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PubMed2000

Cancer survival rates and GDP expenditure on health: a comparison of England and Wales and the USA, Denmark, Netherlands, Finland, France, Germany, Italy, Spain and Switzerland in the 1990s.

Health funding is central to public health planning and clinical practice, hence this comparison of GDP health expenditure and five year post-diagnostic cancer survival rates of England and Wales with the USA and eight European countries. The three lowest proportional GDP health expenditures over the period 1980-1990 were Denmark, England and Wales, and Spain. The USA had the highest proportional GDP expenditure, followed by France, Germany, and The Netherlands. Overall the USA had the best cancer survival rates in the 14 sites reviewed, followed by Switzerland, The Netherlands, and Germany. The least successful were Spain, England and Wales, and Italy. In respect to the high incidence cancers, colorectal, lung, and female breast cancers, England and Wales survival rates were the poorest of all ten countries, followed by Denmark and Spain. Higher GDP health expenditure and longer survival rates for each gender were significantly correlated indicating a possible association between fiscal input and clinical outcomes, which poses problems for the development of effective public health.

Denmark↗
PubMed2003

Temporal and local trends of PCDD/F levels in cow's milk in Switzerland.

Levels of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/F) were determined in 30 Swiss cow's milk samples collected at dairy farms in the vicinity to point sources, in rural/alpine areas distant to known sources, and from tanks in large industrial milk processing plants. The contaminant concentrations in samples collected in 2001 were compared to data from analyses conducted in 1984 and 1990/1991 at the same sites. In 2001, the PCDD/F levels in milk from farms near point sources (0.63+/-0.26 ng I-TEQ/kg milk fat) are slightly but significantly higher in than milk from remote areas (0.36+/-0.09 ng I-TEQ/kg milk fat). Consumer milk collected at the processing plants had intermediary levels (0.51+/-0.19 ng I-TEQ/kg milk fat). However, milk in 2001 was significantly less contaminated than the samples collected in 1990/1991 and 1984. This trend is particularly pronounced near point sources but is also apparent in consumer milk and milk from remote areas. No geographical gradient in the atmospheric input of PCDD/F in Switzerland was found. The reduction in PCDD/F levels in dairy milk is paralleled by and correlated to the remediation of known PCDD/F emitting industries, as enforced by federal authorities.

Air Pollutants↗
PubMed2001

Concentrations and distribution of some polychlorinated biphenyls (PCBs) and polycyclic aromatic hydrocarbons (PAHs) in an ombrotrophic peat bog profile of Switzerland.

An efficient method was developed for the analysis of selected PCBs and PAHs in dry peat samples. The method includes a shaking extraction using acetone and hexane followed by the purification of the crude extract by gel permeation chromatography (GPC) which turned out to be the key clean-up step. The method was used to determine seven indicator PCBs and 16 EPA-PAHs in individual sections of an ombrotrophic peat core in south-west Switzerland. The maximum concentrations of PCBs (19 microg sigma PCBs/kg dm) were found at a peat depth of 10-15 cm which is estimated to correspond to a time period of 1976-1960 whereas the PAH profile showed a maximum (2853 microg sigma PAHs/kg dm) at a depth of 20-25 cm which represents circa 1951-1930. Compared to these maxima, the concentrations of PAHs in the top layer (1990-1986) are six times lower, but the decline in PCBs is only 38%. The concentration profiles are generally consistent with known changes in contaminant emissions, and suggest that more detailed studies of ombrogenic peat bog profiles could be used for detailed reconstructions of the changing atmospheric fluxes of these and other organic contaminants.

Carbon Radioisotopes↗
PubMed2002

The chronology of anthropogenic, atmospheric Pb deposition recorded by peat cores in three minerogenic peat deposits from Switzerland.

Peat cores were collected from three minerogenic peatlands in Switzerland: La Tourbière des Genevez (TGE), in Canton Jura; Gola di Lago (GDL), in Canton Ticino; and Mauntschas (MAU), in Canton Grisons. Chemical analyses of the pore waters and the peats document the increasingly minerogenic character with depth. In particular, the Sr concentration profile in the peats reflects the growing importance of mineral sediment dissolution with increasing distance below the peat surface. Despite this circumstance, Pb concentrations are greatest in the surface layers, and decrease with depth. Thus, dissolution of the basal sediments at these sites appears to be an unimportant source of Pb, compared with atmospheric deposition. Twenty-one new radiocarbon age dates for the three cores provide a chronology of Pb enrichment, and these are consistent with the record of atmospheric Pb deposition recorded by the ombrotrophic peat bog 'Etang de la Gruère' (EGR). Sediment samples from TGE and EGR were reacted at pH 5 with ammonium acetate to dissolve the carbonate fraction, filtered, and the residues analyzed using XRF. These analyses show that much of the Ca, Mg, Sr and Mn is lost when the carbonate fraction is dissolved, but this process does not measurably affect Pb. This finding suggests that carbonate dissolution dominates the weathering of the sediments underlying these peat deposits, but this fraction does not contain significant concentrations of Pb. Minerogenic peat deposits such as those described here, therefore, can serve as reliable archives of atmospheric Pb deposition, provided that mineral dissolution in the underlying sediments does not contribute measurably to the Pb inventory of the peat profile.

Air Pollutants↗
PubMed1991

Prevalence and quality of endodontic treatment in an elderly urban population of Switzerland.

Little oral health data on the elderly are available in Switzerland. This study assessed endodontic findings in 66-yr-old residents of the city of Zurich using intraoral radiographs. Of the 143 volunteers having a total of 2004 natural teeth, 78% had at least one endodontically treated tooth. Twenty percent of all teeth were root filled, two thirds of them being in the upper jaw. Sixty-four percent of the root fillings were judged insufficient and 8.5% of all teeth showed periapical radiolucencies, most of the latter (73%) being associated with insufficient root canal treatments. Ninety-eight percent of the root-filled teeth had intracanal retentive devices. Fifty-two percent of the teeth with insufficient root fillings were judged not to need revision, 37% needed revision, 9% needed apicectomy, and 2% were ready for extraction. The considerable endodontic treatment needs of the elderly can only be reduced by an improvement of quality of initial endodontic treatment.

Aged↗
PubMed2002

Incidence of Creutzfeldt-Jakob disease in Switzerland.

The incidence of Creutzfeldt-Jakob disease (CJD) in Switzerland increased two-fold in 2001, and figures from the first quarter of 2002 indicate that it continues to rise. Neither age at onset nor duration of disease were different from previous years. Genetic analysis of the 27 reported cases revealed only one disease-associated mutation in the prion gene. None of the recognised risk factors for acquired CJD were reported on the official notification forms. Glycotype profiling, histopathology, and immunohistochemistry indicate that none of the cases fulfilled the definition of variant CJD, which is thought to be caused by bovine prions. Several scenarios could account for the increase in CJD, including improved reporting, iatrogenic transmission, and transmission of a prion zoonosis.

Aged↗
PubMed2002

The perpetrator's strategy as a crucial variable: a representative study of sexual abuse of girls and its sequelae in Switzerland.

OBJECTIVE: Little is known about the long-term consequences of "soft" perpetrator strategies. The purpose of the present study is to assess the consequences of love-bargaining strategies compared to those involving force. METHOD: A representative sample of 980 women, aged 20 to 40 years, in the German-speaking part of Switzerland was asked questions regarding psychosomatic well-being, sexual actions, and perpetrator strategies, as well as motivations for tolerating long periods of abuse. The answers regarding strategies were factor analyzed. The effect on psychosomatic well-being was determined by means of stepwise regression analysis and correlation analysis. RESULTS: The prevalence of child sexual abuse (CSA) was 39.8% overall and 14.7% for severe abuse. Using the three variables love-bargaining strategy, self-blaming, and need for affection, an adjusted R2 of .44 was reached in the 3rd step as a dependent variable with a General Symptomatic Index (GSI) calculated from an abbreviated version of the SCL-90-R. The first of the three variables mentioned was by far the most influential. Force was not included in the equation but was closely correlated on a bivariate level with the SCL-90 partial scale "anxiety." CONCLUSIONS: The consequences of CSA produced by the use of soft strategies have been underestimated in the past.

Adult↗
PubMed2002

Risk factors for L. monocytogenes contamination of dairy products in Switzerland, 1990-1999.

Our purpose was to identify the main hazards associated with the spread of Listeria monocytogenes in dairy products in Switzerland and to determine the changes in predominant serotypes of the isolates, using databases on dairy-processing and environments from the Swiss Dairy Research Station during the years 1990-1999. Overall, of 76,271 samples collected, 3722 (4.9%) were positive for the presence of L. monocytogenes. Cheese-ripening facilities had the highest proportion of positive samples (7.6%), followed by small-scale local dairies (4.4%). By sample type, the highest proportion of positive samples (9.5%) was observed in water samples used for cheese-washing, followed by cheese-surface swabs (5.0%). During the 10-year period, no positive samples were obtained from cream, ice cream, milk powder, yogurt, or fresh cheese. Of 3722 L. monocytogenes isolates, 1328 (35.7%) were serologically typeable. Serotypes 1/2a, 1/2b, and 4b accounted for 92.7% of the 1328 isolates. Until 1995, the most-prevalent serotype was 1/2b (annual proportional prevalence 39.3-72.2%)--whereas since 1996, 1/2a was the most prevalent (34.7-54.7%). During 1996-1999, serotype 1/2a increased by 88%, compared to the average of 1990-1995. In the final random-effect multivariable logistic model, the strongest predictor of a positive culture was samples from cheese-ripening plant (OR=1.54; 95% CI: 1.14, 2.08) and the second-strongest predictor was samples collected by someone who was employed by the plant (OR=1.48; 1.29, 1.71). Hard and semi-hard cheeses were more likely to be associated with serotype 1/2b and soft cheeses with serotype 1/2a.

Animals↗
PubMed2002

Prevalence and risk factors for contamination with Listeria monocytogenes of imported and exported meat and fish products in Switzerland, 1992-2000.

A total of 2053 import and 164 export samples from 425 production plants were examined over a 9-year period (1992-2000) for the presence of Listeria monocytogenes (L. monocytogenes) in Switzerland. Overall, 282 samples (12.2%) and 85 plants (20.5%) harbored the pathogen. The highest isolation risk was for marinated fish (38%); the lowest was in cured- and dried-meat products. Unconditional fixed-effect logistic regression was used to identify the main hazards associated with the presence of L. monocytogenes. The plant-level model considered potential risk factors for a positive culture operating at the production-plant level by including a random effect of plant and year. Food category was the only significant factor; sampling site, country of origin and season were not significant. Marinated fish was a strong predictor for positive culture, whereas cooked- and cured-meat products were protective. Plant and year effects were significant. Control measures should be focused on specific food items in each production plant.

Animals↗
PubMed2001

Prevalence and characteristics of shigatoxin-producing Escherichia coli and Listeria monocytogenes strains isolated from minced meat in Switzerland.

A total of 400 minced meat samples from 240 small butcheries in Switzerland were collected and analysed for the presence of Shigatoxin-producing E. coli (STEC) and Listeria monocytogenes. The samples comprised 211 samples of minced beef and 189 samples of minced pork. Shigatoxin-producing E. coli was isolated from 7/400 (1.75%) samples. In particular, 5/211 (2.3%) minced beef samples and 2/189 (1%) minced pork samples were contaminated. Serotyping of the seven strains yielded five different serotypes. but none of the strains belonged to O157:H7. Two STEC strains harboured stx1 and stx2 and five strains harboured stx2c genes. Furthermore, four strains harboured one or more additional virulence factors. However, none of the strains was positive for eae. L. monocytogenes was isolated from 43/400 (10.75%) samples. Nineteen of the 43 strains belonged to serotype 1/2a, two to serotype 1/2b, 12 to serotype 1/2c and 10 to 4b. Forty-two strains harboured the Lhly and 43 strains the plcA genes. Macrorestriction analysis of the L. monocytogenes strains using SmaI yielded 12 different PFGE-patterns. The predominating pattern G was associated to the serotype 1/2c.

Animals↗
PubMed1998

Emergency medicine in Switzerland.

Situated in the heart of Europe, Switzerland's 7 million inhabitants, including 1 million foreigners, live in an area of 41,000 km2. German, French, Italian, and Rhaeto-Romanic are the official languages. The Swiss health service stands out because of the high quality and efficiency of its ambulatory and hospitalized health care management.

Ambulatory Care↗
PubMed2003

Invasive meningococcal and pneumococcal disease in Switzerland: cost-utility analysis of different vaccine strategies.

We performed a cost-utility analysis for various vaccination strategies against meningococcal and pneumococcal diseases (MenC or MenC/PCV-9) in Switzerland. The analysis compared the current recommendations of vaccinating only children with medical risks to the introduction of the vaccination with either the MenC or the MenC/PCV-9 vaccine, administered at 12 or 2, 4 and 6 months of age, into the existing immunisation programme. For a birth cohort of 80,000 children and assuming a vaccine coverage of 80%, the introduction of a generalised vaccination would be cost-effective. The strategy using three doses of MenC/PCV-9 would achieve the highest health benefit, with 440 quality-adjusted life years (QALYs) gained at costs of 34,000 per QALY.

Child↗
PubMed2001

Factors controlling 7Be and 210Pb atmospheric deposition as revealed by sampling individual rain events in the region of Geneva, Switzerland.

Bulk atmospheric deposition of 7Be and 210Pb has been measured at Versoix, close to Geneva, Switzerland. Collectors were continuously deployed from November 1997 through November 1998 for periods from 1 to 22 days depending on the frequency of rain. The activities of 7Be and 210Pb integrated over the sampling interval were moderately well correlated with rainfall (r2 of 0.66 and 0.55, respectively; p < 0.001) and well correlated one with the other (r2 of 0.91; p < 0.001). The 7Be/210Pb activity ratio is close to 13.5, except for samples collected in the periods of very low precipitation which have a distinctly lower ratio. A simple model accounting for rainfall, seasonal variations and reload of the local atmosphere after a rain event explains 90% of the variance of 7Be and 210Pb deposition. Concentrations of 210Pb and Ca++ in rain were correlated with transport time of air masses over the continent as indicated by reconstruction of air mass trajectories over three days.

Air Pollutants, Radioactive↗
PubMed2001

HIV/AIDS institutional discrimination in Switzerland.

A UNAIDS protocol designed to identify discrimination against people living with HIV/AIDS was applied in Switzerland, a country where policies against such discrimination had been actively promoted since the beginning of the HIV epidemic. Discrimination, in its strict legal definition, was examined in nine areas of everyday life, and at three levels: legislation, written regulations, and actual practices. Data concerning both expert opinion and subjective experience of discrimination was gathered by members of an interdisciplinary work group by means of: (1) interviews with over 200 key informants and experts, covering each of the areas investigated, and (2) actively seeking testimonies as to experiences of discrimination through local AIDS groups and through informal contacts of work group members. The study revealed little institutional discrimination in the region investigated, attesting to the efficacy of clear and actively promoted anti-discrimination policies. Individual discrimination and stigmatisation persist, however. It is in combating individual discrimination and stigmatisation that efforts must now concentrate. The UNAIDS protocol was found to be a valuable tool for tracking the sorts of discrimination that can most easily be influenced by policy measures.

Civil Rights↗
PubMed1998

Quality assessment in gynecology and obstetrics. Projects and experience in Switzerland.

The first steps in quality assessment of results of performance in gynecology and obstetrics were taken by the Swiss Association of the OB/GYN Clinics of the Swiss Society of Obstetrics and Gynecology in the 1980's. Currently, medical data of more than 800,000 patients are available, allowing a good comparison of the quality of results. Concerned that purchasing coverage for health services was made exclusively on the basis of cost, resulting in lower public health quality, the Swiss Society of OB/GYN set up a Board of Quality Assessment in 1995. Not only the quality of results, but also the quality of indications, structures and processes are considered by using a modified Donabedian model. Moreover, standardized patient information forms have been worked out for 15 gynecological and five obstetrical operations. Since hysterectomy is the most common major gynecological operation in Switzerland, the evaluation of the quality of the indications is of substantial interest. Guided by the RAND Appropriateness Method, criteria for quality assessment with respect to appropriateness and necessity of hysterectomy have been drawn up. Swiss guidelines and 125 different clinical scenarios are defined by a panel of 22 OB/GYN experts. The aim of this project is to offer an interactive second opinion system, called "Swiss Guidelines for Hysterectomy", and anonymous self-assessment of quality. Appropriateness and necessity of medical procedures have to be defined by medical professionals providing a proper balance between the patient's desires and financial demands.

Female↗
PubMed2003

Antimicrobial resistance and resistance gene determinants in clinical Escherichia coli from different animal species in Switzerland.

Antimicrobial susceptibility testing was performed on a total of 581 clinical Escherichia coli isolates from diarrhea and edema disease in pigs, from acute mastitis in dairy cattle, from urinary tract infections in dogs and cats, and from septicemia in laying hens collected in Switzerland between 1999 and 2001. Among the 16 antimicrobial agents tested, resistance was most frequent for sulfonamides, tetracycline, and streptomycin. Isolates from swine presented significantly more resistance than those from the other animal species. The distribution of the resistance determinants for sulfonamides, tetracycline, and streptomycin was assessed by hybridization and PCR in resistant isolates. Significant differences in the distribution of resistance determinants for tetracycline (tetA, tetB) and sulfonamides (sulII) were observed between the isolates from swine and those from the other species. Resistance to sulfonamides could not be explained by known resistance mechanisms in more than a quarter of the sulfonamide-resistant and sulfonamide-intermediate isolates from swine, dogs and cats. This finding suggests that one or several new resistance mechanisms for sulfonamides may be widespread among E. coli isolates from these animal species. The integrase gene (intI) from class I integrons was detected in a large proportion of resistant isolates in association with the sulI and aadA genes, thus demonstrating the importance of integrons in the epidemiology of resistance in clinical E. coli isolates from animals.

Animal Diseases↗
PubMed2000

Salvia divinorum: an hallucinogenic mint which might become a new recreational drug in Switzerland.

Salvia divinorum Epling & Jativa is an hallucinogenic mint traditionally used for curing and divination by the Mazatec Indians of Oaxaca, Mexico. Young people from Mexican cities were reported to smoke dried leaves of S. divinorum as a marijuana substitute. Recently, two S. divinorum specimens were seized in a large-scale illicit in-door and out-door hemp plantation. Salvinorin A also called divinorin A, a trans-neoclerodane diterpene, was identified in several organic solvent extracts by gas chromatography-mass spectrometry. The botanical identity of the plant was confirmed by comparing it to an authentic herbarium specimen. More plants were then discovered in Swiss horticulturists greenhouses. All these data taken together suggest that many attempts exist in Switzerland to use S. divinorum as a recreational drug. This phenomenon may be enhanced because neither the magic mint, nor its active compound are banned substances listed in the Swiss narcotic law.

Diterpenes↗
PubMed2004

[Contribution of unvaccinated siblings to a measles outbreak in Switzerland].

BACKGROUND: A measles outbreak occurred in Geneva between March and July 2003. An investigation was conducted to determine its magnitude, identify predominant modes of transmission, and assess disease outcome. METHODS: In Switzerland, measles notification has been mandatory for physicians since 1999 and laboratories since 1988. All cases were investigated and followed up by interviewing physicians using a standardized questionnaire. Viral genotype was determined for 4 cases using a saliva specimen processed at the Robert Koch Institute, Berlin. Geographic distribution of cases and vaccination coverage were compared. RESULTS: Overall, 54 cases were notified. Fifty-three cases were between 10 and 19 years of age. Ninety-four percent (n = 46) of 49 cases with known vaccination status were not vaccinated and none were fully immunized (2 doses). Measles complications occurred among 19% (n = 7) of the 36 patients with follow up information: pneumonia (n = 4, combined with pericarditis and hepatitis in one case) and bronchitis (n = 3). Three persons were hospitalized. No complication was reported among 3 persons partially vaccinated (1 dose). The virus belonged to genotypes D8 and D5. Five separate clusters of related cases included 74% of all cases. Transmission mainly occurred within families (43% of all cases) and school (28%). Two of the most affected areas had measles vaccination coverage well below the cantonal average. CONCLUSION: Low vaccination coverage combined with clusters of unvaccinated household contributed to continued virus circulation and represents a threat to the canton of Geneva as new outbreaks of measles may reoccur.

Adolescent↗