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Hepatic toxicity possibly associated with kava-containing products--United States, Germany, and Switzerland, 1999-2002.

Since 1999, health-care professionals in Germany, Switzerland, and the United States have reported the occurrence of severe hepatic toxicity possibly associated with the consumption of products containing kava (i.e., kava kava or Piper methysticum). A total of 11 patients who used kava products had liver failure and underwent subsequent liver transplantation. On March 25, 2002, in response to five such case reports (four in Europe and one in the United States), the Food and Drug Administration (FDA) issued a consumer advisory and subsequently completed an investigation already underway of a similar U.S. case. This report presents the investigation of the two U.S. cases of liver failure associated with kava-containing dietary supplement products and summarizes the European cases. FDA continues to advise consumers and health-care providers about the potential risk associated with the use of kava-containing products.

Adolescent↗

[The problem of hypertension in Switzerland. Analysis of a blood pressure study in 21,589 persons].

Blood pressure measurements (Phyiometrics SR1) were performed on 21 589 persons visiting the Swiss Trade Fair in Basel in 1974. Diastolic pressures were found to be greater than or equal 110 mm Hg in 3%, greater than or equal 100 mm Hg in 7% and greater than or equal 95 mm Hg in 12% of the screened population. Including those under antihypertensive treatment, the prevalence of high blood pressure (diastolic pressure greater than or equal 95 mm Hg) amounted to 19% of the adult population. In 68% of the hypertensive screenees the condition was already known, 49% were under treatment and 35% were controlled (i.e. diastolic pressure less than 95 mm Hg). In other words - and here lies the unsolved problem - 32% of hypertensives are as yet undetected, 19% of the known cases are not treated, and 14% are inadequately treated. Of the hypertensive population 35% are adequately treated and 30% have mild hypertension. The remaining 35%, with diastolic pressure greater than or equal 100 mm Hg, require urgent attention and action. In Switzerland this problem can be tackled and solved by the general practitioner, who already play the major role in detection and treatment.

Hypertension↗

[Bacteriological investigations about paratuberculosis in dairy herds in Switzerland].

In Switzerland clinical bovine paratuberculosis is registered sporadically with on average seven outbreaks per year. Our present studies are aimed to investigate the prevalence of Mycobacterium avium ssp. paratuberculosis (MAP)-infections in the Swiss cattle population and, therefore methods to culture MAP from bovine feces as well as a commercially available ELISA to detect MAP-specific antibodies are evaluated by using fecal samples and blood sera from herds with cases of clinical paratuberculosis. A series of molecular methods i.e. PCR-coupled RFLP analysis of the IS1311-insertion element of M. avium, PCR-coupled RFLP-analysis of the mycobacterial rpoB-gene, and DNA analysis of the mycobacterial 16S rRNA gene are used to identify mycobacterial isolates grown from bovine feces. Up to now, MAP was detected by culture in 12 of 155 (7.7%) animals from herds with paratuberculosis. A rather striking result is the finding of atypical mycobacteria in feces of 75 cattle (48.3%). Among these isolates, M. avium ssp. avium, M. thermoresistibile, and M. hassiacum/M. buckleii have been identified so far.

Animals↗

[Parasuicide and violence: criminological aspects from a study of 21,314 male army recruits in Switzerland].

Suicidal behaviors are not uncommon, but rarely admitted in the families and in society at large. Violence is a public health and social problem of growing concern. Research on the relationship between violence and suicidal behaviors is scarce for the last decades, perhaps because suicide is no longer considered an offense. The present study is based on a sample of 21,314 valid interviews with 20 year old Swiss men, representing over 70% of this cohort. The questionnaire contained over 900 variables, addressing issues such as previous history of parasuicide, self-reported violent acts and injuries, during childhood and adolescence, as well as over the last year before recruits training. The questionnaire also contains various items about mental health, familial and social conditions and situational factors. We used an ordinal scale for measuring violence and operationalisations of mental disturbances according to theoretical and empirical concepts such as conduct disorder and antisocial personality disorder according to DSM IV, the dissocial syndrome according to Rauchfleisch's (1981) definition; 2,6% of the recruits reported at least one suicide attempt during the last year, one third even multiple attempts. Life-time prevalence at age 20 was 3,9%. Suicide attempters often showed signs of psychiatric disorders, especially for a dissocial (OR=6,9) or an antisocial (OR=5,8) syndrome. Other studies have shown that the rate of suicide in France and Switzerland is very high compared to other European countries. Our study confirms the existence of a real behavioural and existential problem among young Swiss men. Half of the suicide attempters had a history of physical violence against others and 20% were themselves victims of violent acts during the previous year. Suicide attempters who were victims were also more violent than those who were not victimized. A suicide attempt during the previous year is a marker for violent behaviours (OR=2,1) and victimisation (OR=1,9) during this same year. We also found a positive link between multiple attempted suicides and the commission of serious violence. It is concluded that parasuicide among young men is related to other violent acts and should be considered as a positive marker of violent behavior in general and victimisation by crime. It seems that suicide is a transgression of social and cultural values because of the amount of aggression behind it, even if it is not a criminal offense. Suicide attempts of young men should receive more attention by professionals in the field of medicine, psychology and social work. Treatment of these men not only prevents an individual mental health problem but also contributes to crime prevention at the community level. Criminological theories could inspire further studies in suicidology, in order to improve the multidisciplinary knowledge of the phenomenology and etiology of parasuicide. In the same way, criminologists as policy makers should attach more attention to parasuicide given its many theoretical and practical connections with crime.

Adult↗

How farmers in Switzerland perceive fertilizers from recycled anthropogenic nutrients (urine).

We studied acceptance of a urine-based fertilizer product using a mail survey of 467 Swiss farmers. We distinguished among four production types: organic or IP farming, and with or without vegetable production. Considering that the idea of urine-based fertilizers is new, acceptance among the answering farmers was surprisingly high, with 57% explicitly stating that they thought it was a good or very good idea, and 42% willing to purchase such a product. The farmers of different production types did not differ strongly in their attitude towards urine-based fertilizers. Especially IP and vegetable farmers, who purchased additional fertilizers anyway, seem willing to accept urine-based fertilizers, hereby preferring a grainy, odorless ammonium nitrate fertilizer. Absolutely essential is a hazard-free product: 30% of all farmers had concerns regarding micropollutants. Based on fertilizer data, we demonstrate an existing demand for the nutrients N, P, and K in Switzerland, which could be partially substituted by a recycled urine product. Finally, we discuss methodological requirements of social science surveys. To obtain representative data on an entire population in a mail survey, multiple contacts with respondents are necessary. We argue that information and participation of stakeholders at an early stage is essential for successful technology transfer.

Adult↗

[Population genetic Hae III/RFLP and HLA-DQ-alpha data of a Caucasian population sample in Switzerland].

DNA from unrelated individuals (Caucasians; n = 200-271) from Switzerland were digested with Hae III and successively hybridized to the DNA probes D1S7, D2S44, D4S139, D10S28, D14S13, D17S26 and D17S79. An allele frequency distribution was determined for each locus. Furthermore, from the same individuals (n = 200) after amplification of DNA the allele and genotype frequencies at the HLA-DQ alpha locus were determined. The allele frequency distribution in Swiss Caucasians is statistically similar to American Caucasian population samples. In criminal cases a DNA-profile derived from four single-locus probes always leads to a very high value of discrimination and in paternity testing the probability of paternity always exceeds 99.9% regardless to the reference population used for biostatistical evaluation. Therefore for use in forensic analysis and paternity testing pooled caucasian databases might be used for the determination of the frequency of occurrence of a DNA-profile.

Alleles↗

[Immigrants in Switzerland: possibilities and difficulties of integration].

Immigrants find it hard--although not all in the same way--to adapt to the language, the social structure and the way of life of their host country. Different factors overlap: the foreigners' social and cultural background, their education and their adaptability to a foreign environment, their plans for the future, the political and legal situation in the host country as well as the local population's acceptance of and tolerance and respect for a foreign culture. The fact that 75% of all foreigners in Switzerland possess a residence permit can be considered as rather positive; however, this does not necessarily mean that these people are familiar with the local language and way of life. Isolation and a continuously postponed return to the home country are conditions well known even among resident foreigners. Seasonal workers, on the other hand, feel great uncertainty and concern. In critical life situations, for instance caused by illness, accidents or unemployment, the process of rehabilitation can strongly be influenced by earlier living conditions. The Swiss legislation on foreigners as well as the legislation on social security can often bring about fundamental fateful questions. In order to find efficient solutions to the wide range of possible difficulties, a whole-hearted interdisciplinary cooperation is extremely important.

Acculturation↗

[Causes of prenatal foal loss in Switzerland].

In Switzerland during the foaling season 1988 and 1989 the cause of abortion in 60 foals was investigated. Special attention was paid to infections with equine herpesvirus 1 (EHV 1). Diagnosis were based on post-mortem, histopathological, bacteriological and immunofluorescence investigation. The results confirm data from other countries, that EHV 1 is the most prevalent viral (20%) cause of abortion, followed by various bacterial agents (12%). Other causes were umbilical torsion, twin pregnancy and malformations. In 18% of the cases the investigation of fetuses did not give any results as to the cause of abortion, suggesting maternal factors as only cause of abortion.

Abortion, Veterinary↗

[Medical emergencies in the dental office: contributions of continuing education. Enquiries among university centers of dentistry, sections of the SSO and private sources of continuing education in Switzerland].

Some dentists feel insecure in the management of medical emergencies as it has been pointed out in the SMfZ already. The focus on a national investigation by means of questionnaire was the training supply in emergencies as well as the course attendance by dentists. The results of this investigation proved, that about half of the dentists, practicing in Switzerland keep themselves more or less up-to-date. They know about the right measures in case of an accident that may put vital functions at risk. However, this investigation also showed that we know little or nothing about the other half of practicing dentists in our country. In the last part of the paper a project of an e-learning course on medical emergencies in the dental office is disclosed.

Education, Dental, Continuing↗

[Dental status in relation to age: research in Switzerland 1980-1990].

The number of missing teeth in relation to the patients' age was assessed in fourteen studies of the oral status of different patient groups performed in Switzerland and published between 1980 and 1990. The prognosis of the future development of the average dentition made by Marthaler in 1978 proved to hold true.

Age Factors↗

[The STIZ and the epidemiology of poisoning in Switzerland (Swiss Toxicologic Information Center)].

Despite the fact that the danger and the sequelae of poisoning are regularly referred to in the media, comprehensive reports about type and frequency of poisoning in Switzerland are not available in the literature. Thus morbidity of poisoning can only be judged by the calls and written replies of treating physicians. According to the retrospective evaluation of the data available to us (1966 to 1991), the number of poisoning leading to severe life-threatening symptoms is tending to decline. This apparent success of prevention and treatment of poisoned patients in our country should be corroborated by extensively investigating quantitative and qualitative aspects of poisoning. Moreover, overall mortality of poisoning is increasing, especially because of the deaths caused by abusing habit-forming drugs. On the other hand, the number of suicides using medicaments shows a tendency to decline. Detailed statistical data about the circumstances and xenobiotics involved in poisoning could efficiently help to develop measures to prevent a fatal outcome.

Adult↗

[Cardiac interventions in Switzerland].

The activity of the working group PTCA and Fibrinolysis of the Swiss Society of Cardiology from spring 1990 to spring 1991 is reported. It included a survey of fibrinolysis for acute myocardial infarction, therapeutic cardiac catheter interventions, and heart operations in Switzerland in 1990. Of the 6096 patients admitted for acute infarction to the participating hospitals, 1768 (29%) underwent fibrinolysis. The number of coronary angiograms performed was 12,501, a 10% increase over the previous year. One third were performed in private hospitals. The number of coronary angioplasties (PTCA) was 2323, a 20% increase. Every fourth PTCA was done in a private hospital. The percentage of PTCAs to coronary angiograms varied from 3 to 35%. There was no correlation to the percentage of multivessel PTCAs. This indicates earlier diagnosis of coronary disease (single vessel disease) in hospitals with increased PTCA activity. The number of bypass operations was 3471. Although the overall figure was higher than that of PTCA, this ratio was balanced or inversed in 3 university hospitals. As for new techniques of interventional cardiology, 24 stents were implanted and 10 atherectomies performed. Moreover, there were 39 valvuloplasties (8 aortic, 20 mitral, and 11 pulmonary), 5 closures of the patent ductus arteriosus, and 24 interventions for arrhythmia (pacemakers excluded). The noncoronary heart operations comprised 694 aortic, 292 mitral, and 100 aorto-mitral operations, 523 operations for congenital or acquired defects, 38 operations for arrhythmia, and 42 transplantations. The development of surgical and nonsurgical cardiac interventions in recent years is characterized by increasing dominance of PTCA in comparison to bypass surgery in most university hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗

[Triplets and quadruplets in Switzerland, 1985-1988].

To determine the incidence of multiple births and associated morbidity and mortality, we collected in a retrospective study all the multiple births (twins excluded) in Switzerland from 1985 to 1988. In all we followed 77 sets of triplets and 9 sets of quadruplets, representing an annual incidence of 1/3968 births for the triplets and 1/33,947 births for the quadruplets. The incidence of induced pregnancies increased in the period 1985 to 1988. The principal complications were premature contractions and preeclampsia. Only 56% of the children were born in a hospital with a neonatal intensive care unit. The mean gestational age was 33 0/7 weeks (ranging from 25 0/7 to 38 5/7) for the triplets, and 30 5/7 weeks (ranging from 27 5/7 to 36 3/7) for the quadruplets. The mean birthweight was 1787 g (ranging from 560 to 3000 g) for the triplets and 1189 g (ranging from 590 to 1980 g) for the quadruplets. RDS was found to be the principal neonatal pathology (65.5% of triplets and 85.2% of quadruplets) with 18.8% of triplets and 61.8% of quadruplets requiring ventilation. The mortality rate in our study was 8.9% for triplets and 14.7% for quadruplets.

Birth Weight↗

["A good death": perception of health personnel in French-speaking Switzerland].

AIMS: To describe the perception of "Good death" among health personnel working in nursing homes in French-speaking Switzerland and to identify the differential explanatory factors. METHODS: A cross sectional study with a self-administered questionnaire, adapted from the "the' new measure of concept of good death", was done among health personnel in 5 nursing homes (2 in Geneva and 3 from Valais) in spring 2004. One hundred and sixty one persons participated at the study representing over 90% of the personel contacted. RESULTS: Four points were considered hallmarks of "Good death" by more than 80% of respondents: i.e. pain control, serenity and peace, presence of family members or close friends, respect of the last will. Up to 70% further consider as important elements the support of health professionals, the opportunity to transmit one's values and access to spiritual and/or religious support. Around 50% of respondents also consider as important "being able to chose the place of death", "having time to prepare one self", "staying conscious to the end" and "having control over body functions". These perceptions vary according to the place of work, the sex, the training in palliative care, the professional experience and of the number of deaths with which respondents were confronted. CONCLUSION: There seems to be converging opinions among health personel on what "Good death" should be. Public health decisions makers need to be informed on this.

Adult↗

Overview of salt fluoridation in Switzerland since 1955, a short history.

After an early start in 1955, the introduction and acceptance of fluoridated salt (FS) for domestic use was slow in Switzerland because up to around 1980 there was no consistent strategy for the support of the use of FS. Part of the dental community still supported water fluoridation, while others criticized the insufficient concentration of fluoride in the salt (90 ppm). All Swiss cantons have a historical monopoly on salt trade, and until 1983 most cantonal governments resolved to authorize the sale of fluoridated domestic salt. Some of the cantonal governments made fluoridated salt the only available type of "kitchen salt" in 1-kg packages. After the concentration had been increased to 250 ppm in 1983, the use of FS gained further acceptance. A temporary setback occurred in 1992-1994, but was successfully met with by making the FS available in several package sizes, while other types of salt (with or without iodine) were available in 500 g packages only. By 2004, the market share of fluoridated domestic salt reached 88%. Further endeavours aim at increasing the use of FS by large kitchens. FS is available in portions of 12.5 kg (since 2001) and 25 kg (since 1976).

Cariostatic Agents↗

[From Kosovo to Switzerland: mental health perceptions and practical implications for health professionals].

A survey was conducted in Kosovo between 2002 and 2003 among 57 health professionals. Covered topics encompassed mental health and disease representations and access to mental health care in Kosovo following the war. At the time of the survey, health services were still widely disorganized and uncoordinated at the local level, with poor access to health care. This work shows that mental disorders remain very stigmatizing for patients and their relatives. Benzodiazepines are the first choice medication, to the detriment of other psychotropic categories. Traditional and religious representations of mental disease prevail in the general population. A few recommendations addressed to professionals taking care of Kosovar patients, in Switzerland or elsewhere, are drawn from these results.

Cultural Characteristics↗

Frequently asked questions at the Quality Control Centre Switzerland (CSCQ).

The Quality Control Centre Switzerland (CSCQ) is one of two National EQAS organisers for the medical laboratory. Frequently asked questions at the CSCQ from two time periods have been analysed and compared. They form one of the sources for continuous improvement. It turns out that question frequency per se is not a criterion for the intended purpose. Well formulated single questions or remarks from different sources, together with the institutionalized practice of process evaluation, can lead to specific measures.

Information Dissemination↗