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PubMed1988

X-linked lymphoproliferative syndrome. Identification of a large family in Switzerland.

Observation of a patient with acquired hypogammaglobulinemia associated with a mononucleosis syndrome led to the identification of one of the largest families affected by the X-linked lymphoproliferative (XLP) syndrome in the world. It is the first such family identified in Switzerland and the largest in Europe. At least nine male subjects over two generations presented phenotypic expressions consistent with the XLP syndrome. Study of the pedigree extending over seven generations suggests that the mutation occurred in the proband's great-grandmother. In the next generation, a second mutation of the X chromosome in one branch of the family resulted in expression of hemophilia A in the children. This remarkably large family, comprising six living obligate female carriers, displays a wide spectrum of the XLP syndrome and offers valuable information for future genetic linkage studies and for genetic counseling.

Adult↗

PubMed1987

Sero-epidemiological survey for alveolar echinococcosis (by Em2-ELISA) of blood donors in an endemic area of Switzerland.

Sera from 17,166 blood donors living in 10 cantons of northern Switzerland in an area endemic for Echinococcus multilocularis were investigated by serological survey for alveolar echinococcosis (AE). A highly species-specific antigen (Em2) and a commonly used E. granulosus hydatid fluid antigen (EgHF) were compared for their suitability in seroepidemiology. EgHF showed a degree of nonspecificity which did not allow direct detection of AE cases. Antibody reaction with Em2 resulted in the detection of 2 asymptomatic clinical cases of AE (seroprevalence 0.01%) within this population of blood donors. A further 4 persons were positive in Em2-ELISA. These 4 persons had negative imaging studies and will be followed serologically and clinically.

Adult↗

PubMed1985

Community-based primary prevention of cardiovascular disease in Switzerland: methods and results of the National Research Program (NRP 1A).

The National Research Program 1A on Primary Prevention of Cardiovascular Disease in Switzerland was designed to determine whether community health education can reduce cardiovascular risk factors in whole population groups. Two towns (12,000 inhabitants each) in the French-speaking and two (16,000 inhabitants each) in the German-speaking part of the country were selected for either intervention or comparison. Following baseline screening in 1977 (stratified random samples) and the community intervention program (1978-1980), a final assessment on the initial participants was made at the end of 1980. In intervention towns, 26.2% of the regular smokers quit during this period compared with 18.1% in the reference towns. In addition, a significant net increase in the proportion of hypertensive patients under effective control was observed. A reduction in cholesterol levels was noted in both the intervention and the reference towns, with no difference between them. However, cholesterol levels in a subgroup of women participating in program activities as compared with those not participating were significantly reduced. The program, with extensive involvement of a diversity of community groups, has enjoyed continued support, even after the end of the research experience, thus demonstrating the viability and acceptability of community-oriented preventive action.

Blood Pressure↗

PubMed1988

Trends in smoking and lung cancer mortality in Switzerland.

Patterns of cigarette smoking in Switzerland were analyzed on the basis of sales data (available since 1924) and national health surveys conducted in the last decade. There was a steady and substantial increase in cigarettes sales up to the early 1970s. Thereafter, the curve tended to level off around an average value of 3,000 cigarettes per adult per year. According to the 1981-1983 National Health Survey, 37% of Swiss men were current smokers, 25% were ex-smokers, and 39% were never smokers. Corresponding porportions in women were 22, 11, and 67%. Among men, smoking prevalence was higher in lower social classes, and some moderate decline was apparent from survey data over the period 1975-1981 mostly in later middle-age. Trends in lung cancer death certification rates over the period 1950-1984 were analyzed using standard cross-sectional methods and a log-linear Poisson model to isolate the effects of age, birth cohort, and year of death. Mortality from lung cancer increased substantially among Swiss men between the early 1950s and the late 1970s, and levelled off (around a value of 70/100,000 men) thereafter. Among women, there has been a steady upward trend which started in the mid-1960s, and continues to climb steadily, although lung cancer mortality is still considerably lower in absolute terms (around 8/100,000 women) than in several North European countries or in North America. Cohort analyses indicate that the peak rates in men were reached by the generation born around 1910 and mortality stabilized for subsequent generations up to the 1930 birth cohort. Among females, marked increases were observed in each subsequent birth cohort. This pattern of trends is consistent with available information on smoking prevalence in successive generations, showing a peak among men for the 1910 cohort, but steady upward trends among females. Over the period 1980-1984, about 90% of lung cancer deaths among Swiss men and about 40% of those among women could be attributed to smoking (overall proportion, 85%).

Adult↗

PubMed1993

Distribution of mesophilic Aeromonas species in raw and ready-to-eat fish and meat products in Switzerland.

A total of 829 poultry, meat, shellfish and fish products commonly consumed in Switzerland were qualitatively and quantitatively examined for the presence of mesophilic Aeromonas spp. Overall, aeromonads occurred in 24.1% of the samples. Raw food products were frequently contaminated (e.g. 94.1% in minced meat), with colony counts up to 6.0 x 10(6)/g. Some ready-to-eat products had a relatively high percentage of positive samples as well, such as cooked ham in slices (38.2%), mortadella (12.9%), smoked cooked sausage (15.6%), hot and cold smoked fish (10.9-14.3%) and gravad salmon (10.5%). Colony counts, however, were somewhat lower (up to 1.7 x 10(3)/g). The high contamination rate of cooked or hot smoked foods suggests recontamination after cooking or smoking, e.g., at the slicing and packaging stage. 61.2% of the identified strains were Aeromonas hydrophila, followed by 22.5% Aeromonas caviae and 16.3% Aeromonas sobria.

Aeromonas↗

PubMed1991

Identification of conserved and variable regions in the envelope glycoprotein sequences of two feline immunodeficiency viruses isolated in Zurich, Switzerland.

The nucleotide sequences of the envelope (env) coding regions of two strains of the feline immunodeficiency virus isolated in Zurich, Switzerland (FIVZ1, FIVZ2) have been analysed. In addition, the complete sequence of the FIVZ1 isolate has been determined. Comparisons have been made with the previously published sequences of three North American isolates (PPR and the Petaluma strains FIV34TF10 and FIV14). The isolate FIVZ1 was very similar to the Petaluma strains of FIV and may represent a clonal derivative acquired by 'contamination'. Overall there are between 2.6% and 15.1% amino acid changes in the env gene products of the five isolates. Of the Zurich isolates, FIVZ2 exhibited the greatest divergence to the other viruses and based on its genotype, phenotype and origins probably represents a new isolate of FIV. Possibly the viruses diverged only recently from a common ancestor. Some 31 of the 33 cysteine residues and 17 of the 21 potential N-linked glycosylation sites of the FIV34TF10 env gene product were conserved among all five isolates. The open reading frame 3 (ORF3, or D) which overlaps the env gene (but is encoded in a different frame) has an ATG codon downstream of a potential splice acceptor site in all five isolates, supporting the view that it encodes a viral gene product. In ORF3 of FIVZ1 a stop codon was located 16 amino acids upstream of the stop codon of ORF3 of the other isolates. The ORF4 (or G) of isolate FIVZ2, thought to be the second coding exon of an FIV rev-like gene, contained a nucleotide deletion in amino acid 45 of ORF4, resulting in a--1 frameshift at this position. Comparison of the LTR sequences of the five isolates identified conserved promoter/enhancer elements. A potential stem-loop structure was identified in the R region of the LTRs of all the isolates, despite the heterogeneity of nucleotide sequences in that region. Such structures (TAR) are present in analogous regions of other lentiviruses and are responsible for tat-mediated trans-activation.

Amino Acid Sequence↗

PubMed1986

The assessment of medical technologist. Examples from Switzerland.

The need for assessment of new medical technologies has recently become evident in many countries, especially for the people responsible for health care policy. There are multiple reasons for making evaluation: rising costs in health care, medical efficacy, safety, as well as social and political issues. Each stage of life of a diagnostic, therapeutic or preventive technology, from its emergence to obsolescence, can be assessed by an appropriate procedure. In Switzerland, a country with decentralized health care as well as political systems, the assessment is made by various institutions. Evaluative aspects are included in some National Research Foundation programs. Most work, however, is done by the division of medical techniques at the Swiss Hospital Institute. The panel of experts has recently prepared a report on magnetic resonance imaging (MRI). As a result of the initial evaluation, the need for this new technology in this country, and the number and sites of MRI systems for the next few years were established. The capital, running and unitary costs of this diagnostic procedure were estimated. The report will be of aid to the people planning investments and dealing with questions of reimbursement and other issues of health care policy. The methods of epidemiology, biostatistics, sociology and health economics used by the institutes of social and preventive medicine are very helpful in the procedures of technology assessment.

Government Agencies↗

PubMed1986

Medical care and social support for the elderly in Switzerland: imbalance and mix.

Medicalization refers to the current practice of providing medical solutions to broad social problems facing the old. This approach is destined to bring about serious economic and sociocultural dilemmas in the coming decades due to the aging trends in Switzerland. On the one hand, additional bed requirements will double, really jeopardizing the present federal savings policy on health and welfare. On the other side, ignoring the specific needs of nearly 20% of the population (as the 65 and over age group are expected to reach in the year 2010), will provoke unwielding social/political tensions. Assigning medical answers to social needs is both expensive and inadequate. This proposition is illustrated by two aspects of Geneva's medical care system for the aged: At the University Geriatric Hospital a large proportion of the patients are admitted for purely social reasons ('home maintenance impossible'). The long term bed stays, medically unjustified, constrains the optimal functioning of this acute care and rehabilitation hospital. The prolonged length of institutionalization reduces the capacity of the elderly out-patients to carry on autonomously. This observation is confirmed by many Swiss medical and sociological surveys which reveal that institutionalization is rarely necessary or desirable in the 10 to 20 first years of post-retirement provided there is an adequate system of social and primary care services available. The drug prescription to those 65 and over consulting at the out-patient department of the Geneva University Medical Policlinic typically amounts to excessive prescription for women and especially of psychoactive drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1989

Coronary arteriography rates in Switzerland--how do they vary?

Coronary heart disease is a leading cause of death for both sexes in developed countries. Controversy has arisen about the health benefits and risks of coronary surgery and, more recently of coronary angioplasty. As a clinical prerequisite to these interventions, coronary arteriography can be considered an indicator of invasive services offered to coronary heart disease patients. We collected data on characteristics of all patients subjected to coronary arteriography during 1984 in Switzerland. A total of 4921 coronary arteriographies were performed among 4359 patients; this corresponds to 77 procedures/100,000 residents and 68 patients/100,000 residents. Rates for men are 4.2 times women's rates, and the highest utilization rate for both sexes are observed in the group aged 40-64. Large variations characterize cantonal and regional coronary arteriography rates. Similarly, the distribution of centers practising this procedure is not uniform. These observations are placed in the context of the general practice of coronary angiography, changes expected in the face of by-pass surgery and angioplasty expansion, and coronary heart disease data.

Adult↗

PubMed1993

Evaluation of AIDS prevention among homosexual and bisexual men in Switzerland.

Attitudinal and behavioural change among gay men in Switzerland was measured between 1987 and 1990 to evaluate the effectiveness of AIDS prevention activities. The methodology used included a self-administered questionnaire published in Swiss gay magazines and distributed by gay organizations (N = 795 in 1987, N = 720 in 1990) and in-depth interviews with men recruited through advertisements and through the questionnaire (N = 42 in 1987, N = 24 in 1990). The two independent sampling procedures yielded similar samples with regard to socio-demographic characteristics, allowing comparisons to be made between the 1987 and 1990 data. Personal confrontation with AIDS (knowing someone who is HIV-positive, or who is ill or dead from AIDS) increased significantly during the period but more adequate ways of coping developed. Behavioural change towards safer sex began well before the first study. The majority of responding homosexuals have adapted their sexual behaviour to the new situation created by AIDS and generally maintain a protective behaviour. However, "exceptions" (condom rupture or episodes of non-protection) are not infrequent and should deserve more attention. Three indicators of sexual behaviour (number of sexual partners, anal sex and use of condom and oral sex with ejaculation), reported for the last 3 months before each study, exhibit few changes between 1987 and 1990: number of partners remained stable, unprotected oral sex decreased. Anal sex slightly increased, the use of condoms remaining stable. Sixty-seven percent of the sample knew their serostatus in 1990 (57% in 1987), and 13% of these stated that they were HIV+ (14% in 1987).

Acquired Immunodeficiency Syndrome↗

PubMed1994

Epidemiological data and costs of burn injuries in workers in Switzerland: an argument for immediate treatment in burn centres.

A complete statistical evaluation of epidemiological data and costs of burn injuries in 1984 with a follow-up for 5 years is presented, considering a collective of 1.77 million workers in Switzerland. The majority of burns are minor injuries; only about 5 per cent of the burn victims are admitted to a hospital, 0.2 per cent died. Burn injuries at work are rare, mainly owing to strict safety measures. Only one-fifth of the costs caused by burns are due to medical treatment. All other expenses result from continuation of payments of salaries and annuities. The treatment of the few severely burned patients in burn units produces effective costs which are higher than the tariff paid by the insurance. Even so, the predominant portion of the enormous costs is taken up by wages while off work and annuities. As our conclusion we stress the importance of primary care for all severe burns including all burns of the hands in a specialized centre. Any economic effort for primary burn treatment, however high it may be, is justified if the duration of rehabilitation and invalidity can be reduced.

Accidents, Occupational↗

PubMed1991

Dehydration in dying patients: study with physicians in French-speaking Switzerland.

We surveyed physicians in French-speaking Switzerland to assess the perception of suffering resulting from dehydration and its relation to the clinical choice between oral and artificial hydration. A questionnaire describing hypothetical cases of dehydration in an elderly terminal cancer patient in different clinical situations (conscious, demented, comatose) was sent to 978 physicians. The physicians were asked to assess the discomfort due to dehydration and the treatment they would propose in order to correct this situation (oral or artificial hydration). The return rate was 41%. The results show that there is no consensus with respect to the assessment of suffering (it gets a "low" score from 33% of replies and a "high" score from 41% of replies) or of thirst ("low": 30%, "high": 43%). Only 28% of the replies indicated artificial hydration for conscious patients while 44% chose this treatment for comatose patients. Physicians choosing artificial hydration were significantly more prone to consider suffering and thirst as "serious" than those preferring hydration by mouth. It can be concluded that two thirds of the physicians who responded think that artificial hydration is not the best way to respond to dehydration in dying patients. The choice depends partly on the assessment of the suffering and thirst resulting from terminal dehydration.

Attitude of Health Personnel↗

PubMed1992

Linkage of death certification of AIDS and cancer registration in Vaud, Switzerland.

58 death certifications (40 males and 18 females) of residents of the Canton of Vaud (Switzerland) which reported AIDS as the cause of death in 1986-1989 were matched with the list of incident cancers available since 1974 from the Vaud Cancer Registry. Such linkage was successful for 20 individuals (age range 25-63, median 37), mostly males (18/20), homosexual or bisexual (11/18) and affected by Kaposi's sarcoma (14 males and 1 female). Other identified neoplasms included one Burkitt's lymphoma, one prostate adenocarcinoma and one multiple myeloma (whose histological picture included, however, lymphocytosis in addition to plasmocytosis). Three additional malignancies (one undifferentiated skin cancer, one carcinoma of the salivary glands and one in situ cervical carcinoma), and one myelodysplastic syndrome had also been diagnosed from 1 to 2 years before AIDS death. Cancer was mentioned on the death certificate, in addition to AIDS, in only 2 cases. Albeit of limited size, the present report confirms that a systematic integration of AIDS and cancer registration statistics provides additional information, of particular interest for histological classification, on the AIDS-cancer relationship.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Concentrations and specific loads of polycyclic musks in sewage sludge originating from a monitoring network in Switzerland.

Polycyclic musks (HHCB, AHTN, ADBI, AHDI, ATII) and a metabolite of HHCB (HHCB-lactone) were analyzed in sewage sludge samples within the framework of a monitoring network in Switzerland. Mean values in stabilised sludge from 16 wastewater treatment plants were 20.3 mg/kg d.m. for HHCB, 7.3 mg/kg d.m. for AHTN and 1.8 mg/kg d.m. for HHCB-lactone, respectively. Contents of ADBI, AHDI and ATII were between 0.1 and 1.8 g/kg d.m. The results show that polycyclic musks origin mainly from private households and that loads from craft industry, industry and atmospheric deposition are negligible. The technology of wastewater treatment and sludge processing seems to be of minor importance for degradation processes of polycyclic musks. The calculated input in wastewater of polycyclic musks is lower by a factor of 5-7 than the estimates based on use volumes. This discrepancy might be explained by degradation processes, other emission pathways than wastewater or inappropriate estimation of production volumes.

Environmental Monitoring↗

PubMed2005

Concentrations and specific loads of UV filters in sewage sludge originating from a monitoring network in Switzerland.

Many substances related to human activities end up in wastewater and accumulate in sewage sludge. The present study focuses on the analysis of widely used UV filters 3-(4-methylbenzylidene) camphor (4-MBC), octyl-methoxycinnamate (OMC), octocrylene (OC) and octyl-triazone (OT) in sewage sludge originating from a monitoring network in Switzerland. Mean concentrations in stabilised sludge from 14 wastewater treatment plants were 1780, 110, 4840 and 5510 microg/kg dry matter for 4-MBC, OMC, OC and OT, respectively. Specific loads in sewage sludge show that UV filters originate mainly from private households, but surface runoff and industries may be considered as additional sources. This indicates that besides use for sunscreens and cosmetics UV filters might occur in plastics and other materials and be released to the environment by volatilization or leaching. Differences between the modeled per capita loads of UV filters in sewage sludge and the observed specific loads in sewage sludge are probably due to erroneous figures of production volumes, degradation and sorption during wastewater treatment as well as degradation processes during transport in the sewer or sludge treatment. Thus, further research is needed to elucidate the fate of UV filters after application and release into the environment. Other compounds used as UV filters should be included in future studies.

Acrylates↗

PubMed2007

Persistent organic pollutants, brominated flame retardants and synthetic musks in fish from remote alpine lakes in Switzerland.

Remote alpine lakes do not receive any direct aquatic inputs from anthropogenic activities. Therefore, these ecosystems may receive persistent organic compounds (POPs) by direct atmospheric deposition, only. Consequently, fish dwelling in these ecosystems represent an excellent indicator for the long-term atmospheric input of bioaccumulating and persistent contaminants. In the present study, fish from seven remote alpine lakes, located between 2062 and 2637 m above sea level in south eastern Switzerland (Grisons), were investigated. Lipid-based fish tissue concentrations of pesticides including dichlorodiphenyltrichloroethane (DDT) and its transformation products (2,4'-DDT, 4,4'-DDT, 2,4'-dichlorodiphenyldichloroethane (DDD), 4,4'-DDD, 2,4'-dichlorodiphenyldichloroethene (DDE), 4,4'-DDE), as well as dieldrin, heptachlor exo-epoxide (HPEX), hexachlorobenzene (HCB), hexachlorocyclohexanes (HCH), polychlorinated biphenyls (PCB), polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/F), and polybrominated diphenyl ethers (PBDE) were measured. In addition, seven synthetic musk compounds (Crysolide (ADBI), Phantolide (AHMI), Fixolide (AHTN), Traseolide (ATII), Galaxolide (HHCB), musk ketone (MK), and musk xylene (MX)) were determined. Concentrations of PCB, PCDD/F, and PBDE were in the same range as in fish from the major lakes situated in the Swiss plateau, indicating mainly atmospheric input of these persistent compounds. In contrast, concentrations of synthetic musks which are used as fragrances in laundry detergents and cosmetic products were distinctly lower than concentrations in fish from Swiss plateau lakes which receive inputs from waste water treatment plants.

Animals↗

PubMed2005

An European survey of structure and organisation of nutrition support teams in Germany, Austria and Switzerland.

BACKGROUND & AIMS: Nutritional support teams (NST) have been demonstrated to be an excellent mechanism for identifying patients in need of nutrition support, improving the efficacy of nutrition support in a variety of hospital environments. Focus of this study was the investigation of function, structure and organisation of NST in Germany (D), Austria (A) and Switzerland (CH). METHODS: Prospective investigation of the function, structure and organisation of NST in D, A and CH, using standardised questionnaires. RESULTS: From a total of 3071 hospitals in D, A and CH, NST have been established at 98 hospitals (3.2%). Their main activities were creating nutritional regimes (100%), education (87%) and monitoring nutrition therapy (92%). In general, the NST are not independently operating units but are affiliated to a special discipline. Seventy-one per cent of the physicians, 40% of the nurses and 69% of the dieticians in the NST held a nutrition-specific additional qualification. A total of 12% of the physicians, 37% of the nurses and 46% of the dieticians are exclusively responsible for the NST. A reduction of complications (88%) and cost saving (98%) were indicated since their establishment. The NST received in 32% funding support. CONCLUSION: In D, A, CH neither a uniform nor comprehensive patient care by NST existed in 2004. Standards of practice, development of guidelines in clinical nutrition and better documentation in NSTs are necessary. Special efforts should be aimed at education of NST members and financing of teams.

Austria↗

PubMed2006

Substance use disorder treatment programs in Switzerland and the USA: Program characteristics and 1-year outcomes.

AIM: This study compared matched samples of substance use disorder (SUD) patients in Swiss and United States (US) residential treatment programs and examined the relationship of program characteristics to patients' substance use and psychosocial functioning at a 1-year follow-up. DESIGN AND SETTING: The study used a prospective, naturalistic design and a sample of 10 public programs in the German-speaking part of Switzerland and 15 US public treatment programs. PARTICIPANTS: A total of 358 male patients in Swiss programs were matched on age, marital status and education with 358 male patients in US programs. A total of 160 Swiss and 329 US patient care staff members also participated. MEASUREMENT: Patients completed comparable inventories at admission, discharge and 1-year follow-up to assess their substance use and psychological functioning and receipt of continuing care. Staff members reported on program characteristics and their beliefs about substance use. FINDINGS: Compared to Swiss patients, US patients had more severe substance use and psychological problems at intake and although they did not differ on abstinence and remission at follow-up, had somewhat poorer outcomes in other areas of functioning. Swiss programs were longer and included more individual treatment sessions; US programs included more group sessions and were more oriented toward a disease model of treatment. Overall, length of program, treatment intensity and 12-step orientation were associated with better 1-year outcomes for patients in both Swiss and US programs. CONCLUSIONS: The sample of Swiss and US programs studied here differed in patient and treatment characteristics; however, in general, there were comparable associations between program characteristics and patients' 1-year outcomes. These findings suggest that associations between treatment processes and patients' outcomes may generalize from one cultural context to another.

Adult↗