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PubMed2004

Radiation exposure by radio-diagnostics in Switzerland: a pilot patient-oriented survey.

A patient-oriented survey was conducted in Switzerland with the aim to establishing the distribution of medical X-ray examinations among the population. A sample of 1235 people aged between 15 and 74 y (589 males and 637 females) was contacted. The participants were asked to give the number of medical X-ray examinations performed during the previous 12 months. Three-fourths of the sample did not undergo any medical X-ray examination during a 12 month-period, and 10% of the population underwent more than 1 medical X-ray examination in a year. These results were independent of the geographic region. The age distributions of the participants who did not undergo any medical X-ray examination and those who underwent one medical X-ray examination were similar. On the other hand, the age distribution of the participants who underwent more than one medical X-ray examination was characterised by a higher contribution from the elderly.

Adolescent↗
PubMed2004

Adult reference levels in diagnostic and interventional radiology for temporary use in Switzerland.

This work aims at establishing a set of diagnostic reference levels (DRLs) for various types of examinations performed in diagnostic and interventional radiology. The average doses for 257 types of radiological examinations were established during the 1998 nationwide survey on the exposure of the Swiss population by radiodiagnostics. They were calculated using appropriate dosimetric models and average technical parameters. The DRLs were derived from the average doses using a multiplying factor of 1.5. The DRLs obtained were rounded and compared to the data reported in the literature. The results are in most cases comparable to the DRLs determined by the 3rd-quartile method. These discrepancies registered in some cases, particularly for complex examinations, can be explained by significant differences in the protocols and/or the technical parameters used. A set of DRLs is proposed for a large number of examinations to be used in Switzerland as temporary values until a national dosimetric database is set up.

Adult↗
PubMed2006

Psychoeducation in schizophrenia--results of a survey of all psychiatric institutions in Germany, Austria, and Switzerland.

INTRODUCTION: Psychoeducation can reduce rehospitalization rates and mental health costs in schizophrenia. The aims of this study were to investigate the percentage of patients and family members participating in psychoeducation in the year 2003 and to evaluate how psychoeducation was conducted. METHODS: Part I of a 2-part postal survey was sent to the heads of all psychiatric institutions in Germany, Austria, and Switzerland; part II was sent directly to the moderators of psychoeducational groups. Responses were analyzed using descriptive statistics. RESULTS: Psychoeducation was offered in 86% of the responding institutions and in 84% of these for schizophrenia (response quotas: part I, 54%; part II, 55%). A mean of 21% of the patients with schizophrenia and 2% of their family members had taken part in psychoeducation in the responding institutions in the year 2003. DISCUSSION: Many readmissions and thus significant costs to the health system and substantial human suffering could be avoided if more patients and their family members participated in psychoeducation. New approaches to offering more psychoeducation would consist in integration of the entire psychiatric team into psychoeducation and peer-to-peer strategies.

Adaptation, Psychological↗
PubMed2003

Medical humanities: a new undergraduate teaching program at the University of Geneva School of Medicine, Switzerland.

In 2001, a new program of medical humanities was initiated at the University of Geneva School of Medicine in Switzerland. Four mandatory seminars and one optional 2-week internship are offered to second-through fifth-year medical students. The program has four interdependent goals: contextualizing, developing personal reflection and judgment, encouraging imagination, and offering specific ways to improve the quality of the therapeutic relationship. The program is based on an integrated vision of the humanities and stimulates the students' imagination and reflection in a way that medical students should find useful. Three steps help teachers to build an integrated vision: familiarization, confrontation, and adjustment to the medical culture. The mandatory seminars are taught by a team consisting of a physician and a humanities teacher. All the physicians, department heads, and clinicians involved in each seminar actively collaborated. The medical humanities program is in the Bioethics Unit, which is housed in the Department of Community Health and Medicine with medical history and legal medicine. This intellectual, institutional, and physical proximity encourages informal dialogue and ensures a more coherent and unified vision of the different disciplines. In their assessments of the program, students stated that the seminars gave them food for thought and met their expectations. However, it is premature to draw conclusions from these assessments because the program is still in its infancy. The program strives to provide students with tools specific to the humanities so that they can strengthen their own judgment, listening skills, open-mindedness, creativity, and curiosity, attributes that are needed to ensure that the therapeutic relationship will be satisfying for both physicians and patients.

Curriculum↗
PubMed1998

Impact of antiretroviral combination therapies on AIDS surveillance reports in Switzerland. Swiss HIV Cohort Study.

BACKGROUND: AIDS reporting in Switzerland is mandatory by law. For the first time since the beginning of the epidemic, health authorities observed a decline in AIDS surveillance reports, from 545 new cases in 1995 to 459 in 1996, a decrease of 86 cases. OBJECTIVE: To examine the extent to which this decline in AIDS surveillance reports is attributable to the introduction of antiretroviral combination therapy. PATIENTS AND SETTING: Swiss HIV Cohort Study, a multicentre cohort of adult HIV-infected patients with national coverage. Participants at risk of developing a first AIDS-defining event, defined as persons with a CD4 cell count below 200 x 10(6)/l or in clinical stage B, were studied. METHODS: A parametric statistical survival model was used to estimate the number of AIDS cases expected in the absence of combination therapies. Taking reporting delays into account, the effect of the introduction of combination therapies in the cohort on national AIDS reports was estimated from the difference between the number of expected and observed cases. RESULTS: A total of 4915 participants contributed 10755 person-years and 2366 initial AIDS events. Between 1990 and 1994, about 35% received antiretroviral therapy, predominantly monotherapy. In 1995 and 1996, the prevalence of antiretroviral therapy increased steadily due to the introduction of dual and triple combinations. The mid-year prevalence of use of combination therapies was 6% in 1994, 13% in 1995, and 48% in 1996. The difference between expected and observed cases per half-year increased from 12 in the first 6 months of 1994 to 69 in the second half of 1996. Taking reporting delays into account, we estimated that 43 (95% confidence interval, 17-69) of the deficit of 86 reports could be attributed to combination therapies. CONCLUSION: The introduction of antiretroviral combination therapies in a single cohort study explained 50% of the decline in national AIDS surveillance reports. Monitoring the use and effectiveness of antiretroviral therapy must become an important component of AIDS surveillance systems.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Indoor Rn levels in different geological areas in Switzerland.

The distribution of indoor Rn concentrations in different geological areas in Switzerland was studied using passive alpha-track detectors. Measurements involving a sample of 400 single-family homes were made in the cellar, on the ground floor and the first floor, respectively. On the basis of a pilot survey, the country was divided into four zones in which the Rn distribution in houses was analyzed separately. The indoor exposure to Rn and Rn decay products is quite variable from region to region. The geology of the different areas was found to be an important factor in determining the mean value Rn levels. In the basin north of the Alps, where the population centers are located, a median Rn gas level of 47 Bq m-3 for the living area was found. The arithmetic mean value of 60 Bq m-3 in this region leads to an annual effective dose equivalent of about 1.8 mSv. For the population living in alpine areas, an arithmetic mean value exceeding 200 Bq m-3 will lead to an annual effective dose equivalent in the range of 6 mSv. The estimated exposure to Rn and Rn decay products for the upper one-percentile of the homes in the most affected alpine region even exceeds the annual limit of 50 mSv effective dose equivalent for occupational exposure.

Air Pollutants↗
PubMed1995

The national dose registry for radiation workers in Switzerland.

The national dose registry began operation in Switzerland in 1990. It is a database maintained by the Federal Office of Public Health. It contains personal, employment, and dosimetric data for all the radiation workers in the country. The data for about 60,000 currently employed radiation workers are transferred from ten external dosimetry services to the registry every month or every three months. The registry was initiated to assist national authorities in controlling and safekeeping of the occupational doses and to allow statistical evaluations. In autumn 1994 the new Radiation Protection Regulations came into effect. Based on the ICRP recommendations, the Regulations introduced lower limits for the annual dose, for the average dose over five years, and for pregnant women and defined the internal dose as an additive component to the total dose. All these items require a high quality registration of occupational doses. This can hardly be achieved without a central registry. This paper describes the design of the Swiss national dose registry in the frame of the particular organization of the personal dosimetry in this country. The database structure and the information content are presented. Special solutions for the data transfer have been found, as the registry is running completely decoupled from the dosimetry services. Applications of the registry for regulatory control, particularly in connection with the new Regulations are described. Some results of statistical analyses are presented. The possibilities and the limitations of using the registry for radioepidemiological studies are discussed.

Databases, Factual↗
PubMed2004

Detection and molecular characterization of Cryptosporidium spp. isolated from diarrheic children in Switzerland.

The prevalence of Cryptosporidium spp. in diarrheic immunocompetent children living in Switzerland was 5.5% (15 of 273). Infection rates increased significantly with age. Anthroponotic Cryptosporidium hominis was identified in 11 children, 9 with a travel history. The zoonotic Cryptosporidium parvum bovine genotype was identified in 3 children (2 without travel history). Hence transmission of Cryptosporidium spp. is primarily of anthroponotic nature in the study area.

Acute Disease↗
PubMedDate not supplied

Condom use among patients attending six sexually transmitted disease clinics in Switzerland.

BACKGROUND AND OBJECTIVES: Persons treated for a sexually transmitted disease have been shown to be at increased risk for human immunodeficiency virus infection. Levels of condom use among these patients are presented, and sociodemographic and behavioral factors associated with self-reported never use of condoms are analyzed. STUDY DESIGN: This was a cross-sectional study of 2,257 patients treated at six sexually transmitted disease clinics in Switzerland between July 1990 and December 1992. RESULTS: Overall, 46.3% of the patients reported that they had never used condoms. Among heterosexual men, this level was 48.3% (n = 1,751), among homosexual and bisexual men it was 21.6% (n = 268), and among heterosexual women it was 60.1% (n = 238). In a logistic multivariate regression analysis, factors significantly associated with never use of condoms among heterosexual men included age over 29 years, not of Swiss origin, low level of education, few partners in the previous 6 months, contraction of the sexually transmitted disease from a stable partner, and not being an injecting drug user. CONCLUSION: These results document the high levels of condoms never being used in this population and highlight the importance of condom promotion activities provided by sexually transmitted disease clinics.

Adolescent↗
PubMed1992

Oesophageal cancer in France and Switzerland: recent time trends.

This paper reports the incidence of oesophageal carcinoma in five cancer registries from France and in a further two from the francophone regions of Switzerland. The cancers are segregated into the two main histological types (squamous cell carcinoma and adenocarcinoma). In Belgium the proportion of adenocarcinomas is much higher than in any of the French registries. A study of time trends shows no clear trend in overall incidence of oesophageal cancer. There is a trend towards an increasing proportion of adenocarcinomas with time, that is most apparent in Doubs, Dijon and Vaud registries.

Adenocarcinoma↗
PubMed2004

The impact of coding process on observed cancer mortality trends in Switzerland.

Official cancer mortality in Switzerland decreased by about 16% over the 9-year period 1990-1998 and this trend has often been used to suggest that secondary prevention by screening for breast cancer could be useless. However, the clear downshift observed between 1994 and 1995 for some cancers, such as female breast and prostate, and the simultaneous change in ICD classification used by the Federal Office for Statistics in 1995 (ICD-8 to ICD-10) could be related, suggesting an impact of coding process on the observed trend. For every death occurred between 1980 and 1999, the death certificates have been retrieved, the cause of death has been recoded and site-specific mortality rates have been calculated again for each year during this period. As suggested, the trend appears to be overestimated: in order to be comparable with current rates, the mortality observed before 1995 should be lowered by about 7% for men and 5% for women. The error may be partially due to attributing the cause of death to co-morbidity factors not normally (and nowadays) defined as the underlying cause. Logically, the impact of such a miscoding is more important among older people and for cancer sites with long survival. For instance, the correction should be around 15% for female breast, 12% for prostate and up to 40% for testicular cancer.

Age Factors↗
PubMed1998

Discordant public perception of doping in elite versus recreational sport in Switzerland.

OBJECTIVE: To assess public awareness of performance-enhancing drug use, that is, doping in sport in Switzerland. DESIGN: Representative telephone survey in September 1995. SETTING: Two of the three Swiss linguistic areas (French and German), representing 96% of the entire Swiss population. SUBJECTS: A total of 1201 respondents between 18 to 74 years old, selected by stratified random sampling. MAIN OUTCOME MEASURES: Perception of the doping problem in elite versus recreational sport, estimated prevalence of doping in different sports, parents' decisions to keep children out of sport because of doping. RESULTS: The use of doping in sport was perceived as a "somewhat serious problem" or "very serious problem" by 84% of the respondents for elite sport and by 44% for recreational sport (p < 0.01 for difference). Doping was mostly perceived to represent a physical health problem or an ethical problem. Track and field (79%) and cycling (27%) were most often cited as sports having doping problems, and 35% of the respondents believed that > 60% of bodybuilders use doping. The black market (91%), athletes and trainers (80%), and fitness centers (74%) were the most frequently mentioned sources of doping substances. Thirteen of 14 parents would not dissuade their children from participating in sport because of a concern about the problems of doping. CONCLUSIONS: The Swiss population perceives a high prevalence of doping in sports. There is a clear distinction, however, made by the respondents between the estimated prevalence of doping in elite sport, seen overwhelmingly as a "very serious problem" or "somewhat serious problem," and recreational sport, in which doping is less often seen as a problem. Doping is considered a serious threat to health and ethics in sport, but despite this judgment, only a few parents would hold back their children from sport because of the risks of doping.

Adolescent↗
PubMed1989

Disabling backache in France, Switzerland, and The Netherlands: contrasting sociopolitical constraints on clinical judgment.

A century has passed since clinicians assumed a linchpin role in the administration of programs to provide recourse and redress for persons suffering the illness of work incapacity. Medicine was asked to certify whether the illness was an injury in the absence of trauma, to ascertain whether further healing was possible, and to quantify the residual functional capacity. The response has been to force the vagaries of clinical judgment into the programmatic algorithm. No country has abandoned or redirected all three of these charges. Physicians have generally remained passive or intransigent as the society in which they function attempts to compensate for the indeterminate nature of these clinical questions. The current study compares the fashion in which the programs in Holland, Switzerland, and France have evolved in response to the clinical uncertainties. The Dutch have discarded the accident question. The Swiss emphasize the accident issue but consider the work-relatedness of the event to be irrelevant. The French have honed the traditional paradigm and have added a tier of clinical judgment within the program to monitor that without. These and other distinctions should cause all physicians to question their own convictions with regard to the three issues and, further, to question whether the basic paradigm is clinically flawed and therapeutically counterproductive.

Accidents, Occupational↗
PubMed2006

Stable virulence levels in the HIV epidemic of Switzerland over two decades.

OBJECTIVE: To determine whether the virulence of HIV-1 has been changing since its introduction into Switzerland. DESIGN: A prospective cohort study of HIV-1 infected individuals with well-characterized pre-therapy disease history. METHODS: To minimize the effect of recently imported viruses and ethnicity-associated host factors, the analysis was restricted to the white, north-west-European majority population of the cohort. Virulence was characterized by the decline slope of the CD4 cell count (n = 817 patients), the decline slope of the CD4:CD8 ratio (n = 815 patients) and the viral setpoint (n = 549 patients) in untreated patients with sufficient data points. Linear regression models were used to detect correlations between the date of diagnosis (ranging between 1984 and 2003) and the virulence markers, controlling for gender, exposure category, age and CD4 cell count at entry. RESULTS: We found no correlation between any of the virulence markers and the date of diagnosis. Inspection of short-term trends confirmed that virulence has fluctuated around a stable level over time. CONCLUSIONS: The lack of long-term time trends in the virulence markers indicates that HIV-1 is not evolving towards increasing or decreasing virulence at a perceptible rate. Both highly virulent and attenuated strains have apparently been unable to spread at the population level. This result suggests that either the evolution of virulence may be slow or inhibited due to evolutionary constraints, or HIV-1 may have already evolved to optimal virulence in the human host.

Adult↗
PubMed2006

Trends in cancer mortality in Switzerland, 1980-2001.

Trends in cancer mortality in Switzerland were analysed over the period 1980-2001, on the basis of the World Health Organization database. Appropriately developed correction factors were utilized for the period before 1995, to allow for spurious trends introduced by the change between the 8th and the 10th revisions of the ICD. Steady declines in cancer mortality were observed, particularly from the mid-1980s onwards. Over the last decade, the fall in overall age-standardized (world standard) cancer mortality was 11.1% in men (from 158.1 in 1990-1991 to 140.6/100,000 in 2000-2001) and 7.6% in women (from 91.6 to 84.7/100,000), and the decline was larger in truncated rates from 35 to 64 years (-18.0 and -9.7%). In men, all major tobacco and alcohol neoplasms have declined until the late 1990s but have levelled off over the last few years, reflecting recent trends in alcohol and tobacco consumption. The fall in male lung cancer mortality was 20% over the last decade (from 42.9 to 34.3/100,000). In contrast, lung cancer mortality in women has steadily increased by 38% between 1981 and 1991 and by 47% between 1991 and 2001, to reach 10.7/100,000 at all ages and 18.3 at age 35 to 64, due to increased prevalence of smoking in subsequent generations of Swiss women. Other sites showing substantial declines include stomach and colorectum in both sexes, (cervix) uteri and breast in women. Likewise, prostate cancer showed modest favourable trends after 1995. Steady declines were observed for leukaemias, Hodgkin's disease and testicular cancer, namely, the neoplasms most influenced by therapeutic improvements, while trends in lymphomas and myeloma showed no clear pattern.

Adult↗
PubMed2006

Unexpected additional increase in the incidence of thyroid cancer among a recent birth cohort in Switzerland.

Data collected by the Swiss Cancer Registries Network (ASRT/VSKR) have been used to analyse trends in thyroid cancer during the last available 20 years, to make within-country geographical comparisons for current incidence rates. Age-standardized (European population) incidence rates per 100,000 for all morphologies combined ranges from 1.62 to 2.99 among males and from 2.13 to 8.09 among females in Switzerland. Regression analyses for both sexes combined detected an increase in time for papillary cases and a decrease for other types. Age-period-cohort analyses revealed that the youngest cohorts of men and women born after 1940 had an increased risk of all types of thyroid cancer while the cohort of people born between 1920 and 1939 were at increased risk of the papillary subtype. Assuming a higher sensitivity to ionizing radiation among the youngest people, a Chernobyl effect cannot be definitively excluded and continuous study of this topic should be encouraged.

Adenocarcinoma↗
PubMed2007

Surveillance systems for sexually transmitted diseases in Switzerland.

BACKGROUND: In Switzerland (population 7.4 million), 3 different systems contribute to surveillance for sexually transmitted infections. GOAL: The goal of this study was to compare time trends from surveillance systems for chlamydia, gonorrhea, and syphilis. STUDY DESIGN: We studied surveillance data (1997-2003) from laboratory reports in women and men, men attending dermatology clinics, and women attending gynecologists. RESULTS: Laboratory reports of episodes of Chlamydia trachomatis and Neisseria gonorrhoeae increased by 31% (from 2573 to 3449 cases) and 104% (from 259 to 528 cases), respectively. Over the same period, chlamydia reports from men attending dermatology clinics and women attending gynecologists did not change and dermatology clinic-based reports of gonorrhea in men increased only slightly. Syphilis reports from dermatology clinics increased by 127% (from 22 to 50 cases). CONCLUSIONS: Increases in laboratory reports of chlamydia and gonorrhea were not consistently detected in sentinel populations. Numbers of cases reported to all 3 systems were low. The performance of surveillance systems for sexually transmitted infections should be evaluated regularly.

Adolescent↗
PubMed1989

The pachypleurosaurids (Reptilia: Nothosauria) from the middle triassic of Monte San Giorgio (Switzerland) with the description of a new species.

The largest and most diverse collection of Pachypleurosauridae (Nothosauria, Reptilia) comes from Monte San Giorgio, Switzerland. Several hundred complete skeletons were collected from four distinct horizons of bituminous limestones and shales of Anisian-Ladinian boundary to early Ladinian age (Middle Triassic). Serpianosaurus mirigiolensis comes from the oldest strata, the Grenzbitumenzone Beds. The three younger strata, all in the Lower Meride Limestone, yield three species of Neusticosaurus. Neusticosaurus pusillus comes from the Cava Inferiore horizon, Neusticosaurus peyeri, new species, from the Cava Superiore horizon, and Neusticosaurus edwardsii, new combination, from the Alla Cascina horizon. Neusticosaurus pusillus is biostratigraphically important because it is one of the rare species reported from both the Germanic and the Alpine Triassic. Neusticosaurus pusillus and N. peyeri are small and very similar in their anatomy. Neusticosaurus species are easiest separated by their number of presacral vertebrae. Ornamentation of the bone surface is distinctive for all four pachypleurosaurids. Soft parts are rarely preserved, except for one partial squamation. The biological age of Neusticosaurus individuals can be determined by skeletochronology (aging by bone annuli). Small species of Neusticosaurus were sexually mature after three to four years and lived for six to nine years. Taphonomic analysis of the small species indicates attritional mortality and suggests weak bottom currents in the Monte San Giorgio basin during early Ladinian times. Morphometric comparison of all four pachypleurosaurids indicates that the changing vertebral numbers between species are largely due to a change in number of segments. All Monte San Giorgio pachypleurosaurids are sexually dimorphic in forelimb development. Sex x has poorly differentiated and relatively short humeri whereas sex y has well differentiated and relatively long humeri. The sexes are of about the same size and represented in roughly equal numbers. Identification of gender was not possible. Good growth series, especially of Neusticosaurus peyeri, from embryo to large adult permitted qualitative and quantitative study of ontogeny. The skull grows with negative allometry; the humerus grows isometrically or with positive allometry, depending on sex and species; the femur grows isometrically. The adult size range in N. peyeri is considerably larger than in modern reptiles. The Monte San Giorgio pachypleurosaurids are a monophyletic group. The phylogeny of this group is congruent with the stratigraphic distribution of its members.

Animals↗