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PubMed2000

[The final stage of rabies in Switzerland].

Since summer 1989, rabies in Switzerland has been restricted to the Jura Mountains in the north-west of the country. Even there, the last endemic focus disappeared in 1990, but a re-infection in the same year caused a new flare-up of the epizootic. Until 1994, the number of rabies cases increased again to 225. Control measures were intensified with doubled vaccination campaigns, increased bait densities, and additional vaccination campaigns to immunize young foxes at the den. As a consequence, the number of cases dropped to 25 in 1995 and to 6 in 1996. On December 21, 1996, the last endemic case of rabies in Switzerland was registered. After two years of continuing vaccination campaigns and surveillance, Switzerland became officially rabies-free at the beginning of 1999. In the present paper, we analyse the final stage of the epizootic. The re-infection in 1990 was caused by infected foxes immigrating from France, but as the immunization of the fox population in Switzerland was insufficient, the disease became again endemic immediately. The lacking herd immunity was partly a consequence of problems related to the vaccination system and even more of the rapid increase of the fox population.

Animals↗
PubMed2000

[Accidental morbidity in adolescence: a retrospective study in 12 to 15 year-old school children in Switzerland] .

Mortality and morbidity from injuries in the adolescent population is substantial in Switzerland as all over the world. The estimation of morbidity from injuries is difficult and depends on the design of the study. Little information is available on morbidity between ages 12 and 15. The Health Behaviour in School-Aged Children (HBSC) study is an international survey based on a self-administered questionnaire for which the Swiss Institute for Prevention of Alcohol and Drug Problems (SIPA) is responsible in Switzerland. 7196 schoolchildren aged 12 to 15 participated in the 1998 survey. Questions covered subjects such as health and health behaviour. A few questions covered injuries, with reference to frequency, context and consequences. 45.3% of adolescents have been treated at least once by a nurse or a doctor for an injury during the past 12 months. It can be deduced that nearly 149,000 adolescents aged between 12 and 15 are injured in more than 260,000 accidents in Switzerland. The rate of injury is 793 per 1000 adolescents per year. Furthermore, one adolescent out of ten injures himself three times or more per year. In conclusion, morbidity due to injuries in adolescents aged 12 to 15 in Switzerland is therefore considerable. This study demonstrates the high prevalence of repeated injuries in adolescents.

Accidents↗
PubMed1985

[Typhus epidemiology in Switzerland 1980-1983. Slight or lack of effectiveness of the live vaccine Vivotif in tropical travel].

214 cases of typhoid fever (TF) occurring in Switzerland between January 1980 and December 1984 were analyzed for travel history, vaccine status and nationality. A subgroup of Swiss tourists who acquired TF in India was compared to a sample of healthy Swiss tourists who travelled to India in 1983 to determine the factors predisposing to TF. Eighty cases of TF occurred in Swiss tourists to the Third World, of whom 26 had travelled in India. Among the latter, the length of stay was longer than in the control sample of 258 healthy tourists, and "trekking" (travelling off the usual tourist routes with backpacking) was more frequent. 20 of the 80 patients had been vaccinated with the live oral typhoid vaccine Vivotif (strain S. typhi Ty 21a, contained in gelatine capsules, to be taken with bicarbonate capsules), marketed in Switzerland in 1981-1984. Comparison of the vaccination rates in case and control groups indicated that the vaccine efficacy was not significantly different from 0% during the time of observation. This lack of efficacy may be related to inadequate dosage and to the lack of stability of the vaccine. Forty cases of TF occurred in Swiss who had travelled in European countries, of whom 8 had not travelled outside Switzerland. The remaining 94 cases occurred in non-Swiss travellers, a majority of whom were from Mediterranean countries. TF in Switzerland was associated with a history of travel in 96% of cases. The live oral typhoid vaccine Vivotif was ineffective between 1981 and 1983.(ABSTRACT TRUNCATED AT 250 WORDS)

Carrier State↗
PubMed1995

[Tuberculosis in Switzerland].

In Switzerland, in 1992, 957 persons suffered from tuberculosis; 52.3% were Swiss, 47.7% foreigners. Most of the swiss TB patients were more than 65 years old, whereas the foreigners generally were young patients originating from countries with high TB-infection rates. Asylum seekers had much higher TB-case rates (131 cases per 100,000) than other foreigners (27 cases per 100,000) or Swiss (9 cases per 100,000). Special refuge reception centers have been set up in Switzerland, in charge of tuberculosis screening procedures in this high-risk group on arrival to this country. Although HIV and AIDS patients bear a much higher risk of developing tuberculosis once infected, the HIV epidemic did not lead to an increase of tuberculosis in Switzerland so far, since young Swiss are rarely infected with tuberculosis. HIV-infected, drug addicts, homeless persons and alcoholics run a higher risk of contracting tuberculosis only when congregating with a person suffering from active tuberculosis not yet diagnosed or improperly treated. In order to maintain low levels of tuberculosis in Switzerland DOT (directly observed therapy) must be implemented in all patients with uncertain compliance, especially as cultural and social backgrounds become increasingly complex.

Adolescent↗
PubMed1995

[The epidemiology of contagious lung disease in Switzerland].

Although contagious bovine pleuropneumonia (CBPP) has not been diagnosed in Switzerland since 1895, anti-CBPP antibodies were detected in several cattle that had been imported from Switzerland to Italy. In order to clarify the current disease situation in Switzerland, detailed epidemiological investigations were performed, including the control of 200,000 slaughter cattle in 108 abattoirs and serological testing of more than 2200 animals from 134 farms. The data collected in the slaughterhouses showed a prevalence of suspect lung lesions of 0.04%. Yet, the causing agent of CBPP Mycoplasma mycoides subsp. mycoides SC could not be isolated from any of these 84 microbiologically analysed lungs. On the other hand, up to 3.5% positive results were obtained from the serological tests. These results are most probably caused by cross-reactions of other mycoplasma. Based on these data Switzerland is still to be considered free of CBPP. Nevertheless, a continued surveillance programme including routine checks of all cattle carcasses at the abattoir and subsequent epidemiological investigation of suspect cases are recommended.

Animals↗
PubMed1996

[Monitoring of a whooping cough epidemic 1994/95 in Switzerland using the sentinel notification system. Sentinella Registry].

Since June 1991 pertussis cases have been reported in the Swiss Sentinel Network (Sentinella). A total of 150-200 general practitioners, physicians specialized in internal medicine, and pediatricians participate in this system on a voluntary basis. Of the three specialties involved, this non-randomized sample represents 3.0%-3.5% of all physicians registered in Switzerland. The objective of this surveillance system is to monitor clinical pertussis over time. The case definition included all patients with a cough illness lasting at least 14 days with one of the following: paroxysms of cough, inspiratory "whoop", post-tussive vomiting (sporadic cases), or an epidemiological link to a pertussis case (epidemic cases). A laboratory diagnosis based on the polymerase chain reaction technique (PCR) was available for 82.7% of cases reported in 1994 and 1995. Of these, 27.7% had a positive PCR result. Reports of epidemic pertussis tested for Bordetella pertussis by PCR were confirmed by the laboratory in 46.5% of cases. The laboratory confirmation rate was more than twice as high among epidemic cases than among sporadic cases (20.7%). The crude incidence rate of whooping cough was 70 cases per 100,000 population per year in 1992 and 1993. Compared to previous years, pertussis incidence was significantly higher in 1994 and 1995 (370 cases per 100,000 population and 280 cases per 100,000 population respectively). The increase in reports was especially marked between July and October 1994 and whooping cough became epidemic in the third trimester of 1994 and at the beginning of 1995. In these 2 years, Switzerland experienced an estimated 40,000 clinical pertussis cases. Based on the proportion of PCR-positive pertussis cases in the sentinel sample, 12,500 of these would have been laboratory-confirmed. Most cases were observed in infants and in children up to 6 years of age. Assuming a vaccination coverage of 90%, the global efficacy of vaccination (3 or more doses versus less than 3) for 1994 and 1995 among children aged 12 to 47 months and not born before 1991 was 0.74 (0.59 and 0.88 for a vaccination coverage of 85% and 95% respectively). Vaccine efficacy was higher in PCR-positive cases (0.87; 0.79; 0.94) than in PCR-negative cases (0.54; 0.27; 0.78). Vaccination efficacy estimates on the basis of surveillance data are certainly less precise than those inferred from clinical trials. However, our results indicate that the efficacy of vaccination in children significantly declined with increasing age. Whooping cough still has the potential to cause epidemics in Switzerland in spite of a high vaccination coverage. With the introduction of acellular pertussis vaccines and new vaccination schemes in Switzerland, the Swiss Sentinel Network fulfills an important task as a monitoring system and contributes to the evaluation of new vaccination strategies.

Bordetella pertussis↗
PubMed1998

[Is dirofilariasis in dogs spreading in south Switzerland?].

Microfilarial infections could be detected by the Difil Test in 11 (2.2%) of 479 blood samples of clinically asymptomatic dogs from the South of Switzerland. Dirofilaria repens and D. immitis were identified in 3 (0.6%) and 8 dogs (1.6%), respectively, by the acid phosphatase activity of the microfilariae. 10 dogs with microfilaremia had been abroad or a stay outside Switzerland could not be excluded. One dog diagnosed with D. immitis could have had acquired the infection in the canton Tessin according to information given by the owner. Dogs with microfilaremia are a potential source of infection for mosquitoes. An indigenous cycle of infection in the South of Switzerland is possible since the mean average temperature in summer is above 18 degrees C which is necessary for optimal parasite development in the vector. A strict control of imported dogs or animals exposed to the disease in endemic regions as well as the therapy of infected dogs in the South of Switzerland is advisable.

Acid Phosphatase↗
PubMed2005

Prevalence of psychotropic drug use in nursing homes for the aged in Quebec and in the French-speaking area of Switzerland.

BACKGROUND: The use of psychotropic drugs is high in institutionalised elderly, which raises the question of its appropriateness. This study aimed to: (1) estimate the use of psychotropics, for each family, in terms of the prevalence and dosage among the elderly in nursing homes in French-speaking Switzerland and Quebec; and (2) assess, for each family of psychotropic drugs and for each care facility, the prevalence of use and departure from average prescription (ratio of observed-to-expected prevalence). METHOD: An administrative database was used for this cross-sectional analysis. The sample included 8183 Quebec and 7592 Swiss long-term care residents. Three classes of psychotropics (antipsychotics, antidepressants, hypnotics-anxiolytics) were defined as dichotomous variables. Logistic regressions were conducted to identify residents characteristics associated with the use of each psychotropic type and to compute expected prevalence. RESULTS: Swiss residents were slightly older and less dependent than Quebec residents. Use of psychotropic drugs was higher in Swiss than in Quebec residents, on the whole as well as for each family of drug. A total of 78.1% of Swiss residents used at least one drug as compared to 66.9% in Quebec. Ninety percent of residents were given less than 7 defined daily doses per week, irrespective of the drug family. According to Beer's criteria, only 4.9% of prescriptions were inadequate. In Quebec and in Switzerland, the prevalence of antidepressant use was associated with the prevalence of hypnotic-anxiolytic use. No ratios of observed-to-expected reached statistical significance. INTERPRETATION: There was a considerable use of psychotropics in Quebec and Switzerland with, seemingly, no dramatic departure from the average practice. Our data cannot tell if there is a global overuse of psychotropics, but indicated that dosage and medication selection seem adequate. Physicians should critically reassess the necessity of prescribed medications for their patients.

Activities of Daily Living↗
PubMed1993

International comparison of asthma prevalence in children: Australia, Switzerland, Chile.

The aim of the study was to determine if the prevalence of symptoms suggestive of asthma in school-age children was similar in three countries with differing language and culture. To answer this question, we used the same instrument, translated appropriately, for schoolchildren in Melbourne, Australia, St. Gallen, Switzerland, and La Serena, Chile. A three page respiratory symptoms questionnaire was issued to schools for distribution to children for completion by parents and return to the school. Three age groups were selected for study, based on the average age of the school grade. Grades were used with average ages of 7, 12, and 15 years, respectively. A total of 26,628 questionnaires were issued to parents (Australia, 10,981; Switzerland, 4,464; Chile, 11,183). The response rates for each country were 89% for Australia, 97.5% for Switzerland, and 71% for Chile. The prevalence of wheezing in the last 12 months for 7 year olds was 23.1% in Melbourne, 7.4% in St. Gallen, and 26.5% in La Serena; for 12 year olds it was 20.9% in Melbourne, 6.0% in St. Gallen, and 21.1% in La Serena; for 15 year olds it was 18.6% in Melbourne, 4.5% in St. Gallen, and 17.7% in La Serene. A history of wheezing was more common in boys than girls at age 7 in Melbourne and St. Gallen, but not La Serena. This difference was less at age 12 and was not seen at age 15. Among those who had reported wheezing in the last 12 months, bronchodilator use was reported by 83% (1,611/1,948) from Melbourne, 46% (118/259) from St. Gallen, and 47% (538/1,140) from La Serena.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Tetanus in Switzerland 1980-1989.

Tetanus cases that occurred in Switzerland between 1980 and 1989 have been reviewed with the help of three data surveillance systems: a) morbidity data from the Federal Office of Public Health (FOPH), b) mortality data from the Swiss Federal Statistical Office (SFSO), and c) data from the Association of Swiss Hospitals and Clinics (VESKA), completed by a written enquiry to clinics which did not (or only partly) participate in the VESKA system during the study period. For every case, a questionnaire was sent to the clinic to verify the diagnosis and to obtain additional information on the circumstances of occurrence. Ninety-one cases were identified. This corresponds to a yearly incidence of 1.93 per million population between 1980-84 and 0.88 for the 1985-89 period (p < 0.01). Eighty-one percent of the cases were older than 50 years of age and women were significantly more frequently affected than men. None of the cases identified had a documented primary immunization series. Data available at the FOPH and SFSO level have been compared to data obtained through the VESKA system using the Chandra Sekhar and Deming method. It is estimated that 134 tetanus cases (95% CI: 91-197) have occurred in Switzerland between 1980 and 1989, together with 28 deaths (95% CI: 27-31). Based on these estimates, FOPH appears to detect only 6-13% of tetanus cases occurring in Switzerland. By contrast, SFSO had fairly consistent data for 81-100% of tetanus associated deaths. The low rate of tetanus reported by physicians necessitates a sustained effort to increase the understanding of epidemiological surveillance by Swiss practitioners.

Adolescent↗
PubMed2000

A survey of institutional influenza vaccination in Switzerland.

In June 1998, a questionnaire was sent to evaluate the influenza vaccination practices in Switzerland: 429 health care institutions were to assess the level of influenza vaccination and the coverage of specific groups; each institution was required to specify whether vaccination coverage was known precisely (based on recorded data) or estimated. The response rate was 42.4%. Among institutions which responded, the mean accurate vaccination coverage rate for all patients was 40% and the estimated rate was 29%; these rates were slightly higher for people older than 65 years. For the entire staff, the accurate vaccination rate was 16% (14% estimated) whilst for the medical staff, the mean coverage was higher at 30% (measured) and 16% (estimated). The mean vaccination rate for patients and residents was 59% in the French speaking region of Switzerland, 54% in the Italian speaking canton, but only 37% in the German speaking region. The same ranking was found for vaccination coverage of medical staff: 21% in the French speaking region, 15% in the Italian speaking canton, and 13% in German speaking areas. These results suggest that cultural differences could play an important role in the attitudes and behaviour of the population regarding influenza vaccination programmes among the linguistic regions in Switzerland.

Aged↗
PubMed1997

[Influenza surveillance in Switzerland].

The Swiss Sentinel Network (SSN) has monitored influenza activity in Switzerland since 1986. Between 2600 and 6600 cases of influenza-like-illness (ILI) are reported each influenza season by the 150-200 general practitioners, internists and paediatricians who voluntarily participate in the SSN. Based on these figures, there are an estimated 100,000 to 230,000 cases of ILI in Switzerland each year during the main influenza-season (10 week-peak-periods). Among patients over 60 years, 13% to 20% developed pneumonia and 1.3% to 2.7% had to be hospitalised. This represents an estimated 1800 hospitalisations caused by influenza for the country as a whole each year. Based on data from the Swiss Medical Statistic VESKA (H+), there are an estimated 1600 hospitalisations per year, confirming the estimation of the SSN. Collaboration with the Swiss National Center for influenza allows identifications of circulating influenza-strains and the determination of eventual deviations from the vaccine strains. The SSN has been a valuable surveillance tool during the last ten years and has provided useful data on the extent and importance of influenza in Switzerland. It therefore makes an important contribution to the elaboration of targeted and appropriate prevention measures against influenza.

Adolescent↗
PubMedDate not supplied

[Demography and medicine in Switzerland: medical manpower and project "DEMOMED"].

The situation as regards medical manpower in Switzerland in 1975 is characterized by high enrollment in the medical schools and a doubling time for the number of physicians in practice of approximately twenty years. A federal commission concerned with problems related to medical studies (CEPREM) conducted a study aiming at defining an optimum figure for intake of students into the medical schools. A survey of the international literature and a statistical study of availability of physician services region by region in Switzerland were conducted. The results show that it is impossible to define with precision an optimum "medical density" for Switzerland. The system of health and the functions of its various professions are not defined, and powers of decision in this field are not uniformly attributed. In the national survey, the most striking feature was disparity between various regions as regards access to medical or paramedical services. This disparity is parallel to state of economical development, and unlikely to be corrected even by an excess of overall medical manpower. Four hypotheses are presented on the consequences of increase, decrease, or stable enrolment in the medical schools. We conclude that there is no technical basis for defining an optimal medical density, but that it would be reasonable to decrease the number of second-year students by a factor of the order of 25% on the basis of a political decision.

Physicians↗
PubMed1983

[Results of recent intervention studies on prevention of heart disease and their significance for Switzerland].

Recently published intervention studies and their implications for Switzerland. Recently published results of large scale intervention studies (Multiple Risk Factor Intervention Trial, MRFIT, and European Intervention Study, World Health Organization European Collaborative Group) seem to question, according to some observers, the basis of population oriented cardiovascular prevention. As the National Research Program 1A "Prevention of Cardiovascular Disease in Switzerland" was based on the same assumptions regarding the relationship of risk factors and cardiovascular disease, the authors discussed the implication of the two studies for Switzerland. A detailed analysis of the European Intervention Study shows, that in spite of the overall non-significant mortality reduction of 8% there were important differences between participating countries, With significant differences in Belgium and Italy, both with innovative health education programs. MRFIT shows an important reduction of risk factors also in the control group, indicating a beneficial effect of "usual care" by practising physicians. Together with the recent recommendations of a WHO expert committee the authors conclude, that the two studies do not invalidate the principles of cardiovascular prevention.

Adult↗
PubMed1997

Incidence and direct medical costs of hospitalizations due to osteoporotic fractures in Switzerland.

The objective of this study was to estimate the annual direct medical costs of hospitalizations due to osteoporotic fractures in Switzerland. Days of hospital stay in 1992 were quantified using the casuistic of the medical statistics department of VESKA (Vereinigung Schweizerischer Krankenhäuser, the Swiss Hospital Association), which covers 43% of all hospital beds of that country. Number and incidence of total hospitalizations due to fractures were calculated by extrapolating to 100% the 43% VESKA-selected sample. To estimate number and incidence of hospitalizations due to osteoporotic fractures, internationally accepted age-specific osteoporosis attribution rates were applied. According to the latter the probability of a fracture being caused by osteoporosis increases with age. Mean length of stay for all fractures was calculated (= total hospital days divided by number of cases). By multiplying these mean lengths of stay by the number of osteoporosis-related fracture cases, the number of bed-days due to osteoporotic fractures was calculated. To compare the direct medical costs of hospitalization due to osteoporosis with those due to other frequent diseases, days of hospital stay caused by chronic obstructive pulmonary disease (COPD), stroke, acute myocardial infarction and breast cancer were estimated using the same methodology. A total estimate of 63,170 (f: 33,596, m: 29,574) hospitalizations due to fractures (and other osteoporosis-related diagnoses) was calculated, thus leading to overall annual incidence rates of hospitalizations for fractures of 950/100,000 women and 877/100,000 men. In women, 548,615 hospital days were found to be caused by osteoporosis, 353,654 days by COPD, 352,062 days by stroke, 200,669 days by breast carcinoma and 131,331 days by myocardial infarction. In men, COPD caused more hospitalization days (537,164) than myocardial infarction (196,793), stroke (180,524) or osteoporosis (152,857). Taking a mean price for a hospital day in Switzerland of 845 Swiss francs, the annual costs of acute hospitalizations due to osteoporosis and its complications were approximately 600 million Swiss francs (f: 464, m: 130 million Swiss francs) in 1992. We conclude that there is enough economic evidence to justify wide-scale interventions against osteoporosis in Switzerland.

Adolescent↗
PubMed2005

Economic burden of obesity and its comorbidities in Switzerland.

OBJECTIVES: To estimate the total annual economic costs caused by overweight and obesity in Switzerland. METHODS: Top-down estimation of direct treatment costs for obesity including medication, nutritional counselling, and surgical interventions was carried out. Using Swiss prevalence data (2002) and literature-based estimates of the relative risks the population attributable fraction (PAF) was calculated for 18 overweight- and obesity-related diseases. PAF was then used in combination with estimates of the total (direct and indirect) health care costs of these diseases to estimate the economic burden of obesity for Switzerland. RESULTS: The estimated total costs in Switzerland amounted to CHF 2691 million per year (on cost basis 2001). Allowance for uncertainty in parameter assumptions and values in the published literature used applying a sensitivity range of +/- 20% gave a cost range of between CHF 2153 and 3 229 millions, representing approx. 2.3-3.5% of total health care expenditures. Overweight and obesity contribute each approx. 50% to these costs. CONCLUSION: Overweight and obesity represent a considerable financial burden to the Swiss society. According to their present trends, this economic burden is expected to grow over the coming years.

Body Mass Index↗
PubMed2002

Genetic variation of oaks ( Quercus spp.) in Switzerland. 3. Lack of impact of postglacial recolonization history on nuclear gene loci.

Quercus petraea, Quercus pubescens and Quercus robur are closely related and interfertile white oaks native to Switzerland. The three species are known to share identical cpDNA haplotypes, which are indicative of the postglacial recolonization history of populations. Only two haplotypes are common in Switzerland. We compared variation of cpDNA and of isozymes in 28 oak populations from Switzerland in order to assess the impact of the postglacial population history on current genetic structures of nuclear controlled isozyme gene loci. Species delineation was based on Principal Component Analysis of leaf morphological traits. The species status of populations was reflected at isozyme gene loci, but differentiation between populations with different cpDNA haplotypes and hence different recolonization history was very low at enzyme gene loci for all species. Thus, glacial and postglacial population history was not reflected at nuclear gene loci on the temporal and spatial scale covered by the present study. Extensive gene flow through pollen among populations is likely to have blurred a previously existing genetic differentiation at biparentally inherited gene loci that possibly evolved in the different glacial refugia of the above mentioned cpDNA haplotypes.

Alleles↗
PubMed2003

Device-specific weighted T-score for two quantitative ultrasounds: operational propositions for the management of osteoporosis for 65 years and older women in Switzerland.

The World Health Organization (WHO) criteria for the diagnosis of osteoporosis are mainly applicable for dual X-ray absorptiometry (DXA) measurements at the spine and hip levels. There is a growing demand for cheaper devices, free of ionizing radiation such as promising quantitative ultrasound (QUS). In common with many other countries, QUS measurements are increasingly used in Switzerland without adequate clinical guidelines. The T-score approach developed for DXA cannot be applied to QUS, although well-conducted prospective studies have shown that ultrasound could be a valuable predictor of fracture risk. As a consequence, an expert committee named the Swiss Quality Assurance Project (SQAP, for which the main mission is the establishment of quality assurance procedures for DXA and QUS in Switzerland) was mandated by the Swiss Association Against Osteoporosis (ASCO) in 2000 to propose operational clinical recommendations for the use of QUS in the management of osteoporosis for two QUS devices sold in Switzerland. Device-specific weighted "T-score" based on the risk of osteoporotic hip fractures as well as on the prediction of DXA osteoporosis at the hip, according to the WHO definition of osteoporosis, were calculated for the Achilles (Lunar, General Electric, Madison, Wis.) and Sahara (Hologic, Waltham, Mass.) ultrasound devices. Several studies (totaling a few thousand subjects) were used to calculate age-adjusted odd ratios (OR) and area under the receiver operating curve (AUC) for the prediction of osteoporotic fracture (taking into account a weighting score depending on the design of the study involved in the calculation). The ORs were 2.4 (1.9-3.2) and AUC 0.72 (0.66-0.77), respectively, for the Achilles, and 2.3 (1.7-3.1) and 0.75 (0.68-0.82), respectively, for the Sahara device. To translate risk estimates into thresholds for clinical application, 90% sensitivity was used to define low fracture and low osteoporosis risk, and a specificity of 80% was used to define subjects as being at high risk of fracture or having osteoporosis at the hip. From the combination of the fracture model with the hip DXA osteoporotic model, we found a T-score threshold of -1.2 and -2.5 for the stiffness (Achilles) determining, respectively, the low- and high-risk subjects. Similarly, we found a T-score at -1.0 and -2.2 for the QUI index (Sahara). Then a screening strategy combining QUS, DXA, and clinical factors for the identification of women needing treatment was proposed. The application of this approach will help to minimize the inappropriate use of QUS from which the whole field currently suffers.

Absorptiometry, Photon↗