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Before starting the health education program of the National Research Program lA "Primary Prevention of Cardiovascular Disease in Switzerland", a baseline assessment in a stratified random sample in Aarau, Solothurn, Nyon and Vevey was performed (1977/1978). Results of this baseline assessment are given for blood pressure, plasma cholesterol and smoking habits.
Dengue fever is probably the most important arthropod-borne viral infection worldwide. The World Health Organization estimates an incidence of 100 million cases per year. Dengue fever is of clinical importance mainly in tropical and subtropical zones, but the increasing number of travellers visiting these endemic areas means that physicians in temperate zones will meet this tropical infectious disease more frequently. To estimate the frequency of dengue fever in Switzerland, we retrospectively analyzed a cohort of patients in whom clinicians wished to rule out a case of malaria on the assumption that some of these patients may have been exposed to dengue virus while travelling in tropical and subtropical areas. Dengue was diagnosed by serology on contemporary stored serum samples with a commercially available assay that has been evaluated before. During the study period (1.1.93 to 1.7.94) a malaria diagnosis was requested by the physicians in our center in 87 cases and malaria was diagnosed in 10 (11.5%). In 38 of these 87 cases a stored serum sample was available for dengue serology. All of these patients had visited an area where not only malaria but dengue virus was endemic. In 7 of these 38 cases (18%) malaria was diagnosed. In 3 patients (8%) the dengue serology (IgM and IgG) was indicative of acute dengue fever. All 3 cases had clinical findings compatible with the disease. In 4 more patients (10%) anti-dengue IgG antibodies were found. All of these 4 patients had previous exposure to dengue virus but no acute clinical illness.(ABSTRACT TRUNCATED AT 250 WORDS)
The discovery of the tubercle bacillus by Robert Koch in March 1882 was immediately reported by the medical press, including that of Switzerland. Among the clinicians most active in introducing the new views and techniques to Swiss medical practitioners was Ludwig Lichtheim (1845-1928), professor of internal medicine in Berne (1879-1888), who had been acquainted with Koch since their time in Breslau. Lichtheim's successful efforts are illustrated by quotations from his (unpublished) memoirs.
Individual oral hygiene, professional dental care and subjective satisfaction with the oral health were investigated in 600 persons representative for the German- and French-speaking population of Switzerland. They cleaned their teeth on average 2.4 x per day, 85% had a "family dentist" whom they had last visited 14.6 months ago and who works to their full satisfaction. On average, every 13.5 month they underwent professional cleaning of their teeth which was performed in 55% by their dentist and in 45% by a dental hygienist. They were well satisfied with the condition of their teeth and gums and even better so with their reconstructions. In 1984 a gap of consumption of toothbrushes and toothpastes had been apparent in over 50-year-old people. Today this is just visible in the over 60 year old. 40 to 60 year old people care for their oral hygiene and regularly go to professional control and cleaning appointments. Only over 60 year old people are consuming slightly less dental services and buying less toothbrushes and toothpastes. Turning points are loss of teeth, retirement, isolation and sharp cuts in income.
Examination of over 3700 dogs has proven that 42% of all purebred dogs in Switzerland are affected by CHD despite control programs for the last 30 years. Breeding with dysplastic dogs and lack of progeny control are responsible for this slow progress.
Two years after introduction of maternal serum screening for Down's syndrome in German-speaking Switzerland, based on measurements of alpha-fetoprotein, unconjugated estriol and total beta-HCG, results were analyzed of the two cytogenetic laboratories in Zurich and of a separate collective of the Department of Obstetrics at the University of Zurich. In a total of 489 cases with increased risk for Down's syndrome (> or = 1:380 at term) 19 (1:26; approximately 4%) had an abnormal fetal karyotype from which 16 had a trisomy 21. 13 out of these 16 mothers were aged below 35 years. Thus, after ultrasound, maternal serum screening detects the highest percentage of fetuses with chromosomal abnormalities. At the Department of Obstetrics 2962 serum screening tests were performed during a period of 2 1/2 years. 14.6% of the women were > or = 35 years old, 7.6% showed increased risk and 14 fetuses had an abnormal karyotype including 10 with Down's syndrome. 7 of these 10 were detected by the serum test. Nevertheless, the limited sensitivity of serum screening, its limitation predominantly to detection of fetuses with Down's syndrome and the rather late stage of screening, make effective first trimester screening mandatory.
In teamwork with agricultural schools data were collected by questionnaire, concerning management and housing of calves. Aim of the study is to get an overview about actual husbandry systems, and to allow some evaluation of application of ethological knowledge in practice. The results concerning different dimensions of system-details are interpreted widely being full-filled in terms of animal welfare legislation (Switzerland). Concerning more qualitative requirements it is found that application of animal welfare knowledge should be increased.
From February to December 1991, 167 sporadic cases of Campylobacter enteritis in Switzerland and 282 controls were enrolled in a case-control study using self-administered questionnaires. In the multivariate matched analysis, travel abroad was identified as the most important risk factor for an infection with Campylobacter (adjusted odds ratio [OR] = 21.2, 95% confidence interval [CI]7.6-56.2). Having foreign citizenship also increased the risk (OR = 6.7, 95% CI 1.3-34.5). Among food items consumed within five days before onset of illness, consumption of poultry liver was shown to be a risk factor (OR = 5.7, 95% CI 1.4-22.8), while the consumption of curd or cottage cheese lowered the risk (OR = 0.5, 95% CI 0.3-0.9). The unmatched analysis confirmed travel abroad and the consumption of poultry liver as risk factors and the consumption of curd or cottage cheese as being protective, and, in addition, identified the consumption of poultry as a risk factor (OR = 2.0, 95% CI 1.1-3.3). The study showed the feasibility of using self-administered questionnaires for this type of analysis. The method is logistically simple and reduces the cost of case-control studies.
There is current debate whether prevalence of insulin-dependent diabetes mellitus is increasing in western countries. In Switzerland every male at age 19 years is legally obligated to appear before the Military Conscript Board, where health status is determined by physicians. We analyzed prevalence data concerning the diagnosis of diabetes mellitus in four full surveys (1972, 1982, 1987, 1993). The study included data from 162,607 Swiss males at age 19 years. Case numbers of birth cohorts and prevalence rates per 1000 are the following: [table: see text] Although the number of years surveyed is limited, trend analysis showed no evidence of an increase in the diabetes rates (total chi 2 = 4.953, DF = 3, 0.1 < p 0.2; chi 2 due to linear regression = 3.013, DF = 1, 0.05 < p < 0.1; chi 2 due to departure from linear regression = 1.940, DF = 2, 0.3 < p < 0.5). Overall cumulative incidence of diabetes mellitus was 1.30/1000 conscripts (95% confidence interval: 1.13-1.48/1000). We conclude that, in contrast to reports from other European countries, the cumulative incidence of insulin dependent diabetes mellitus has not increased among cohorts of Swiss males at age 19 years.
Since 1986, 150 to 180 general practitioners, internists and pediatricians in private practises have reported morbidity data to the Swiss Federal Office of Public Health within the Sentinella network. Data on a certain number of infectious diseases, some noninfectious diseases and other reasons for consultation are collected through this reporting system. The number of participating physicians corresponded to 2.3 to 3.1% of all family practitioners for each of the three specialties. They also covered approximately 2.7% of the total annual number of consultations in Switzerland. In 1992/93, all cantons and all half-cantons except Nidwalden and the two half-cantons of Appenzell were represented by at least one physician who reported during 75% or more of the total reporting period. When compared to other countries, the network density of the Swiss Sentinel network is high. Since 1986, several infectious diseases have been continuously monitored by the Sentinella system (measles, mumps, rubella, influenza). Surveillance of pertussis, which was started in 1991, will be continued for several years. According to these data, an annual pertussis incidence rate of 60 out of 100,000 population and 100 out of 100,000 population was estimated in 1991/92 and 1992/93, resp. More than 55% of cases were children aged between one and eight years. Of these children, 70.4% were reported to be vaccinated, and 62.6% had a well-documented vaccination status (based on a vaccination certificate). In 95.6% of these cases, at least three vaccine doses were given.(ABSTRACT TRUNCATED AT 250 WORDS)
Psychoanalysis has developed in a unique way in every country where it exists. This article discusses historical reasons for the favorable reception of psychoanalysis in Switzerland. Information is provided on the roles of psychiatrists, educators, and pastors in early twentieth century Swiss psychoanalysis. The factor of nationalism in the reception of psychoanalysis is emphasized. It is suggested that, in some countries, religion has played a positive role in the development of psychoanalysis.
An outbreak of Salmonella typhi murium caused by person-to-person contacts was observed in Kurhaus (NE Switzerland) in late 1973. In all, 18 patients with clinical symptoms and 8 asymptomatic carriers were registered. However, 1 1/2 months elapsed before the etiologic diagnosis could be established. The infection was then transmitted, probably by a visiting nurse, to the personnel of a neighbouring school. An outbreak followed thereafter including 31 clinically manifest patients and 10 asymptomatic carriers. Infected food was most probably responsible for the dissemination of the disease, since two asymptomatic carriers were detected among persons engaged in the preparation of food. The close correlation between the two epidemics was confirmed by phague typing of isolated Salmonella strains according to the method of GUINEE. A common Biotype I, Lysotype 650, was identified in all cases. Clinical findings revealed diarrhea in 77,6%, fever in 59,2% and vomiting in 18.4% of cases. Only two patients who were admitted to the hospital, were given chemotherapy. The excretion of Salmonellae in the stools was observed on average for about one month in clinical cases and for 12 days in asymptomatic carriers. All the strains, with one exception, were in vitro sensitive against tetracycline, Chloramphenicol and trimethoprim-sulfamethoxazole. In one case the tetracycline treatment resulted in homologous resistance. In this case the carrier state had been observed for 111 days. Serologic tests were made one month after the outbreak was detected using Widal reactions with antigens of homologous strain. In most patients with clinical symptoms antibody titers were at serum dilutions of more than 1:80, whereas only 4 of the 9 asymptomatic carriers investigated presented with titers in this range. Patients who were not excreting Salmonellae had uniform antibody titers of less than 1:80.
Switzerland has adopted a prevention strategy including the promotion of non-sharing injection material and use of condoms. The access to sterile equipment has been made easier, but regional differences still exist. Studies conducted between 1989 and 1992 among drug users in different Swiss regions are reviewed in order to examine if progress in prevention occurred. Syringe sharing diminished everywhere, but rather high sharing rates persist where sterile material is less accessible. Condom use increased, but the situation is still unsatisfactory considering the high HIV prevalence among i.v. drug users. Where several surveys have been conducted consecutively, a stabilization of HIV prevalence was observed. This suggests a slowing down of the progression of the epidemic among drug users. These results, obtained in few years, are encouraging in the light of the pessimism which prevailed at the beginning of the epidemic about the ability of drug users to adopt preventive behaviour.
Extremely low birthweight infants are attracting increasing attention in the medical literature, mainly in audits from selected hospitals not representative of the entire population of a country. The Swiss Neonatology Group gathered selected data on mortality, morbidity and medical treatment of all liveborn infants weighing between 500 and 999 g at birth for the years 1979-81, 1983-85 and 1989-91. The results were compared and completed with information from the Swiss Office of Statistics. From 1979-81 to 1989-91 the incidence of extremely low birthweight infants increased from 1.3 to 2.2 per thousand livebirths. At the same time the survival rate increased from 23% to 53%, resulting in three times more infants being discharged from hospital in this weight group. The number of days of mechanical ventilation, which is an indicator of intensity of care, increased from 320 days to 1440 days per year. In contrast to mortality, morbidity scarcely decreased within this 12-year period and was still considerable in 1989-91. 57% of the survivors had chronic lung disease and 15% had sepsis. Intracranial hemorrhage was present in 35% of the survivors and 71% of the deaths. Retinopathy was noted in 38% of survivors. These facts, which are representative of the whole of Switzerland, show the increasing medical and economic significance of this patient group. Before the implications of this development can be fully assessed, extremely low birthweight infants must be followed up until adult life.
In the years 1978 to 1987 29 patients died in Switzerland following hymenoptera strings, most usually from honey bees and wasps (vespula). The vast majority of these fatalities were due to one single sting and thus most probably caused by IgE-mediated anaphylaxis. Three quarters of the victims were male. The mean age was 60 and most of the patients had a history or autopsy evidence of preexisting cardiovascular or pulmonary disease. Death occurred within 30 minutes of the sting in 50% and within 4 hours in 75% of the victims. Of the 10 patients with previously known hymenoptera sting allergy, none had a suitable emergency kit available when stung and none was on venom immunotherapy. Treatment by the emergency physician must be regarded as inadequate in one third of the patients.
For many decades trichinellosis has not been reported among Swiss domestic pigs. Considering the fact that Trichinella occurs in a sylvatic cycle in Switzerland, a study was designed to reevaluate the present epidemiologic situation by investigating 10,904 fattening pigs, 218 pigs with free access to pasturage or being kept on an alp, 104 domestic boars, 106 horses, 44 wild boars and 538 foxes using a direct and an indirect diagnostic technique (digestion method and serology with ELISA and an excretory/secretory antigen, respectively). The digestion method was performed according to EC-guidelines. Furthermore, 25,239 sera originating from a Swiss sow-serum bank were tested retrospectively for anti-Trichinella antibodies. Trichinella was not detectable in all domestic pigs using the digestion method. Serologically, 3 fattening pigs (0.027%) and 9 sows (0.036%) demonstrated weak antibody reactivities against the Trichinella E/S-antigen. Based upon statistical calculations for the negative-positive threshold, these antibody-reactions were considered to be within the normal range of variability of the test. Although statistically restricted, the results of the present study indicate the absence of Trichinella within the Swiss pig population. Based upon the rational applicability of the ELISA and its diagnostic sensitivity and specificity, this test appears as the most suitable method to perform large-scale screenings among slaughter pigs. Pigs with free access to pasturage and boars were all parasitologically and serologically negative for Trichinella. The digestion method showed that horses and wild boars were all parasitologically negative, whereas 1.3% of the foxes were positive for Trichinella larvae.
On the background of similar analyses (American and European), this analysis was aimed at investigating the scientific activity in physical medicine and rehabilitation in Germany, Austria and Switzerland. A medline search covering 1 year was performed, all relevant publications were identified and evaluated according to the following criteria: address and speciality of author, subject (diagnostic or therapeutic), journal, and study design. The results show that the majority of publications does not originate from institutions of physical medicine and rehabilitation. Therapeutic subjects dominate with a predominance of exercise therapy. Their study design leaves room for improvement. This investigation might stimulate consequent and rigorous research in our field.
The opinion about their residents of 60 heads of surgical departments of non-university hospitals in Switzerland is presented. Problems concerning employment criteria of residents, their professional education, operative activity and work hours are discussed.