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PubMed2004

[Place of death: "Where do people die in Switzerland nowadays?"].

BACKGROUND: Official information on the place of death has not been collected by the Swiss Federal Office of Statistics since 1987. Thus, no statements can be made for the developments in Switzerland. METHODS: Physicians from the German speaking part of Switzerland who had filled in a death certificate between June 1 and October 30, 2001 were sent a questionnaire about circumstances of the specific death case. The frequencies of the place of death (at home, in hospital, in home for elderly, in nursing home, other place) were compared with the official data of the years 1969 until 1986. Using logistic regressions predictors for the place of death were estimated. RESULTS: In 2001 in the German speaking part of Switzerland death occurred most frequently in hospital (37.2% of all death cases) followed by a home for elderly (33.5%) and dying at home (22.7%). Relevant predictors for the place of death were cause of death, sex, marital status and partly religion. Whereas between 1969 and 1986 a development towards dying in institutions was found, between 1986 and 2001 the place of death shifted within the institutions from hospitals to homes for elderly. CONCLUSION: The relevance of the home for elderly as the place of death will further grow in the future. To allow people to fulfill the tasks of caring for their relatives at home the ambulant emergency services will have to be augmented and relatives have to be motivated and supported.

Aged↗
PubMed2005

Incidence of first-ever ischemic stroke in the Canton Basle-City, Switzerland: a population-based study 2002/2003.

Our study sought to estimate the incidence rate of first-ever ischemic stroke (FEIS) in the geographically well-defined population of the Canton Basle-City, Switzerland. An one-year prospective population-based study among the permanent residents of the Canton Basle-City (188015 inhabitants, census 2002) was carried out. Multiple overlapping sources of information were used. Stroke was defined according to the WHO criteria. The diagnosis of FEIS was based on clinical assessment and neuroimaging findings. 269 patients (114 males; mean age 72.8, standard deviation (SD) +/- 12 and 155 females; mean age 78.4, SD +/- 11) with FEIS were identified. The overall crude incidence of FEIS amounted to 143 per 100000 population (95% confidence interval (CI) 126 to 160) and it was higher among females (156; 95% CI 132 to 181) than in males (128; 95% CI 105 to 152). The age-specific incidence rates of FEIS approximately doubled with each decade of life, increasing from 17 (95 % CI 2 to 31) among 0-44 years old group to 1034 (95% CI 774 to 1293) for those aged 85 or more years. The overall incidence rate of FEIS adjusted for age to the European standard population was 76 per 100000 inhabitants (95% CI 66 to 86) and it was higher in males-89, 95% CI 72-106-than in females-66, 95 % CI 53-77. Moreover, in comparison with studies from other developed countries (e. g. Germany, Italy, Australia)-carried out in the middle of 1990s-the standardised incidence rates of FEIS were substantially lower in Switzerland. Our results indicate that the risk of ischemic stroke might be low in Switzerland. However, giving a major reduction in the age and gender specific stroke incidence over the past years our findings might-alternatively-mirror this favourable trend.

Adult↗
PubMed1997

A new mutation, 3905insT, accounts for 4.8% of 1173 CF chromosomes in Switzerland and causes a severe phenotype.

We have analysed 1173 cystic fibrosis (CF) chromosomes from Switzerland for eight mutations in the CF transmembrane conductance regulator (CFTR) gene. This permitted the identification of 88.5% of all mutations present. A novel insertion mutation in exon 20 of the CFTR gene, 3905insT, was discovered. This mutation accounted for 4.8% of CFTR gene mutations in Switzerland and has since been identified in other populations of probable Swiss descent. It is associated with a highly variable clinical phenotype but always with pancreatic insufficiency. Haplotype analysis with three intragenic microsatellites in the CFTR gene showed that the mutation is associated with a haplotype rarely identified on other CFTR alleles and, therefore, that the frequency of the mutation in Switzerland is explained by a founder effect of a relatively recent mutation event.

Cystic Fibrosis↗
PubMed2002

Verocytotoxin-producing Escherichia coli in patients with diarrhoea in Switzerland.

The present study was conducted between October 1996 and October 1998 to estimate the frequency of verocytotoxin-producing Escherichia coli among outpatients with diarrhoea in Switzerland. Among 3,041 subjects studied, 16 (0.5%) verocytotoxin-producing Escherichia coli infections were identified. Eleven cases were in infants and children </= 6 years of age. In 15 cases, a verocytotoxin-producing Escherichia coli strain was isolated. These strains belonged to 11 different serotypes, and only two were serogroup O157. In five cases, the infection was probably acquired outside Switzerland. Verocytotoxin-producing Escherichia coli apparently play a minor role in the aetiology of diarrhoeal disease in adult outpatients in Switzerland, but they are important pathogens in preschool children in whom the most severe symptoms are observed.

Adult↗
PubMed2005

Association of alcohol consumption to mortality and person-years of life lost in Switzerland--measuring the impact of some methodological options.

OBJECTIVES: The present study is designed to estimate the health impact of alcohol consumption in terms of the number of deaths and person-years of life lost (PYLL) in Switzerland. To that end, three hypothetical situations have been compared to the current situation used as a reference. The underlying question was: how many deaths and person-years of life lost would be avoided if all individuals were: (1) non-drinkers, (2) low drinkers only or (3) both (either abstainers or low level drinkers)? METHODS: Etiological fractions of alcohol-related health consequences by age and gender were applied to the officially reported numbers of deaths to estimate the total number of deaths and PYLL. RESULTS: Depending upon the hypothetical situation, the estimated number of alcohol-related deaths varied between an overall net protective and an overall net causal effect: in situation (1), there would occur 730 additional deaths in reference to the current situation (+1.2% of the total alcohol-related mortality in Switzerland), whereas in situation (2) there would be 3460 deaths less (-5.5%). Thus, the current situation in Switzerland would be preferable compared to a society, in which no one drinks alcohol. A society, however, in which every individual drinks at low levels, would be preferable to the current situation. The corresponding figures for PYLL are 23,596 vs. 29,229 (6.4% vs. 7.9% of total PYLL). CONCLUSIONS: The hypothetical situation decisively impacts on the number of deaths attributable to alcohol. In contrast, it has much less influence on the number of alcohol-related PYLL. Thus, mortality is at least a questionable indicator of alcohol-related health outcomes. The study also indicated that more lives and PYLL were saved in the low-risk situation than in the abstinence situation. Public health policies should not concentrate on the promotion of abstinence.

Adolescent↗
PubMed2026

First case of Brucella suis biovar 1 infection in a dog in Switzerland.

As one of the most common zoonoses globally, brucellosis threatens not only animals but also humans with Brucella (B.) melitensis, B. abortus and B. suis biovar 1&3, being more virulent for humans than B. canis, B. ovis and B. suis biovar 2. Canine brucellosis is caused mainly by B. canis, however, B. suis infections in dogs have been reported sporadically in Europe and more frequently in Australia. B. suis infection in dogs is mainly associated with hunting or wild-animal exposure and rarely with consumption of commercial raw meat products. In Switzerland, B. canis is sporadically diagnosed in dogs and B. suis biovar 2 is present in wild boar and brown hare. We report a case of brucellosis in a dog from Switzerland, neither having a history of hunting nor travel-associated risk of exposure. The intact male dog showed clinical signs (fever and epididymitis) consistent with brucellosis, which was confirmed by culture and molecular methods in urine and by serological methods. Culture and subsequent whole genome sequencing revealed the isolate as B. suis biovar 1, ST-14. The most closely related strain was shown to be a strain isolated in 2021 from a dog in Germany. Based on the lack of any previous report, infection by B. suis in dogs has not previously been diagnosed in Switzerland. This case highlights the need for vigilance regarding this less expected pathogen of high zoonotic importance in dogs.

Animals↗
PubMed1995

Identifying adolescent drug users: results of a national survey on adolescent health in Switzerland.

OBJECTIVE: To explore the proportion and characteristics of adolescents who use illicit drugs and contrast them with adolescents who do not use such drugs in Switzerland. To facilitate the detection of adolescents with drug related difficulties. METHODS: We used data from a national survey on adolescent health in Switzerland (N = 9,273) conducted in 1992 and 1993. The survey is based on self-administered questionnaires among a representative sample of adolescents enrolled in schools and apprenticeship programs. We used exploratory analysis for identifying characteristics which set the drug user apart from non-users and performed confirmatory multivariate logistic regression analysis to examine which variables remain independently associated with heroin or cocaine use. RESULTS: In Switzerland, 3.1% of adolescents have taken heroin or cocaine at least once in their life, and 27.7% have already used cannabis. Analysis of lifestyles and health of adolescents show that young drug users present difficulties in integrating in society, have health problems and difficulties in relationships, situations which tend to be less common among other adolescents. Yet, they also display marked similarities, most notably in that over 70% had seen a physician in the past year. However, while 40% of the drug users expressed a need for help with drug related problems, only 6% had actually talked about them with a physician. Characteristics that remained independently associated with heroin and cocaine use after controlling for confounding factors were age, sex, nationality, type of education, feelings of suicide, past and present smoking, and use of cannabis. CONCLUSION: The level of illicit drug use among Swiss adolescents is high compared to other European countries but lower than the United States. Drug-using adolescents display a constellation of characteristics which should make it possible to identify them and offer help. Yet, even though they may have frequent contact with the health services, their drug problems are generally not recognized by the gatekeepers of the health services and no specific aid is available to them. Drug prevention must be intensified and medical doctors sensitized to the drug problems which adolescents may face.

Adolescent↗
PubMed2006

Gyneco-psychosomatic counseling in Germany and Switzerland--aims and state of the art.

OBJECTIVE: To investigate actual counseling models for gynecological patients in Switzerland and in Germany. METHODS: A questionnaire investigating psychosomatic care was sent to all Swiss (N=183) and German (N=1078) departments of gynecology, obstetrics, and/or endocrinology. RESULTS: One hundred twenty-eight (27%) completed questionnaires from Germany and 57 (31%) from Switzerland were available for statistical evaluation. Eighty-seven percent of the answering clinics from Switzerland and 93% of those from Germany (ns) considered psychosomatic counseling for gynecological and obstetrical patients as very important or important. Seventy-two percent of the Swiss and 70% of the German departments (ns) offered psychosomatic support. Models of counseling varied greatly between types of hospitals and both countries. Less than 15% of the medical doctors had a formation for psychosomatic counseling. CONCLUSION: Actual possibilities seem to be below the need for psychosomatic care. An adequate formation of medical doctors and considering the effects of psychosomatic care in the discussion on cost reduction for medical treatment would help to improve counseling structures.

Attitude of Health Personnel↗
PubMed2005

Genetic heterogeneity of pestiviruses of ruminants in Switzerland.

We have genetically analyzed ruminant pestiviruses. All >150 bovine viral diarrhea (BVD) viruses isolated from cattle in Switzerland belonged to genotype 1, with subgenogroups e, h, k and b found in decreasing frequency. To date, representatives of subgenogroup k have been detected in Switzerland only. Despite serological evidence of Border disease in sheep, only few Border disease viruses have been isolated, all of which belong to the novel group 3. Serological evidence suggested that pestivirus infections may occur also in wild ruminants in Switzerland but no isolates are available for analysis. In addition, we describe two pestiviruses, one a cell culture contaminant and the other isolated from a buffalo, that cluster with a recently proposed novel pestivirus species.

Animals↗
PubMed2006

Analysis of national serological surveys for the documentation of freedom from porcine reproductive and respiratory syndrome in Switzerland.

Results of national serological surveys for porcine reproductive and respiratory syndrome (PRRS) conducted in Switzerland in 2001 and 2004 were analyzed. In 2001, 41,124 breeding sows from 2,540 herds out of 6,406 were sampled, and in 2004, 7,498 animals were sampled from 1,074 herds out of 5,320. All serum samples were tested for PRRS using an ELISA developed at the Institute of Virology and Immunoprophylaxis (IVI), Switzerland with a sensitivity (Se) and specificity (Sp) of 94 and 97%, respectively. Positive samples were re-tested with a commercial ELISA (IDEXX) with Se of 100% and Sp of 99%. Samples positive in the second test were confirmed with the fluorescent antibody test (FAT). A stochastic model using data from the main survey conducted in 2001 was done to verify whether the sampling scheme used could detect at least one infected herd with 99% confidence level if the herd designed prevalence was at 0.1 or 0.2%. Additionally, a Bayesian approach was conducted to calculate the post-survey probability of freedom from PRRS using data from the 2001 and 2004 surveys. A Monte Carlo simulation with 5000 iteration was run for each model. Eleven samples in 2001 and six in 2004, all from different farms, could not be conclusively confirmed as negative by the FAT. All other samples were negative. Truly infected animals and herds were not predicted by a stochastic model at the 99% confidence level and 0.1% herd prevalence using data from the 2001 survey. However, it was demonstrated that the prior probability of freedom from PRRS increased from 89.3 to 99.2% after the 2001 survey. Upon completion of the 2004 survey, the probability of freedom from PRRS reached a value of 99.7%. Based on our results, we could conclude that the pig industry in Switzerland is free of PRRS virus with this level of confidence. Restricted import activities over the last decades are a possible explanation for the continuing absence of PRRS-infection in the Swiss swine population. Import requirements defined by the pig industry minimize the risk of introduction of PRRS-infected animals in the future.

Animals↗
PubMed2007

Genotyping of Babesia bigemina from cattle from a non-endemic area (Switzerland).

In August 2002, bovine anaplasmosis and concurrent infections with Mycoplasma sp. and piroplasms were reported in a cattle herd in an alpine region of Switzerland. The piroplasms were identified by PCR/sequencing of part of the 18S rRNA gene as Babesia bigemina and Theileria of the buffeli/sergenti/orientalis-complex, which have never been diagnosed in Switzerland before. The B. bigemina isolate was genetically characterised at two loci and compared with isolates from Italy, Spain, Turkey, Kenya and Mexico. Analysis of the internal transcribed spacer 2 (ITS2) of the rRNA genes revealed high polymorphism not only among the isolates but even within the isolates, and the presence of two types of the ITS2 in every isolate was confirmed. A dendrogram based on ITS2 sequences showed that the Swiss isolate was most closely related to a Spanish isolate but no sequences of the isolate from Switzerland were identical to any of the other isolates. The isolate from Italy was not positioned in the same cluster as the Swiss and the Spanish isolate. This had been anticipated as the nearest known endemic area of B. bigemina in Central Italy. Sequence analysis of the rhoptry-associated protein-1c gene (rap1c) confirmed the similarity of the Swiss and Spanish isolate. Hence, our molecular analyses of the Swiss B. bigemina isolate did not unequivocally track its geographical origin and the way of introduction remains obscure.

Animals↗
PubMed1997

Population genetic structure of Ixodes ricinus in Switzerland from allozymic data: no evidence of divergence between nearby sites.

Ixodes ricinus is a vector and reservoir of numerous infectious agents, especially Borrelia burgdorferi, the agent of Lyme disease. In Switzerland, its ecology and physiology have been well studied. Moreover, the foci of some infectious agents transmitted by this tick are identified. They can display relatively to extremely small geographical size depending on the diseases considered. In order to understand how the gene flows occur and to characterise the genetic structure of Ixodes ricinus populations, we used an indirect method based on genetic markers: allozymes. The sampling was carried out in 5 localities. Eighteen loci were analysed and 2 appeared polymorphic. This shows the low allozymic variability displayed by Ixodes ricinus. Based on these 2 loci, the populations appeared panmictic in Switzerland. This may be explained by the wide range of vertebrate species this tick can infest, especially birds. However, the result is surprising if we consider the extreme localisation of the foci of some infectious agents. We conclude that more powerful genetic markers could be used in order to better understand the epidemiology of tick-borne diseases in Switzerland.

Alleles↗
PubMed2003

Cost-effectiveness of a pneumococcal conjugate immunisation program for infants in Switzerland.

OBJECTIVE: To compare projected economic costs and health benefits associated with using pneumococcal conjugate heptavalent vaccine as routine immunisation in healthy children in Switzerland. DESIGN: A cost-utility analysis was performed from both the societal as well as the sickness funds' perspective. SETTING: Simulated birth cohorts of 80,000 children (the approximate size of a birth cohort in Switzerland) were followed from birth up to age of 5. MAIN OUTCOME MEASURES: Reduction in disease burden, costs of vaccination, cost-utility ratio (cost per quality-adjusted life year (QALY)). RESULTS: With a vaccine coverage of 70% vaccination of newborns only would avert 4 deaths, 8 cases of meningitis, 37 cases of other invasive pneumococcal disease, 150 cases of pneumococcal pneumonia and about 2700 cases of otitis media (OM) per year. The net cost of the vaccination program would be 22 Mio. CHF per year for society and about 19 Mio. CHF for the sickness funds. This results in a cost-utility ratio of 35,700 CHF (approximately 26,300 USD (1)) per QALY from the societal perspective and 39,300 CHF (28,900 USD) per QALY from the sickness funds' perspective. Additional catch-up vaccination of all infants <24 months in the years after vaccine introduction would result in additional benefits at a cost of 33,600 CHF per additional QALY gained. However, if the catch-up vaccination should include all children <60 months, each additional QALY would be gained at a very high cost (162,000 CHF per additional QALY). CONCLUSIONS: Routine vaccination of healthy infants <2 years in Switzerland can reduce mortality and long term neurologic impairment resulting from invasive pneumococcal disease at a reasonable cost-utility ratio.

Bacteremia↗
PubMed2001

Ozone exposure thresholds and foliar injury on forest plants in Switzerland.

Canton Ticino in southern Switzerland is exposed to some of the highest concentrations of tropospheric ozone in Europe. During recent field surveys in Canton Ticino, foliar symptoms identical to those caused by ozone have been documented on native tree and shrub species. In Europe, the critical ozone level for forest trees has been defined at an AOT40 of 10 ppm.h O3 (10 ppm.h accumulated exposure of ozone over a threshold of 40 ppb) during daylight hours over a six-month growing season. The objective of this study was to determine the amount of ambient ozone required to induce visible foliar symptoms on various forest plant species in southern Switzerland. Species were grown within eight open-top chambers and four open plots at the Vivaio Lattecaldo Cantonal Forest Nursery in Ticino, Switzerland. Species differed significantly in terms of the ppb.h exposures needed to cause visible symptoms. The most to least symptomatic species grown within open-plots in this study rank as Prunus serotina, Salix viminalis, Vibrnum lantana, Rhamnus cathartica, Betula pendula, Rumex obtusifolius, Sambucus racemosa, Morus nigra, Prunus avium, Fraxinus excelsior, Rhamnus frangula, Alnus viridis, Fagus sylvatica and Acer pseudoplatanus. Similar rankings were obtained in the non-filtered chamber plots. The ranking of species sensitivity closely follows AOT values for the occurrence of initial symptoms and symptom progression across the remainder of the exposure season. Species that first showed evidence of foliar injury also demonstrated the most sensitivity throughout the growing season, with symptoms rapidly advancing over ca. 25-30% of the total plant leaf surfaces by the end of the observation period. Conversely, those species that developed symptoms later in the season had far less total injury to plant foliage by the end of the observation period (1.5 to < 5% total leaf area injured). The current European ambient ozone standard may be insufficient to protect native plant species from visible foliar injury, and many more native species may be sensitive to ozone-induced foliar injury than are currently known.

Environmental Monitoring↗
PubMed2000

Management of heart failure in Switzerland.

Similar to other countries, heart failure is a major cause of morbidity and mortality in Switzerland. Among heart failure patients admitted to a Swiss university hospital in 1998, admission therapy included: ACE inhibitors/AT-II blockers in approximately two-thirds; diuretics in approximately 70%; and beta-blockers in approximately one-third. Easy access to diagnostic tests and limited results of surveys suggest that quality of care of heart failure patients is satisfactory in Switzerland. However, results from ongoing studies are required to assess more reliably the quality of diagnosis and therapy of this high-risk population in Switzerland.

Heart Failure↗
PubMed2002

Operating room management and strategies in Switzerland: results of a survey.

BACKGROUND AND OBJECTIVE: Operating room management structures and interrelationships both within the operating suite and with other departments in the hospital can be very complex. Several different professional and support groups are represented that often have infrastructures of their own that may compete or conflict with the management hierarchy in the operating room. Today, there is often little actual management of the operating suite as an entity. We surveyed current operating room management in Switzerland. METHODS: A questionnaire was sent to the chief anaesthesiologists of all public hospitals in Switzerland. It asked for information about the structure, organization and management of operating rooms as well as respondents' opinions and expectations about management. Derived from both the literature and the results of the survey, a 'stages of excellence' model of best practice was developed. RESULTS: The overall response rate was 70%. Most anaesthesiologists were unsatisfied with current management policies and structures in their operating rooms. Of the hospitals questioned, 40% did not have an information system at all for the operating rooms. The remaining 60% had an information system that allowed rough scheduling in 71%, but only a few had more sophisticated systems that enabled dynamic scheduling (19%), user-defined conflict checking (5%), administration of a subsequent patient transfer station (postanaesthesia care units, intensive medical care, intensive care units) (10%) or other more advanced uses. All hospitals questioned offered some type of ambulatory surgery in a 'hospital-integrated' manner (i.e. use of the same operating room for both in- and outpatient surgery), but none had implemented a more efficient system where outpatient surgery was performed in separate facilities. CONCLUSIONS: Current management of the operating room in Switzerland is far from best-practice standards.

Anesthesiology↗
PubMed2001

Health technology assessment of three screening methods in Switzerland.

OBJECTIVE: To describe the level of health technology assessments for three screening methods in Switzerland. METHODS: Analysis of documents and expert opinions on mammography screening, ultrasound examinations during normal pregnancy, and screening for prostate-specific antigen (PSA) with a focus on services provided, recommendations, formal regulations, national papers, projects, and formal assessments. RESULTS: Preventive services are explicitly recommended by the Swiss federal law on health insurance. Two routine ultrasound examinations during normal pregnancy as well as PSA analysis for men over 40 years of age on medical indication are covered by basic health insurance. Mammography screening every 2 years has been covered since 1997 for women over 50 years. A systematic screening program for mammography exists in the western part of Switzerland, and a nationwide program is planned. However, a national program may not come into being until a quality assurance program for evaluation is established, and a nationwide fee for reimbursement-to include all costs of such a program-is accepted by providers and insurers. CONCLUSION: According to the Swiss health insurance law, the effectiveness of mammography screening and ultrasound examinations during normal pregnancy have to be proven. Systematic evaluation of these screening methods is in preparation. PSA is not part of current evaluation. It can be concluded that health technology assessment in Switzerland is now required by law for several medical services. However, limited financial and personnel resources as well as the lack of disease registers may hamper progress in the near future.

Adult↗
PubMed2004

Occurrence of methyl triclosan, a transformation product of the bactericide triclosan, in fish from various lakes in Switzerland.

The bactericide triclosan and methyl triclosan, an environmental transformation product thereof, have been previously detected in lakes and a river in Switzerland. Both compounds are emitted via wastewater treatment plants (WWTPs), with methyl triclosan probably being formed by biological methylation. Passive sampling with semi-permeable membrane devices (SPMDs) showed the presence of methyl triclosan in some lakes, suggesting some potential for bioaccumulation of the compound. In this study, we report the presence of methyl triclosan in fish (white fish, Coregonus sp.; roach, Rutilus rutilus) from various lakes in Switzerland receiving inputs from WWTPs. Identification of the compound was based on mass spectral (MS) evidence including MS/MS data. The concentrations of methyl triclosan in the fish were up to 35 ng g(-1) on a wet weight basis and up to 365 ng g(-1) on a lipid basis with concentrations in a relatively narrow range for fish from the same lake (Thunersee, 4-6 ng g(-1); Zürichsee, 32-62 ng g(-1); Pfäffikersee, 43-56 ng g(-1); Greifensee, 165-365 ng g(-1), lipid basis). No methyl triclosan (<1 ng g(-1), lipid basis) was detected in fish (lake trout, Salmo trutta) from a remote lake in Sweden (Häbberstjärnen) and in fish (roach) from a small lake in Switzerland with no input from WWTPs (Hüttnersee, <2-<5 ng g(-1), lipid basis). The concentrations of methyl triclosan in fish correlated (r2 = 0.85) with the ratio of population in the watershed to water throughflow of the lakes (P/Q ratio), which is considered to be a measure for the domestic burden from WWTPs to a lake. Passive sampling with SPMDs confirmed the presence of methyltriclosan in lakes and a river (Zürichsee and Greifensee; Limmat) but not in a remote mountain lake (Jörisee) and in Hüttnersee. The bioconcentration factor (BCF) of methyl triclosan estimated from the fish data and SPMD-derived water concentrations was in the order of 1-2.6 x 10(5) (lipid basis) and thus in the range of other persistent organic pollutants. SPMDs were found to be reliable for monitoring low concentrations of methyl triclosan in surface water. Methyl triclosan appears to be a suitable marker for WWTP-derived lipophilic contaminants in the aquatic environment and fish.

Animals↗