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PubMed2004

Genetic variability and founder effect in the pitcher plant Sarracenia purpurea (Sarraceniaceae) in populations introduced into Switzerland: from inbreeding to invasion.

BACKGROUND AND AIMS: The long-lived and mainly outcrossing species Sarracenia purpurea has been introduced into Switzerland and become invasive. This creates the opportunity to study reactions to founder effect and how a species can circumvent deleterious effects of bottlenecks such as reduced genetic diversity, inbreeding and extinction through mutational meltdown, to emerge as a highly invasive plant. METHODS: A population genetic survey by random amplified polymorphism DNA markers (RAPD) together with historical insights and a field pollination experiment were carried out. KEY RESULTS: At the regional scale, S. purpurea shows low structure (thetast=0.072) due to a recent founder event and important subsequent growth. Nevertheless, multivariate statistical analyses reveal that, because of a bottleneck that shifted allele frequencies, most of the variability is independent among populations. In one population (Tenasses) the species has become invasive and genetic analysis reveals restricted gene flow and family structure (thetast=0.287). Although inbreeding appears to be high (Fis >0.410 from a Bayesian estimation), a field pollination experiment failed to detect significant inbreeding depression upon F1 seed number and seed weight fitness-traits. Furthermore, crosses between unrelated individuals produced F1 seeds with significantly reduced fitness, thus showing local outbreeding depression. CONCLUSIONS: The results suggest that, under restricted gene flow among families, the species may not only have rapidly purged deleterious alleles, but also have undergone some form of selection for inbreeding due to co-adaptation between loci.

Biological Evolution↗
PubMedDate not supplied

Infectious complications in drug addicts: seven-year review of 269 hospitalized narcotics abusers in Switzerland.

In a retrospective survey of patients hospitalized in the Department of Medicine of the University Hospital, Basel, Switzerland, from 1980 to 1986, we found 269 patients with history of past or current drug abuse. The charts of these patients were analyzed for infectious complications according to defined criteria. Heroin was the principal drug consumed by 95%. In 127 patients (47%) at least one infectious complication was diagnosed. In 125 (31%) of 404 admissions, the infectious problem was the main reason for hospitalization. Among the 269 patients, 217 infective episodes occurred. Pulmonary infections were the most frequently occurring (52 episodes). There were 44 cases of viral hepatitis, 30 of human immunodeficiency virus infection, and 25 of minor genital infections. Bone and joint infections and sepsis/endocarditis were diagnosed in seven cases each. The overall mortality was 4.1%; however, only three of the 11 deaths were attributed to infections. Intravenous drug addiction is complicated by a high morbidity because of infections that were seldom lethal during the observed period.

Adolescent↗
PubMed1992

Epidemiology and clinical significance of nontuberculous mycobacteria in patients negative for human immunodeficiency virus in Switzerland.

Over the last decades, the rate of isolation of tubercle bacilli has declined in the developed countries, while the incidence of infection with nontuberculous mycobacteria (NTM) has increased. In a retrospective study, we analyzed all cases of patients negative for human immunodeficiency virus (HIV) and from whom NTM were isolated in the Zurich area of Switzerland from 1983 to 1988. During the 6-year study period, 513 patients infected with NTM were identified, 34 of whom had clinically significant disease. The presentation of mycobacteriosis was found to be lung disease in 23 cases, soft-tissue disease in 10 cases, and disseminated disease in one case. The highest attack rate of pulmonary mycobacteriosis was 0.49% and was found in the group of patients 41-50 years old. During the 6-year period, the incidence of tuberculosis declined from 16.2 to 13.2 per 100,000 population, while the incidence of mycobacteriosis increased from 0.4 to 0.9 per 100,000 population. Clinically nonsignificant NTM isolates were found more frequently in patients with chronic lung diseases (P less than .01) and especially in patients with a history of tuberculosis (P less than .001).

Adolescent↗
PubMed1995

An epidemic of food-borne listeriosis in western Switzerland: description of 57 cases involving adults.

This article describes 57 cases of listeriosis that occurred in adults in western Switzerland during an outbreak associated with the consumption of a soft cheese. Twenty-one percent of the cases were of bacteremia, 40% were of meningitis, and 39% were of meningoencephalitis. Overall, 42% of the patients had an underlying disease and 54% were > 65 years of age. Patients with bacteremia were significantly older than those with meningitis or meningoencephalitis (median ages, 75, 69, and 55 years, respectively). The epidemic strain, defined by phage typing, was isolated in three-quarters of the listerial cases observed during the epidemic period and did not appear to differ significantly from the nonepidemic strains in terms of virulence. The overall mortality associated with the 57 cases was 32%. Among the patients' characteristics, age and type of clinical presentation were independent predictors of death in a multivariate logistic regression model (pseudo-r2 [coefficient of determination], .26; both P values < .05), and a presentation of meningoencephalitis was associated with an increased death risk (odds ratio, 6.5; 95% confidence interval, 1.1-39.5; P < .05). Neurological sequelae developed in 30% of the survivors of CNS listeriosis.

Adult↗
PubMedDate not supplied

Duration of immunity after rubella vaccination: a long-term study in Switzerland.

In Switzerland 319 of 594 young women seronegative for rubella antibody vaccinated at 15-25 years of age against rubella with the Cendehill vaccine strain were retested 15 years later with three tests (hemagglutination inhibition, enzyme-linked immunosorbent assay, and a neutralization technique) for the presence of rubella antibodies. For 307 women rubella antibodies were still detectable by all three techniques. For nine women rubella antibodies were demonstrable by only one or two tests. Only three vaccinees were seronegative by all three tests. These three women also showed no booster response after challenge with the vaccine strain. The high percentage of women with persistent rubella antibodies 15 years after vaccination might be explained in part by the presence of subclinical reinfections due to a wild rubella virus.

Adolescent↗
PubMed2005

Health status and health care utilisation of patients in complementary and conventional primary care in Switzerland--an observational study.

BACKGROUND: The study is part of a nationwide evaluation of complementary and alternative medicine (CAM) in primary care in Switzerland. OBJECTIVES: Patient health status with respect to demographic attributes such as gender, age, and health care utilisation pattern was studied and compared with conventional primary care. METHODS: The study was performed as a cross-sectional survey including 11932 adult patients seeking complementary or conventional primary care. Patients were asked to document their self-perceived health status by completing a questionnaire in the waiting room. Physicians were performing conventional medicine and/or various forms of complementary primary care such as homeopathy, anthroposophic medicine, neural therapy, herbal medicine, or traditional Chinese medicine. Additional information on patient demographics and yearly consultation rates for participating physicians was obtained from the data pool of all Swiss health insurers. These data were used to confirm the survey results. RESULTS: We observed considerable and significant differences in demographic attributes of patients seeking complementary and conventional care. Patients seeking complementary care documented longer lasting and more severe main health problems than patients in conventional care. The number of previous physician visits differed between patient groups, which indicates higher consumption of medical resources by CAM patients. CONCLUSIONS: The study supports the hypothesis of differences in socio-demographic and behavioural attributes of patients seeking conventional medicine or CAM in primary care. The study provides empirical evidence that CAM users are requiring more physician-based medical services in primary care than users of conventional medicine.

Adolescent↗
PubMed1993

Evaluating modifications in epidemic surveillance systems: a method and an application to AIDS surveillance in Switzerland.

A method is presented for evaluating the impact of a modification in a surveillance system for an epidemic disease among reporting sources susceptible to the modification. The approach requires a control series with reports from sources that are not affected by the modification. The measure of effect is the reporting odds ratio (ROR) which estimates the ratio of reporting proportions (completeness) before and after the change. The proportions themselves remain unknown. Various potential biases are identified and an investigation of one potential bias is proposed. The method may prove useful in supplementing techniques that estimate absolute values of completeness of registry systems. The application to AIDS surveillance data in Switzerland shows that the transition from voluntary to mandatory reporting had an impact that was enhanced by the 1987 revision of the Centers for Disease Control case definition for AIDS. Reporting sources were 1.9 (95% confidence interval [CI]: 1.4-2.6) times more likely to report their patients after introduction of mandatory reporting. It is estimated that 15% of all reports were attributable to mandatory reporting.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Paediatric, invasive pneumococcal disease in Switzerland, 1985-1994. Swiss Pneumococcal Study Group.

BACKGROUND: Cost effective use of new vaccines against pneumococcal disease in children requires detailed information about the local epidemiology of pneumococcal infections. METHODS: Data on 393 culture-confirmed cases of invasive pneumococcal infection in children (<17 years) hospitalized in Swiss paediatric clinics were collected retrospectively for the years 1985-1994. RESULTS: Meningitis (42%) was most frequent, followed by pneumonia (28%) and bacteraemia (26%). The overall annual incidence was 2.7 cases per 100000 children <17 years old and 11 cases per 100000 children <2 years old. Annual incidence rates were stable over the study period. Lethality was high for meningitis (8.6%) and bacteraemia (8.9%). A history of basal skull fracture was reported in 3.3% of children with pneumococcal meningitis. Residence in a rural region was associated with an increased risk of pneumococcal infection (relative risk = 1.45, 95% confidence interval: 1.01-2.00). CONCLUSIONS: Paediatric, invasive pneumococcal disease seems to be less frequent in Switzerland than in other European and non-European countries. This may be due to differences in diagnostic strategies and lower frequency of risk factors such as the use of day care. Children with a history of basal skull fracture are at increased risk for pneumococcal meningitis. Further investigation of the association of invasive pneumococcal infection with rural residence and the use of antibiotics for upper respiratory tract infections might give new insight into the dynamics of Streptococcus pneumoniae infection and the development of antibiotic resistance.

Adolescent↗
PubMed1999

Susceptibility to levofloxacin of clinical isolates of bacteria from intensive care and haematology/oncology patients in Switzerland: a multicentre study.

The objective of this study was to examine the susceptibility of clinical isolates to levofloxacin, a fluoroquinolone with extended activity against Gram-positive bacteria, and other antibiotics in 12 Swiss clinical microbiology laboratories using the NCCLS disc diffusion technique. Isolates were prospectively collected from intensive care units (ICUs (59%), oncology wards (7%) and other units with haematology/oncology patients (34%) from June 1995 to March 1996. The levofloxacin breakpoints used were as recommended by the manufacturer. A total of 310 Gram-positive and 580 Gram-negative isolates from the respiratory tract (36%), skin/wounds (12%), blood (16%), urine (17%) and other sources (19%) were tested. The percentage of isolates susceptible to levofloxacin was 100% for Enterococcus spp. (38 strains), Streptococcus agalactiae (13), Streptococcus pneumoniae (65), Acinetobacter spp. (11), Citrobacter diversus (6), Citrobacter freundii (17), Klebsiella oxytoca (39), Morganella morganii (16), Proteus mirabilis (20), Proteus vulgaris (23), Serratia spp. (19), Stenotrophomonas maltophilia (10) and Haemophilus influenzae (41). The percentage of isolates susceptible to levofloxacin for Staphylococcus aureus (95 strains, including 2% MRSA) was 94%, coagulase-negative staphylococci (85) 65%, Enterobacter spp. (75) 99%, Escherichia coli (111) 97%, Klebsiella pneumoniae (45) 98% and Pseudomonas aeruginosa (124) 87%. In conclusion, levofloxacin is a new fluoroquinolone to which the most common clinical isolates in Switzerland are susceptible. The susceptibility of Enterococcus spp. and S. pneumoniae to levofloxacin was particularly remarkable. This compound appears to be a promising therapeutic alternative for the treatment of Gram-positive infections.

Anti-Infective Agents↗
PubMed1995

Strain variation of Lyme disease spirochetes isolated from Ixodes ricinus ticks and rodents collected in two endemic areas in Switzerland.

The relationship among Lyme borreliosis, Borrelia genospecies, rodent reservoirs, and Ixodes ricinus L. ticks was studied in two endemic areas in Switzerland. Ear punch biopsies and sampling of internal organs were used to isolate Borrelia burgdorferi (Johnson, Schmid, Hyde, Steigerwalt and Brenner) from small mammals, Apodemus sylvaticus L., A. flavicollis Melchoir, Clethrionomys glareolus Schreber. Spirochetes were isolated from ear tissue and spleen of the rodents. Isolates were homogeneous and belonged to typing group II identified as B. afzelii (Canica, Nato, du Merle, Mazie, Baranton and Postic). Our data show that a specific association exists between B. afzelii and rodent reservoirs in European foci. Borreliae were also isolated from field-collected I. ricinus ticks from the same study areas. Proteinic and antigenic analysis indicated that more than one genospecies were present in the tick population. This suggests that other vertebrate hosts may serve as reservoirs of other Borrelia genospecies implicated with Lyme disease.

Animals↗
PubMed1991

Health and health-related problems in a cohort of apprentices in Switzerland.

Out of a cohort of 1200 apprentices in Switzerland, 781 boys and 417 girls completed a questionnaire on their perceived health and health problems in their selected apprenticeship. Each participant was interviewed afterwards by the school nurses in three state-owned professional schools where the apprentices attended their classes. Ninety-five per cent of the respondents enjoyed excellent health, 28 cases had nervous system or psychological problems, 17 cases had problems of a locomotor nature, 12 subjects had gastrointestinal or endocrinological symptoms, and there was one with a past history of a malignant disease. Twelve cases also had respiratory symptoms or diagnoses. One hundred and nineteen apprentices reported that they had been troubled by the workplace. Exposure to solvents, chemicals in general, dust, smoke and noise were often mentioned as causes. Thirty-eight of them had contacted their family physician in connection with these problems. The cohort had experienced, mostly during their first year, 191 cases of accident necessitating medical care. Cuts, shocks and falls were the most common occurrences. Meat cutters and butchers had the highest frequency of accidents. Near-accidents had been experienced so far by 46 per cent of the respondents. At the interviews, school nurses provided counsel and intervened in flagrant cases of occupational risks. It seems that an ordinary medical certificate does not predict accident-proneness or possible medical problems, while in-school health programmes could provide rapid intervention and support.

Accidents, Occupational↗
PubMed1992

The circadian rhythm of the perinatal mortality rate in Switzerland.

The authors examine the relation between the perinatal mortality rate (PMR), birth weight in four categories, and hour of birth throughout the week in Switzerland, using data on 672,013 births and 5,764 perinatal deaths recorded between 1979 and 1987. From Monday to Friday, the PMR follows a circadian rhythm with a regular increase from early morning to evening, with a peak for babies born between 7 and 8 p.m. This pattern of variation has two main components: The circadian rhythms for the proportion of births in the four weight categories and the PMR circadian rhythm for babies weighing more than 2.5 kg. According to a cosinor model, which describes about 40% of the total variation in the PMR, the most important determinants are changes in the proportions of births: Low birth weight increases toward the afternoon and night. Mechanisms underlying the weight-specific timing of birth are discussed, including time selection of birth according to obstetric risks, the direct effect of neonatal and obstetric care, and chronobiologic behavior.

Birth Weight↗
PubMed1993

Epidemiologic pathology of ovarian cancer from the Vaud Cancer Registry, Switzerland.

OBJECTIVE: To provide further information on the descriptive epidemiology and survival of ovarian cancer patients by specific histologic types. STUDY DESIGN: Descriptive epidemiological study. Cases of ovarian cancer registered between 1974 and 1988 in the Vaud Cancer Registry, Switzerland (based on a population of approximately 530,000 inhabitants), were analysed. RESULTS: A total of 649 cases were registered, corresponding to an overall age-standardized (world population) incidence of 9.6/100,000. The most common histotype was serous carcinoma (41%, incidence rate 4.0/100,000), followed by endometrioid (13%), mucinous (12%), clear cell (5%), and undifferentiated carcinomas (3%); 20% of the cases were classified as 'epithelial, unspecified', and 6% were non-epithelial cancers. There was a tendency for the incidence of all epithelial types to rise up to the seventh decade of age, and to level off thereafter. The increases between the ages of 45 and 65 were, however, mostly in serous carcinomas whose proportion of total ovarian epithelial cancer peaked in middle age. Overall, 5-year relative survival was 32%. Survival rate was 32% for serous carcinomas, but was significantly higher for endometrioid (51%) and, among nonepithelial neoplasms, for germ-cell cancers (68%). Survival rates were poor for undifferentiated and 'epithelial, unspecified' carcinomas (16%). Relative survival was systematically higher below age 60 than at age 60 or over. In the two subsequent calendar periods examined (divided according to the approximate time when the use of platinum-based chemotherapy began to spread, i.e., 1982), 5-year relative survival rates were 28% and 36%, respectively (chi 1(2) = 6.1, p = 0.02). CONCLUSION: The present report is a population-based description of the epidemiologic pathology and prognosis of ovarian cancer, and provides evidence of a significant improvement of survival over the past decade. This may be due to changed diagnostic methods (e.g., ultrasonography), improved surgical approach, (platinum-based) chemotherapy, or a combination of all these factors.

Adult↗
PubMed1994

Descriptive epidemiology of early and advanced gastric cancer in Ticino, Switzerland, with special emphasis on time trends.

BACKGROUND: The main purpose of the study was to describe early gastric cancer (EGC) epidemiology in the population of Ticino, Switzerland (about 280,000 inhabitants) over the period 1981-1990, as compared with the epidemiology of overall gastric cancer (GC). PATIENTS AND METHODS: Incidence data were derived from the diagnosis data-file of the Cantonal Institute of Pathology. Numbers of certified deaths were abstracted from the registries of the Swiss Federal Office of Statistics. RESULTS: The age-standardized (world population) incidence was 1.6/100,000 males and 0.7/100,000 females for EGC (sex ratio: 2.3) and 19.8/100,000 males and 9.1/100,000 females for GC (sex ratio: 2.2). Age- and sex-specific incidence rates for GC and for EGC showed similar distribution patterns. Mortality rates from GC declined over the period considered by about 20% in both sexes, while incidence rates decreased by only about 7%, suggesting diminished lethality. There was a slight increase in EGC incidence, which was restricted to men younger than 65 years and women older than 64 years. CONCLUSIONS: EGC incidence rates were less than 10% of advanced gastric cancer incidence rates for both sexes and most age groups. Early and advanced gastric cancer had similar age and sex distributions. The downward trend in GC lethality over 1981-1990 was not entirely explained by the increase in the incidence of EGC.

Adult↗
PubMed1997

An economic analysis of ischaemic heart disease in Switzerland.

AIMS: Direct and indirect costs of ischaemic heart disease were assessed in Switzerland, for the period 1988-1993, in order to evaluate the economic consequences of more intensive treatment of the disease and of the decreasing mortality from ischaemic heart disease in the working population. METHODS AND RESULTS: A societal perspective was taken for a prevalence-based assessment of the direct (total resources consumed by outpatients and inpatients) and indirect (due to morbidity, invalidity, and premature death, using the human capital approach) costs. The results showed the total costs were 21 million US dollars per 100000 population in the year 1993 (47% direct, 53% indirect costs). The largest components were the direct costs of inpatient care and indirect costs due to premature death (each approximately 25% of the total). Trends showed a large increase in direct costs (+9% per year, constant dollars). Indirect costs stabilized or decreased slightly due to the reduction of work losses. CONCLUSIONS: Today's medicine and preventive measures have proven effective for ischaemic heart disease, although such remedies have required increasingly large financial resources. However, society benefits because indirect costs decrease, although this gain does not compensate for all direct costs.

Adult↗
PubMed1994

Fatal road accidents caused by sudden death of the driver in Finland and Vaud, Switzerland.

We investigated the incidence of fatal traffic accidents caused by sudden incapacity of the driver due to cardiac and other illnesses. The retrospective analysis was gleaned from Finnish traffic accident data files from 1984-1989, and police records of traffic accidents, from Canton de Vaud, Switzerland from 1986-1989. The annual rates of all traffic fatalities per million inhabitants were 125 in Finland and 212 in Vaud. Sudden driver incapacity due to acute illness caused 1.8 and 7.3 automobile driver deaths annually per million inhabitants in Finland and in Vaud, respectively. The corresponding rates for all-cause traffic deaths were 326 and 423, for driver deaths 105 and 167, and for those due to driver incapacity 4.7 and 15.6. Sudden driver incapacity caused 1.5% of all traffic deaths in Finland, and 3.4% in Vaud. Probable cardiac arrest caused 2.1% of all drivers' deaths in Finland and 1.7% in Vaud, respectively. Deaths caused by professional drivers' sudden incapacity were responsible for 0.11% of all traffic deaths in Finland, and for 0% in Vaud. Old age and short mileage were associated with illness-caused accidents. Accidents caused by sudden incapacity of the driver are rare causes of traffic deaths and hard to foresee. While this report relates to all drivers, we suggest there should be individual risk stratification for professional drivers with heart disease. However, non-professional drivers who are elderly and who have symptomatic cardiac disease should limit their driving to short distances and at low speed.

Accidents, Traffic↗
PubMed2001

A review of the properties of the dosimetric systems and the quality assurance programmes of 48 dosimetric services in the European Union and Switzerland.

This paper summarises the evaluation of the 1997 EURADOS questionnaire on dosimetric systems able to assess personal dose equivalent. In total, 56 approved dosimetric services in the European Union and Switzerland responded, together monitoring approximately 615,000 occupationally exposed persons. Of these services, 48 stated they were able to assess the external doses in terms of personal dose equivalent. The general aspects of the dosimetric systems and the quality assurance programmes of these services are discussed.

European Union↗
PubMed2001

Present status of approval procedures in the EU member states and Switzerland.

The European Union Council Directive 96/29/EURATOM requires that 'individual monitoring shall be ... based on individual measurements which are established by an approved dosimetric service' and that 'Each Member State shall make arrangements to recognise, as appropriate, the capacity of ... approved dosimetric services'. At present, approval of dosimetric services does not have the same meaning within EU Member States and Switzerland. In some countries, service and dosemeter approval is clearly separated, in some others only one of the two is supposed to be tested, and in others no approval is required. Dosimetric requirements and criteria are based on different international documents (e.g. IEC, ISO, ANSI, CEC report) or national specific rules. Approval frequency can be once, every 2 or more years. Approval can be based on either evaluation of technical and management reports, irradiation tests, inspection on-site or the three steps together. In most cases, approval involves photon dosimetry while beta and neutron dosimetry test procedures are not as well established. However, comparisons may lead to some convergent evolution of procedures and to a greater degree of harmonisation and quality consolidation.

European Union↗