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We analysed two case-control studies of women from Italy and Switzerland, including 195 cases of oral and pharyngeal cancers and 1113 controls. The multivariate odds ratio was 4.6 for heavy smokers and 2.7 for high alcohol intake. Vegetables, fruit, beta-carotene and wholegrain foods were inversely, butter and retinol directly, related to risk.
In Vaud, Switzerland, the incidence of carcinoids based on 218 malignant and 215 benign cases rose from 19.6/10(6)in 1974-85 to 28. 2/10(6)in 1986-97, more so among males and malignant neoplasms. Lung was the commonest site for malignant and large intestine for benign carcinoids. Sixty-eight (16%) carcinoids had another neoplasm.
OBJECTIVE: The present contribution aims at illustrating the methodological problems that may arise from investigating the indirect social costs of alcohol consumption. METHODS: In order to estimate the alcohol-related productivity losses through excessive morbidity, regression analysis was performed, using data from the 2(nd) Swiss Health Survey (1997). For the purpose of sensitivity analysis two approaches were used (a) Rice and b) Harwood), and all models were calculated with and without smearing-adjustment as well as with and without adjustment for confounding variables. RESULTS: The present study shows that small changes in method may result in major variations in the estimated total costs. In monetary terms, the indirect costs for alcohol consumption in Switzerland through excess-morbidity were estimated at between 0.119 billion Francs (model Harwood, smearing-adjusted) and 2.175 billions Francs (model Rice, adjusted for confounding variables). CONCLUSION: Since many methodological problems in estimating the indirect costs of alcohol consumption have not been adequately resolved yet, results of those studies have to be interpreted with caution.
We conducted a study on the prevalence of multiple sclerosis in the canton of Berne (Switzerland) at the Department of Neurology (inpatient and outpatient sections) of the Inselspital hospital (University of Berne) in Berne. The canton of Berne is a heterogeneous region, geographically speaking, extending from the foot of the Jura mountains to high Alpine regions. There are approximately 920,000 inhabitants in an area of 6,000 square kilometers. Sources of our study were, besides the Department of Neurology of the University and the practising neurologists of Berne, the Association of Swiss Hospitals (VESKA) and the Swiss Multiple Sclerosis Society. For ensuring a safe diagnosis we employed a diagnosis score suggested by C. M. Poser et al (1983). This covered only safely established and probable cases of MS. To make sure of the actual residence of the retrospectively assessed patients we conducted a checkup with the relevant authorities. Besides personal data it was also possible, in a majority of patients, to obtain data on the onset and course of the disease. On 1, 1, 1986 1,016 MS patients were residents in the canton of Berne, according to our investigations. This corresponds to a prevalence rate of 110 MS patients for every 100.000 inhabitants. The sex ratio (female/male) is about 1.8: 1. The average age of the MS patients covered by the study was 50 years with an average duration of the disease of 18 years. From the data concerning the course of the disease our study was able to gain further pointers on the beginning of the disease, on the pattern of symptoms, course of the disease, and progression of multiple sclerosis.
There is no conclusive evidence that electronic monitoring during gastrointestinal endoscopy reduces patient morbidity and mortality. The aim of this nationwide Swiss survey was to assess the impact of monitoring on the outcome for patients. We therefore evaluated the monitoring practice and the rate of sedation-related clinically relevant complications in a country with a low monitoring prevalence, and compared the results with those for a country in which monitoring is widely applied. A questionnaire pertaining to 1990 was mailed to all 173 Swiss gastroenterologists. The response rate was 71.1%. Data from 115,200 endoscopies performed by 123 gastroenterologists were analysed. Sixty percent of the procedures were performed under sedation. Patient's vital signs were rarely monitored clinically (< or = 25%). Electronic monitoring was virtually never performed: oximetry was used by 2.5% and an electrocardiogram by 0.8%. The overall sedation-related complication rate was 0.10%, and no deaths occurred. Thus, the morbidity and mortality related to conscious sedation in Switzerland is low, and not higher than it is in countries with a high monitoring level, such as the USA (0.06-0.54%). We conclude that clinically detectable and relevant complications attributable to conscious sedation are rare even when vital parameters are not monitored routinely. There is need for a prospective study to evaluate the effect of electronic monitoring on the complication rate for average-risk patients undergoing routine gastrointestinal endoscopy.
All suicides in Switzerland in 1990 where drugs were involved (179 persons; 12.2% of all suicides) were analyzed by examination of death certificates and direct contacts with physicians and medico-legal institutions. Nearly 50% of these people took overdoses of combinations of different drugs and in 26% of the cases alcohol was reported to have been taken with the drugs. Unexpectedly, we found 29 suicides in which persons had obviously used drug combinations recommended by EXIT, an organization advocating the freedom of the individual to decide about his own time and nature of death. In EXIT-suicides usually barbiturates and anticholinergic drugs were taken together. Interestingly, the barbiturate compound used most often had officially been withdrawn from the market the previous year. Altogether, psychotropic drugs represented 78.7% of all drugs taken, with benzodiazepines being named most often (38.9%), followed by barbiturates (16.6%) and antidepressants (13.6%). Among the benzodiazepines flunitrazepam, diazepam, and triazolam were used most often and surprisingly, benzodiazepines were named as single drugs on 27 death certificates. Among the antidepressants (taken in 20.3% of overdoses) maprotiline was the most common drug used, followed by mianserin and trimipramine. This order of frequency reflects the prescribing habits of Swiss doctors. Two suicides were recorded with neuroleptics alone.
An analysis is presented of 1763 consecutive injuries that occurred in the Ybrig region in Switzerland, a ski resort, during the 1976-1982 ski seasons. The study included all persons injured while skiing and treated at the emergency care facility at the base of the Ybrig region. Fractures were the most frequent injury. Over the years, a decrease in the total number of injuries was noticed. The severity of the injuries was increased. More attention should be paid to the individual preparation of the skier.
The sensitivity studies of 706 cases from January 1, 1973 to December 31, 1977, at the University department of Gynaecology in Bern, Switzerland, were reviewed. The sensitivity studies were classified as to type of bacteria, site of infection and source of infection (hospital acquired or non-hospital acquired). The sensitivity of the bacteria to several antibacterial drugs was tested. E-coli was the leading cause of infection in 46.9% of the cases. The most frequent site of infection for both hospital acquired and non-hospital acquired infection was the urine. The number of hospital acquired infections was twice as high as the number of infections acquired outside of the hospital. No significant change in the sensitivity during the time of review was noted.
In Switzerland, as in most other western European countries, the patient-physician relationship is based on the mandate relationship in private law. Its main provisions are laid down in the Swiss civil code, the law of obligations and the penal code. The physician is obliged at all costs to fulfill his responsibility to enlighten the patient. The authors discuss the extent and nature of this duty to provide information, in particular regarding the patient's right of access to medical and laboratory reports.
The cost-effectiveness of photodynamic therapy with verteporfin in the treatment of patients with predominantly classic subfoveal choroidal neovascularization secondary to age-related macular degeneration was investigated by a Markov Model over a time horizon of three years in Switzerland. This model describes patients moving between three levels of visual acuity (e.g., good vision, impaired vision, highly impaired vision) and death in terms of transition probabilities. Transition probabilities as well as effectiveness values were derived from a randomized, controlled, double-masked clinical trial. Effectiveness for verteporfin therapy and for placebo was calculated in terms of vision years: 1.068 and 0.494, respectively. Cost per level of visual acuity was assessed in ascending order by expert panels from a societal perspective. Cost strongly increased parallel with vision loss on a patient-per-year basis from 4683 CHF at good vision to 8443 CHF at impaired vision, and was highest with 15231 CHF at highly impaired vision. The model-calculated cost per visionyear were 14907 CHF for patients in the verteporfin therapy group, versus 21047 CHF for patients in the placebo group. The incremental cost per vision-year additionally saved through verteporfin therapy was 9624 CHF. The study demonstrated that greater effectiveness of verteporfin therapy versus placebo compensated for the cost of the therapy so that verteporfin therapy was clearly costeffective. Therefore, for the indicated patients with AMD that causes severe vision loss, verteporfin therapy can be recommended as the therapy of choice, on both clinical and economic grounds.
This study includes 80 patients (38 children and 42 adults) who contracted aseptic meningitis in the summer of 1996 in Fribourg, Switzerland. Virological studies revealed an enteroviral infection in 65 out of 70 (93%) investigated patients. In 47 out of the 53 cases (89%) where a precise virus could be identified, the causative agent was an Echovirus 30. More than 50 patients lived in an area within a 5-km radius. The patients presented with the classic symptoms and signs of aseptic meningitis. In contrast, polymorphonuclear leukocytes predominated in the cerebrospinal fluid in the first 24 h and 32% of the cases had a left shift in their peripheral blood smear. The patients' age did not influence white blood cell count, the proportion of polymorphonuclear leukocytes or protein concentration in the cerebrospinal fluid. Thirty-three patients (41%) received antibiotic treatment, and 38 patients (48%) left the hospital within 24 h. Only 2 neuroradiological procedures and 1 electroencephalographic recording were performed. The outcome was favourable in all patients.
Phase I of the Zurich Prometheus Study is a cross-sectional study focusing on an up-to-date serology for HIV and hepatitis B/C and associated risk factors for all clients in four participating clinics offering opiate substitution in Zurich, Switzerland. The mean age of the 603 respondents is 30.7 years (SD = 6.2) and 38% of them are women. Seventy-five per cent of the respondents have a history of injecting drug use (IDU), and over half have injected within the past six months. Laboratory-confirmed seroprevalence for HBV (50%) and HCV (57%) is twice that of HIV (24%). There is an 80% risk reduction for all three viral infections among those starting IDU after 1991--when harm reduction efforts were in full swing--compared to those who began before 1988--before clean needles were widely available. These findings suggest a strongly protective effect of harm reduction measures. But while a stabilization in HIV prevalence at 15% can be seen among drug users who started injecting after 1991, prevalence rates for HBV and HCV still remain several times higher. The prevalence data in this study support data showing continued high incidence rates for HBV and HCV, even among new injectors in the harm reduction era.
The aim of this paper is to present trends in reported HIV-related behaviours among men having sex with men (MSM) in Switzerland. In 1992, 1994, 1997 and 2000 a standardized anonymous questionnaire was placed in gay newspapers and distributed in gay associations. High levels of protection (no anal sex or consistent condom use) with casual partners were found: around 90%, with a peak in 1994 and a slight decrease in 2000 to the level of 1992. With the steady partner, the level of protection was 57% in 1992, 61% in 1997 and decreased in 2000 to the same level as in 1992. The proportion of couples with both HIV statuses known increased from 49% in 1994 to 59% in 2000. In 2000, 26% of concordant HIV negative couples protected themselves compared to 83% of those exposed to an actual or potential risk (HIV status discordant or unknown). Within each category of couples, there was no change over time in the level of reported practice of anal sex and condom use. This slight decrease in prevention behaviour justifies efforts to maintain HIV/AIDS prevention targeted at gay men.
As a part of an assessment of the Swiss drug harm-reduction policy, cross-sectional surveys were conducted in 1994, 1996 and 2000 among attenders of all needle exchange programmes (NEP) in Switzerland to assess changes in specific aspects of their health related to drug use. Data were gathered in each NEP over one week, using a questionnaire completed partly with an interviewer and partly self administered. The questionnaire covered socio-demographic characteristics, drug consumption, risk, prevention behaviour and state of health. Over a 6-year period (1994-2000), the average age of NEP attenders rose by 4 years. The prevalence of reported HIV remained fairly stable at around 10%. Reported level of Hepatitis C prevalence was high (59%). Incidence of used injection equipment sharing during the last 6 months was low and stable (9% in 1994, 12% in 2000); however, other forms of risk behaviour linked to intravenous drug use, such as sharing spoons, cotton or water, were more frequently reported. The HIV epidemic among NEP attenders seems to be contained, but this is not the case with Hepatitis C, and more attention should be paid to its prevention.
DESIGN: A multicenter, retrospective study of the single-rod contraceptive implant, Implanon (NV Organon, Oss, The Netherlands), was carried out in Switzerland in 1183 women. METHODS: Assessments included duration of use, bleeding pattern, side-effects and subjective acceptability and satisfaction with the method. RESULTS: A total of 991 women (84%) had at least one follow-up visit and 306 (26%) had two visits with a mean duration between insertion and follow-up of 224 days (7.4 months) and 347 days (11.4 months), respectively. Implanon was removed prematurely in 235 women (24%), primarily because of side-effects (20%) and for family planning reasons (4%). Side-effects leading to discontinuation were mainly bleeding disturbances (45%), acne (12%) and other reasons (15%). The mean duration between insertion and removal for discontinuers was 280 days (9.2 months). Side-effects related to bleeding (visit 1) included infrequent bleeding (28%), amenorrhea (33%), prolonged bleeding (15%), and metromenorrhagia (frequent and heavy bleeding) (16%). Other reported side-effects at visit 1 included dizziness (12%), acne (11%), mood swings (8%) and headache (5%). The incidence of side-effects reported at visit 2 was generally comparable to that at visit 1. CONCLUSIONS: The results of this study show that early discontinuation of implant use is primarily due to bleeding problems. Extensive counseling before implant insertion may help to prevent this. It is also important to develop an easy solution to successfully treating progestogen-induced bleeding disturbances.
In Switzerland, there have been intensive public debates about biotechnology because of the specific Swiss political system of direct democracy that led, in 1992 and 1998, to two national referenda on biotechnology regulation. As a result, the Swiss population is well informed but skeptical about this technology. These findings contrast with the deficit model of public understanding of science, which predicts a positive correlation between knowledge of, and support for, a specific technology. What role did the media play in the development of public opinion? This question is discussed because of a content analysis (time series) of national newspapers. In addition, representative surveys and focus groups yield insights into the public perception of biotechnology and the influence of mass communication for opinion formation.
We reviewed the descriptive epidemiology of thyroid cancer using data from the Cancer Registry of the Canton of Vaud, Switzerland, a consistently well-surveilled population with relatively high rates of the disease, between 1974 and 1998, on the basis of a total of 596 registered cases. Overall thyroid cancer incidence tended to increase moderately in both genders over the 25-year period considered, to reach rates of 5.4 and 2.0 per 100,000 (world standard) in females and males, respectively. There were also changes in histologic classification, with some increases in papillary neoplasms and corresponding decreases in other and unclassified ones. Ten-year relative survival rates for cases diagnosed in 1988-1993 were 94% for papillary cancer in females and 69% in males, and 59% for follicular cancer in females. Corresponding figures were 12% for undifferentiated, and 31% for other and unspecified neoplasms in both sexes combined. Multivariate analysis confirmed the unfavorable influence of male gender (hazard ratio [HR] = 1.9), elderly age (HR = 16.5 for age > or = 65 vs. < 45 years) and undifferentiated histotype (HR = 3.5 vs. papillary) on the long-term prognosis of thyroid cancer, and showed no consistent evidence of appreciably improved prognosis over more recent calendar periods.
BACKGROUND: Tobacco smoking is one of the main risk factors for oral, pharyngeal and oesophageal cancers in developed countries. Information on the role of the tar yield of cigarettes in upper digestive tract carcinogenesis is sparse and needs to be updated because the tar yield of cigarettes has steadily decreased over the last few decades. PATIENTS AND METHODS: We analysed two case-control studies, from Italy and Switzerland, conducted between 1992 and 1999, involving 749 cases of oral and pharyngeal cancer and 1770 controls, and 395 cases of squamous-cell oesophageal carcinoma and 1066 matched controls. Odds ratios (ORs) were estimated by unconditional multiple logistic regression models, including terms for age, sex, study centre, education and alcohol consumption. RESULTS: Based on the brand of cigarettes smoked for the longest time, the multivariate ORs for current smokers compared with never smokers were 6.1 for <20 mg and 9.8 for >or=20 mg tar for oral and pharyngeal neoplasms, and 4.8 and 5.4 for oesophageal cancer, respectively. For the cigarette brand smoked in the previous six months, the ORs for >or=10 mg compared with <10 mg were 1.9 for cancer of the oral cavity and pharynx and 1.8 for oesophageal cancer, after allowance for number of cigarettes and duration of smoking. CONCLUSIONS: The present study confirms the direct relationship between the tar yield of cigarettes and upper digestive tract neoplasms, and provides innovative information on lower tar cigarettes, which imply reduced risks compared with higher tar ones. However, significant excess risks were observed even in the lower tar category, thus giving unequivocal indications for stopping smoking as a priority for prevention of upper digestive tract neoplasms.