, it is the task of the 26 cantons to organize the provision of health services for the population of around 7 million people. This permits the system to be responsive to local priorities and interest as well as to new developments in medical and public health know-how. However, the increasing and complex difficulties of most health care delivery systems raise questions about the need for mechanisms for coordination at federal level, as well as about the equity and the effectiveness of the decentralized approach. The Swiss case shows that in a strongly decentralized system, health policy and strategy elaboration, as well as coordination mechanisms among the regional components of the system, are very hard to establish. This situation may lead to strong regional inequities in the financing of health care as well as to differences in the distribution of financial, human and material inputs into the health system. The study of the Swiss health system reveals also that, within a decentralized framework, the promotion of cost-effective interventions through a well-balanced approach towards promotional, preventive and curative services, or towards ambulatory and hospital care, is difficult to achieve, as agreements between relatively autonomous regions are difficult to obtain. Therefore, a decentralized system is not necessarily the most equitable and cost-effective way to deliver health care.

Efficiency, Organizational↗
PubMed2006

Survival with trisomy 18--data from Switzerland.

We collected records of 352 cases of trisomy 18 karyotyped between 1964 and May 2003 from the two major cytogenetic laboratories in Northeastern Switzerland. For more detailed information about the cases we contacted the referring physicians and/or the families of the patients. In this way we collected data about survival and malformations of 161 live births, 136 induced abortions and 29 stillborns or spontaneous abortions. In 26 cases of trisomy 18, only incomplete records were available. We observed that each year more cases of trisomy 18 were cytogenetically diagnosed in the two laboratories. Before 1984 almost no prenatal diagnoses were made; however, after this date the number of prenatal diagnoses increased and in the last 10 years, accounted for 75% of all cases. A decrease in the number of postnatally diagnosed cases was also observed over the same period of time. One third of the live-born children with trisomy 18 died during the first day of life. After 1 week, 1 month and 1 year of life the survival rates were 40, 22 and 6%, respectively. The median survival was 4 days, and only 1% of the children survived until their 10th birthday. Females were more likely to survive long term. In 63 cases autopsy reports were available for review. In 97% of these cases three or more malformations were found: 67% had VSD, 32% had horseshoe kidneys, 21% had esophageal atresia, 14% had omphalocele, 14% had facial clefts, and 11% had diaphragmatic hernias. In more than 50% genital hypoplasia was also described. We further analyzed survival of live-borns in relation to the length of gestation and to VSD and esophageal atresia.

Abnormalities, Multiple↗
PubMed2005

Skeletal manifestations of hypothyroidism from Switzerland.

Hypothyroidism is caused by a deficiency in the synthesis of thyroid hormone. Dwarfism is the most obvious skeletal manifestation, but most people with hypothyroidism do not have any skeletal evidence of the disease. When the skeleton is affected, the severity of this manifestation depends on the degree of the deficiency and age of onset. Endemic hypothyroidism typically is linked to specific ecological settings such as the high mountains where iodine is absent, or else it occurs with very low concentrations in water and soil. In these areas, the prevalence may be as high as 8%. The disease can be expected to occur in archaeological human skeletal samples from endemic regions. Sporadic hypothyroidism is caused by a deficiency in the thyroid gland itself, and is not linked to any specific environmental context. The disease may be the result of a genetic defect, but can also be caused by other pathological conditions that may affect the thyroid gland, including infection and cancer. The skeletal abnormalities of the two variants will be indistinguishable in archaeological human remains. In order to identify hypothyroidism in archaeological skeletal samples, one must be aware of the differences in pathological skeletal changes seen in hypothyroidism in comparison with other diseases, such as achondroplasia, that can cause similar abnormalities. Twelve clinically documented cases of hypothyroidism provide data for understanding the skeletal abnormalities associated with this disease. All 12 are modern documented cases from Switzerland, where endemic hypothyroidism occurred in the iodine-deficient Alpine regions. However, at least one case in the sample was caused by a defect in the thyroid gland itself.

Anthropometry↗
PubMed2004

Incidence of severe anorexia nervosa in Switzerland: 40 years of development.

OBJECTIVE: The current study examined the development of the incidence of severe anorexia nervosa with five sampling periods covering the years 1956-1995 in a geographically defined region of Switzerland. METHOD: Applying the same methodology as in the earlier sampling periods, the medical records of all hospitals of the canton of Zurich were screened manually for first-time hospitalizations of female anorexia nervosa patients during the years 1993-1995. Incidence rates were compared with the previous sampling period (1956-1985). RESULTS: The incidence rate of severe anorexia nervosa in the total population and the rate in the population at risk (females 12-25 years old) did not differ significantly from the incidence rates of 1983-1985. DISCUSSION: The incidence of severe anorexia nervosa in the canton of Zurich rose significantly during the 1960s and 1970s. Since then, the incidence appears to have reached a plateau.

Adolescent↗
PubMed2003

n-3 polyunsaturated fatty acid intake and cancer risk in Italy and Switzerland.

Data from a series of case-control studies, conducted in Italy and Switzerland between 1991 and 2001, have been analyzed to evaluate the role of n-3 polyunsaturated fatty acid (PUFA) intake in the etiology of cancer of oral cavity and pharynx (736 cases, 1772 controls), esophagus (395 cases, 1066 controls), large bowel (1394 colon, 886 rectum, 4765 controls), breast (2900 cases, 3122 controls) and ovary (1031 cases, 2411 controls). Controls were patients admitted to hospital for acute, non-neoplastic conditions, unrelated to modifications in diet. The multivariate odds ratios (OR) for the highest quintile of n-3 PUFAs compared to the lowest one were 0.5 for oral and pharyngeal cancer, 0.5 for oesophageal cancer, 0.7 for colon cancer, 0.8 for rectal and breast cancer and 0.6 for ovarian cancer; the estimates and the trends in risk were significant for all cancer sites, excluding rectal and breast cancer. The estimates for an increase in n-3 PUFAs of 1 g/week were 0.70 for oral and pharyngeal cancer, 0.71 for oesophageal, 0.88 for colon, 0.91 for rectal, 0.90 for breast and 0.85 for ovarian cancer. All the estimates were statistically significant, excluding that for rectal cancer, and consistent across strata of age and gender. These results suggest that n-3 PUFAs decrease the risk of several cancers.

Adult↗
PubMed2003

Important increase of invasive lobular breast cancer incidence in Geneva, Switzerland.

A recent paper from the United States reported a sharp and unexplained increase in invasive lobular breast cancer incidence since 1977 (Li et al., Cancer 2000;88:2561-9). We investigated if this trend was also present in Geneva, Switzerland, where breast cancer incidence is one of the highest in Europe. We analyzed trends in breast cancer incidence according to histologic subtype, age and stage, to clarify the pattern. Our population-based study includes all histologically confirmed invasive breast carcinomas (n = 6,247) recorded between 1976 and 1999 at the Geneva Cancer Registry. Breast histology was classified as ductal carcinoma, lobular carcinoma and other. Incidence trends were studied by log-linear regression analyses. Models including effects of age, period and birth cohorts were used to describe rising incidence trends. The incidence of ductal carcinoma increased 1.2% per year (p(trend) < 0.001) from 85.2 to 110.1/100,000. This increase concerned women aged 50-69 years and early-stage tumors. Lobular cancer incidence increased disproportionately (14.4% per year, p(trend) < 0.01) and rose from 2.9 to 20.5/100,000. This increase affected all age categories and both localized and advanced stages. In addition, a strong age-cohort effect was present (p < 0.05), and women aged 50-59 years born after 1944 experienced the most marked increase. Our study shows a disproportionate increase of lobular breast cancer incidence compared to ductal cancer incidence. Contrary to ductal cancer, trends for lobular cancer are unlikely to be explained by increased use of screening mammography. Other explanations must be researched, in particular the role played by hormone replacement therapy.

Aged↗
PubMed1988

Cancer of the larynx/hypopharynx, tobacco and alcohol: IARC international case-control study in Turin and Varese (Italy), Zaragoza and Navarra (Spain), Geneva (Switzerland) and Calvados (France).

A case-control study on larynx and hypopharynx cancer was carried out in 6 populations including the city of Turin and the province of Varese (Italy), the provinces of Navarra and Zaragoza (Spain), the canton of Geneva (Switzerland), and the département of Calvados (France). This report presents an analysis of the risk associated with alcohol and tobacco consumption based on 1,147 male cases and 3,057 male population controls. Special attention was given to the study of the risk at various sites of larynx and hypopharynx. The effect of tobacco is similar for all sites and the risk associated with ever smoking is on the order of 10. The risks from alcohol drinking depend on site. They are similar for epilarynx and hypopharynx (RR = 4.3, for more than 80 g/day) and lower for endolarynx (RR = 2.1, for more than 80 g/day). For all sites the risk decreases after quitting (RR = 0.3 after 10 years); exclusive use of filter cigarettes is protective (RR = 0.5 relative to smokers of plain cigarettes only) as is exclusive use of blond tobacco (RR = 0.5 relative to smokers of black tobacco only). Inhalation increases the risk of endolaryngeal cancer but not that of hypopharynx or epilarynx. The relative risks for joint exposure to alcohol and tobacco are consistent with a multiplicative model.

Adult↗
PubMed1988

HTLV-1 in Switzerland: low prevalence of specific antibodies in HIV risk groups, high prevalence of cross-reactive antibodies in normal blood donors.

Sera from various Swiss population groups were tested for antibodies against the human T-cell leukemia virus type I (HTLV-I). Particle agglutination and ELISA were performed for screening; Western blot was done for confirmation. True-positive sera were found at a prevalence of 0.12% in a cohort of 846 individuals at risk for AIDS tested in 1984-1985. Prevalences of 0.35% were found among 575 HIV-I positives tested in 1987, and of 1.3% among 292 HIV-I positives of a different group tested in 1988. The 6 positives found in our study represent the first cases of HTLV-I infection, or HIV-I/HTLV-I double infection, diagnosed in Switzerland. In addition, high proportions of sera, regardless of whether they were from normal blood donors, HIV-positives, or individuals at risk for AIDS, had antibodies that reacted weakly with one or several proteins of the size of viral gag proteins. The prevalence of such antibodies in normal donors was in the range of 10 to 40%, depending on the strictness of interpretation. Competition Western blots performed with some of these sera showed that these antibodies reacted with HTLV-I, but not with HIV-I or cellular antigens, and had a lower affinity to HTLV-I proteins than the antibodies of human or goat antisera. The results indicate that these antibodies may be induced by agents immunologically related to, but different from, HTLV-I, which are highly prevalent in the Swiss population. Oligopeptide stretches with sequence homology to HTLV-I are known to exist in various normal body proteins, several infectious agents including common viruses and protozoa, but the results might also indicate the existence of additional human retroviruses. Screening of blood donors with sensitive tests for antibodies to HTLV-I might produce an unacceptably high rate of false-positive results, if stringent rules of interpretation analogous to those common in HIV screening are not used.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Cancer incidence and mortality among teenagers in Vaud, Switzerland, 1974-1992.

Data from the Vaud Cancer Registry, Switzerland, were used to analyse incidence and mortality from cancer in teenagers (aged 10 to 19 years) over the period 1974-1992. A total of 113 males and 87 females were registered. Of these, 23% were lymphomas, 16% leukaemias, about 15% central nervous system neoplasms, 10% germ cell tumours and bone neoplasms and 8% soft tissue sarcomas. The overall incidence rate (age-adjusted, world standard population) for all cancers combined was 167 per million boys and 128 per million girls. In both sexes, there was some indication of rising trends over time, to reach 196 per million males and 141 per million females in 1986-1992. The only types of cancer showing consistent upward trends in both sexes were lymphomas. A total of 53 cancer deaths were certified, due to leukaemias in about 40% of cases in both sexes and to lymphomas and brain tumours in 15%-20%. The overall mortality rate at age 10-19 years (age-standardised, world standard) was 47 per million boys and 31 per million girls, and no trend in mortality was observed over time. The 2 main findings of our analysis are (i) the absence of major trends in cancer incidence in adolescents, with the sole exception of a possible increasing incidence of lymphomas, and (ii) the lack of appreciable trends in mortality, in view of the declines in cancer mortality observed in children and young adults over the same calendar period.

Adolescent↗
PubMed1995

Cancer incidence and mortality in young adults in Vaud, Switzerland, 1974-1992.

Trends in cancer incidence and mortality in young adults (aged 20 to 44 years) over the period 1974-1992 were analyzed using data from the Vaud Cancer Registry, Switzerland. A total of 1,497 cancers were registered in males, after excluding non melanomatous skin cancers. The most common neoplasms were testis, lymphomas, lung, skin melanoma and oral cavity and pharynx. The overall age-standardized (world population) incidence was 750 per million males, and increased from 676 in 1974-1979 to 808 in 1986-1992. These upward trends were due mainly to cancers of the oral cavity and pharynx, lung, skin melanoma and colorectum, while testicular cancer rates remained stable. For females, a total of 1,899 malignant neoplasms was notified, corresponding to an overall age-standardized incidence of 914 per million. The overall rate increased from 818 in 1974-1979 to 1,003 in 1986-1992. The most frequent neoplasms were breast, skin melanoma, ovary, thyroid and lymphomas. The major types of cancer responsible for these upward trends were breast cancer, skin melanoma and lung cancer. In the period studied there were 458 cancer deaths in males and 408 in females, corresponding to an overall age-standardized rate of 227 per million males and 193 per million females. Death rates in males tended to decline, to reach 194 per million in 1986-1992, but no consistent trend was observed in females. The decline in males was essentially due to the fall in rates for testicular cancer and Hodgkin's disease. In females, falls in death rates were observed for cancer of the cervix uteri, ovary and Hodgkin's disease. Death rates were upwards for lung cancer in both sexes, and for skin melanoma and breast cancer in females.

Adult↗
PubMed2004

Prevalence of human T-cell leukemia virus types I and II in Switzerland.

The retroviruses human immunodeficiency virus (HIV)-1/2 and human T-cell leukemia virus (HTLV)-I/II share modes of transmission, suggesting that efforts to monitor the current HIV-1 epidemic in Switzerland should be complemented by assessment of HTLV-I/II prevalence. This study presents an updated evaluation of HTLV-I/II infection among groups within the Swiss population polarized towards either low or increased risk of infection. Archived serum and peripheral blood mononuclear cell (PBMC) samples were examined for evidence of HTLV-I/II infection by enzyme-linked immunosorbant assay (ELISA), type-specific Western blot, type-specific polymerase chain reaction (PCR), DNA sequence analysis, and virus culture. Among blood donations obtained from low-risk Swiss donors, we report a complete lack of HTLV-II infection and the occurrence of HTLV-I infection limited to a prevalence of 0.079 per 100,000 (1/1,266,466). Among high-risk HIV-positive persons and HIV-negative persons at increased risk of HIV-infection, we report a focus of HTLV-I and HTLV-II infection at prevalence rates of 62 per 100,000 (1/1,620) and 309 per 100,000 (5/1,620), respectively. The finding of low HTLV-I/II prevalence among Swiss blood donors and containment of HTLV-I/II infection within known risk-groups does not support initiation of HTLV-I/II screening for Swiss blood, tissue, and organ donations.

Blood Donors↗
PubMed1995

Childhood NHL in Switzerland: incidence and survival of 120 study and 42 non-study patients.

Based on the Swiss Pediatric Oncology Group (SPOG) cancer registry data during 1981-1991, a high average incidence of 8 new NHL per million children younger than 15 years per year was found. Of 162 children with NHL registered in 1976-1991, 120 were study patients, i.e., officially registered and treated according to SPOG or Pediatric Oncology Group (POG) protocols, while 42 were non-study patients, i.e., patients not officially enrolled on protocols. Overall, 91 of 120 (76%) study patients remained alive. Seventy-nine study patients were treated according to older SPOG protocols, and 53 (67%) of these survived, while 38 of 41 (93%) study patients treated according to newer POG protocols remained alive (P = 0.0068). Only 22 (52%) of the 42 non-study patients survived (P = 0.0001). There was no improvement if the survival of non-study patients before and since 1986 was compared. Population-based treatment results in Switzerland were similar to those in the United Kingdom. They provided an important base for the development of future treatment strategies.

Adolescent↗
PubMed2000

Biotechnology in Switzerland and a glance at Germany.

The roots of biotechnology go back to classic fermentation processes, which starting from spontaneous reactions were developed by simple means. The discovery of antibiotics made contamination-free bioprocess engineering indispensable, which led to a further step in technology development. On-line analytics and the use of computers were the basis of automation and the increase in quality. On both sides of the Atlantic, molecular biology emerged at the same time, which gave genetic engineering in medicine, agriculture, industry and environment new opportunities. The story of this new advanced technology in Switzerland, with a quick glance at Germany, is followed back to the post-war years. The growth of research and teaching and the foundation of the European Federation of Biotechnology (EFB) are dealt with. The promising phase of the 1960s and 1970s soon had to give way to a restrictive policy of insecurity and anxiousness, which, today, manifests itself in the rather insignificant contributions of many European countries to the new sciences of genomics, proteomics and bioinformatics, as well as in the resistance to the use of transgenic agricultural crops and their products in foods.

Agriculture↗
PubMed1992

Renal retransplantation in Switzerland: poor HLA matching of first and subsequent allografts does not appear to affect overall graft survival.

In Switzerland graft survival after primary renal transplantation can be considered as satisfactory, although our current policy does not favour HLA compatibility except for acute rejectors or sensitized patients. This low level of HLA matching could result in increased sensitization and affect subsequent graft survival. A total of 318 non-primary renal transplants were performed in 293 recipients during the period 1981-1990. Of these, 271 were second transplants, 40 were third transplants and seven were fourth or fifth transplants. Survival rates at 1, 2 and 5 years were 75%, 68% and 60% for second grafts, and 72%, 60% and 54% for third grafts, respectively. Results after multiple grafts were poor, but our experience was limited. The number of sensitized patients (peak PRA > 50%) awaiting retransplantation slightly increased (51 to 69), but decreased as a proportion (72% to 66%). Our policy of relying only marginally on HLA compatibility does not appear to have affected our results adversely.

Actuarial Analysis↗
PubMed1992

Research and hospital ethics committees in Switzerland.

This paper presents the situation concerning research and hospital ethics committees (HEC) in Switzerland. In fact, HECs are almost nonexistent. All the so-called "Ethics Committees" deal with the review of research projects. As there is no legislation governing research on human subjects, the Swiss Academy of Medical Sciences (SAMS) has issued guidelines concerning research on human subjects and, more recently, guidelines concerning Research Ethics Committees (REC). There is a wide disparity in the composition and the functioning of these committees, however. Half of them belong to university hospitals. Six of them review two-thirds of all reviewed protocols. Many RECs function more as educational bodies to enhance the quality of submitted protocols than as committees having the task to control and prohibit particular research projects.

Advisory Committees↗
PubMed1984

[Role of drugs in traffic accidents. A pilot study of traffic accident offenders in Switzerland (Bern region)].

Toxicological analyses of blood and/or urine specimens collected between 1980 and 1981 revealed that 34.7% of all traffic accident victims (n = 144) had measurable concentrations of drugs. Analyses of blood samples taken from traffic offenders (n = 250) in 1979, on the other hand, showed 22.4% to have consumed drugs with or without alcohol. This percentage is comparable with values reported in other studies. Our results indicate that the widespread use of drugs represents a hazard for traffic safety in Switzerland. Road safety is additionally jeopardized by the often concomitant consumption of alcohol.

Accidents, Traffic↗
PubMed1995

Supportive and palliative care of cancer patients at the Kantonsspital St. Gallen, Switzerland.

In 1991, the first unit for oncology palliative care within an oncology centre in the country was opened in St. Gallen, Switzerland. The main admission criterion is symptom distress due to advanced cancer disease. The mean duration of hospitalisation was 23 days in 140 patients in 1994. Approximately one third of the patients die within the unit, while one third can be discharged for home care. The aims and strategies of interdisciplinary palliative care are described. The need for the 11-bed unit is documented by its high occupancy, by patient satisfaction and by its influence on palliative care development in and outside the country.

Cancer Care Facilities↗