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PubMed1996

[Tuberculosis in Switzerland in 1996: prevention and treatment].

Tuberculosis is currently a rare disease in Switzerland and its incidence is slowly decreasing. Nevertheless, the increase in the proportion of foreign-born patients, the occurrence of multidrug-resistant bacilli and the increase of tuberculosis in HIV-infected individuals give rise to concern and have prompted changes in the management of the disease. The first aim is to cure the patients with adequate chemotherapy in order to prevent relapses and the development of drug-resistant germs. The best way to do so is to provide directly supervised treatment, particularly in cases where compliance with the treatment may be uncertain. Tuberculosis is transmissible to sensitive individuals. Therefore, some preventive measures are still indicated in settings where patients with a known or unknown bacillary form of tuberculosis may be cared for.

Antitubercular Agents↗
PubMed1996

[Use of complimentary medical therapies in HIV/AIDS in Switzerland].

The aim of the present survey was to evaluate the incidence and spectrum of complementary therapies among HIV-infected persons in Switzerland. Under the auspices of the SATG (Swiss Aids Treatment Group), a 13-page questionnaire was created to gather data on socio-demographics, stage of HIV infection, current regimes on opportunistic infections and antiretroviral medication, current and past use of complementary treatments, and reasons for choosing and terminating complementary therapies. Approximately 640 questionnaires in French and German were distributed among HIV-infected subjects. Distributing organizations were People with Aids (P.W.A.), the University Hospital Zurich and the regional "Aids-Hilfe" institutions. With 129 questionnaires returned, the feedback was about 20%. More than 80% of participants used at least one complementary therapy. Each person currently used four therapies (median) from a spectrum of more than 60 specific complementary treatments. The following treatments were used by more than 25% of respondents: vitamins, special diets, food supplements, physical exercise, meditation, phytotherapy, homeopathy, and psychotherapy. 47% of participants took either antiretroviral medication, prophylaxis against opportunistic infections, or both.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[Quantitative and qualitative changes in mortality between 1790 and 1990 in a mountain village of central Switzerland].

The quantitative and qualitative change of mortality has been compared between 1790 and 1990. The survey was done in the limited geographical area of a mountain village in central Switzerland. It shows a drop in mortality and infant mortality as well as a dramatic rise in life expectancy. Infectious diseases were partly replaced by the heart and circulatory diseases during these two centuries.

Adolescent↗
PubMed1979

[Anti-smoking activities in Switzerland and their evaluation].

Activities against smoking in Switzerland are planned and evaluated by the "Swiss Interagency Council on Smoking and Health". With special regard to the particular local situation it tries to coordinate the programs of its members (private organization as well as state authorities) in accordance with a multi-step plan (information about the effects of smoking, publicity, motivation for change of behavior, support of smoking-withdrawal programs, influencing legislation). Evaluation of anti-smoking programs so far has only been fragmentary, showing some circumstantial evidence for a trend towards non-smoking. It is planned to evaluate the impact of future programs by periodical surveys of representative samples of the adult population, monitoring knowledge of the hazards of smoking, attitudes towards smoking, motivation for change of behavior as well as the actual smoking habits.

Adult↗
PubMedDate not supplied

Demographic and behavioral factors associated with adolescent pregnancy in Switzerland.

Switzerland has the lowest adolescent fertility rate in Western Europe. According to data collected in 1993 as part of the Swiss Multicentre Adolescent Survey on Health, 5% of 1,726 sexually active adolescents in a group of 3,993 15-20-year-old women enrolled in academic or vocational classes had ever been pregnant; most of these women (80%) had terminated their pregnancy. Adolescents who had ever been pregnant did not differ significantly from those who had not by demographic characteristics. Multiple logistic regression analysis identified seven factors associated with pregnancy: having had four or more sexual partners; not having used contraceptives at first intercourse; ever use of less-effective contraceptive methods; having used illicit drugs during the last 30 days; living apart from one's parents; recently experiencing stress; and perceiving a lack of future prospects.

Adolescent↗
PubMed1996

[HIV infection, tuberculosis and tuberculin test in Switzerland. The Swiss HIV Cohort Study].

BACKGROUND: The usefulness of the tuberculin skin test (TST) for HIV-infected subjects may be questioned because false-negative results are increasingly common with advanced immune deficiency. The objectives of this research were thus to describe the use and the results of TST among patients with HIV infection in Switzerland and to measure the usefulness of isoniazid preventive chemotherapy and the incidence of tuberculosis (TB) relative to TST and CD4 cell count at the time of TST. DESIGN: Prospective multicentric cohort study of HIV infected patients; comparison of patients tested and non-tested, and of those with positive and negative TST. Multivariate comparison (Cox model) of TB incidence taking into account TST results and CD4 cell count at the time of TST. RESULTS: Out of 5802 patients followed up in the Swiss HIV cohort study as of September 1994, 34.6% were tested. Native Swiss were more likely to be tested than patients from high TB prevalence countries (36% vs 21% of native Africans). Patients registered after 1990 were more often tested than before (50% vs 26%). Of 2010 tested patients, 6.8% had a > 5 mm induration. African patients were more frequently TST positive (26%) than Swiss nationals (6%). Among patients with CD4 > 500 per mm3 at the time of the test, 16% were TST positive compared to 1% of those with CD4 < 200 per mm3. Out of 25 cases of tuberculosis among tested patients, 84% (21) occurred among TST-negative patients. Tuberculosis incidence among TST-negative patients with CD4 > or = 200 per mm3 at the time of the test was 0.3 per person-year. In comparison, the adjusted relative risk of tuberculosis among TST-positive patients with CD4 > or = 200 per mm3 was 5.5 (95% confidence interval [CI]: 1.2-23.9) and 6.6 (CI: 2.3-19.0) among TST-negative patients with CD4 < 200 per mm3. CONCLUSION: Despite its usefulness, TST is often performed too late and is therefore difficult to interpret. TST should be done as early as possible. TST should be done as early as possible. Among patients with CD4 < 200 per mm3, a negative TST should not preclude the use-of preventive chemotherapy, particularly in those originally from countries with a high incidence of tuberculosis.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Quality assurance in invasive cardiology: Switzerland].

In Switzerland, since 1985 mortality and morbidity data concerning either diagnostic and therapeutical coronary catheterization have been annually collected and analyzed. All interventional centres of the country (1994: 5 universities, 9 private and 3 public non academic hospitals) delivered their respective data. While there was a marked increase in diagnostic catheterizations (1989: 11'197, 1994: 20'603) and PTCAs (1989: 1'976, 1994: 5'590), the incidence of procedure related myocardial infarctions, emergency coronary artery bypass graftings (CABG) and in-hospital deaths evolved as shown in table 1 (results separated for university and non-university centres). Procedure related myocardial infarction and emergency CABG rates in patients undergoing PTCA have dropped from 2.1% to 0.9% and 3.1% to 1%, respectively, within 5 years. In the same period of time, the incidence of myocardial infarction after PTCA slightly increased from 0.7% to 0.9%. The higher rates of infarction and death in university hospitals do not necessarily mean poor quality of treatment but may reflect a more complex patient population in these centres. Furthermore, as declaring complications tends to be influenced by the concern of a negative impact on referrals, our data probably underestimate the true complications rates. For future surveys we consider anonymous data presentation and per-sonal audits at the individual centres.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Hantavirus: an ignored pandemic in Switzerland?].

As numerous publications attest, knowledge on hantaviruses progressed rapidly since the isolation of the agent of Korean hemorrhagic fever in 1978. This trend was even enhanced after the recognition of a previously unknown hantavirus that caused an outbreak of acute respiratory distress syndromes in the southwestern United States in 1993. Hantaviruses are carried by rodents worldwide and may cause severe diseases in humans. Hantavirus pulmonary syndrome in the New World and hemorrhagic fever with renal syndrome in Asia and Europe are being more and more reported. This could reflect a growing threat to public health as a consequence of behavioural and environmental changes. Though such infections are likely to occur in Switzerland too, prevalence and incidence of hantaviral infections among wild rodents and humans have not been studied yet in this country. The present paper reviews the epidemiology and clinical presentations of hantavirus infections.

Animals↗
PubMed1997

Prenatal diagnosis in Switzerland.

Switzerland, with a population of slightly over 7 million, has about 83,000 births per year. There is no comprehensive national registry for prenatal diagnosis (PND) or congenital malformations. Health care is largely organised within each of the 23 countries. Whereas ultrasound screening is available to all pregnant women, the availability of other types of PND is largely determined by proximity to the university medical centres or specialised clinics. Maternal biochemical serum screening is offered by some 15-20 laboratories, and cytogenetic analyses are performed in 8. DNA-based diagnosis is essentially limited to the medical genetics departments/divisions of the 5 university medical schools. It can be estimated that slightly over 10% of gestations are monitored by invasive prenatal diagnostic techniques. The greatest challenge for the future will be the training of the medical and paramedical personnel necessary for the current and future pre- and postnatal diagnostic testing.

Female↗
PubMed1997

[Ecstasy--the status in French-speaking Switzerland. Composition of seized drugs, analysis of biological specimens and short review of its pharmacological action and toxicity].

Methylenedioxy-N-methylamphetamine (MDMA, "Ecstasy") and other related phenylethylamines are nowadays used extensively in Western Switzerland at dance clubs and raves. There is a widely held belief among teenagers and misusers that ecstasy is safe. In the last years however, an increasing number of reports of MDMA-related deaths has been reported. Acute clinical toxicity problems following MDMA ingestion include hyperthermia, convulsions and arrhythmias. There is also growing concern that these phenylethylamines are neurotoxic and cause long-term damage to serotonineric nerve terminals in animal brains. Qualitative analyses by GC-MS of street samples of ecstasy showed that only a part of them contain MDMA or related phenylethylamines (MDA, MDEA, MBDB and 2C-B). Most of them were mixed with caffeine and an excipient (sugars or polyols [e.g. mannitol]). Amphetamine cut with caffeine and other drugs (e.g. testosterone), stimulants (e.g. pseudoephedrine) and other drugs unrelated to stimulants and phenylethylamines (e.g. LSD, chloroquine, vasodilators) were also detected. Quantitative determinations performed by HPLC-DAD or EC-DAD reveal huge fluctuations in the amount of active substance(s) per tablet. MDMA and related compounds display unique psychoactive properties, acting as a stimulant and inducing feelings of empathy. The effects of MDMA intake are very likely the results of the large release of serotonin (5-HT) in the synaptic cleft, of the inhibition of the re-uptake inactivation of 5-HT and of the inhibition of a key-enzyme involved in the biosynthesis of 5-HT. Forensic investigations performed at our institute showed significant blood levels of MDMA, MDEA and MDA in samples drawn from people suspected of driving under the influence of psychoactive drugs. Up to now, no death could be attributed to MDMA intoxication only because our analyses always revealed the additional presence of toxic amounts of other psychoactive drugs (e.g. opiates, cocaine). Our study shows that because of the variable composition of ecstasy tablets, unpredictable types and amounts of drugs may be taken by MDMA misusers. Moreover, there is considerable concern that traffic accidents may be caused by MDMA-abusers. MDMA intake could result in severe intoxication and even death, especially when combined with other types of drugs.

Chromatography, High Pressure Liquid↗
PubMed1997

[Pregnancy interruption in Switzerland 1942-1996].

In spite of restrictive legislation, practice of legal abortion has become liberal in Switzerland, bringing illegal abortions to disappear. Moreover, sex education and widespread contraception have reduced the number of legal abortions. Today, in spite of liberalization, the abortion rate is among the lowest worldwide. Prevention targeted specifically at migrant women and spreading knowledge about postcoital contraception might reduce it further. Liberalization in practice must be followed by liberalizing legislation.

Abortion, Illegal↗
PubMed1997

[Cardiac interventions in Switzerland].

For the year 1995, as for the previous 10 years, a survey of cardiac invasive and surgical procedures in Switzerland was carried out by a standardised questionnaire. At the 25 Swiss centres (10 public non academic, 10 private and 5 academic centres) a total of 11,198 coronary revascularisation procedures were performed, the majority of them (60%) by percutaneous transluminal coronary angioplasty (PTCA). Of all PTCAs, 89% were single vessel interventions. PTCA for ongoing infarction accounted for 6% of all PTCAs. The use of coronary stents has increased to 28% of all angioplasties. Other devices like directional atherectomy and rotablations have lost ground (41 cases). Thirteen interventions with intracoronary laser catheters were recorded. Among the new diagnostic tools, only coronary ultrasound has been used regularly (191 cases). Percutaneous balloon valvuloplasties (64 cases) and catheter closure of congenital shunt defects (32 cases) remained rare interventions. Procedure related mortality for PTCA was 0.7%, infarction occurred in 1.1% and emergency coronary artery bypass grafting (CABG) became necessary in 0.7%. For the first time, the total number of CABGs (4485) decreased. Among the 2077 non-coronary operations, 56% were performed for valve disease and 44% for congenital heart disease. Heart transplantation was performed in 44 patients. The majority of interventional catheter procedures were performed at the 5 university centres whereas the majority of CABGs were carried out at private centres. Four centres performed diagnostic procedures, exclusively. In-house surgical stand-by for PTCA was present in 17 of the 21 interventional centres.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Iodine supply at various periods in life and ultrasonographic thyroid volume in school children in a region of Switzerland].

In Switzerland the previous severe iodine deficiency has been corrected by iodization of salt. Changing food habits make it mandatory to periodically monitor iodine intake. In 1994 we therefore measured thyroid volume by sonography in 217 schoolchildren, and iodine, creatinine and sodium in casual urine samples of 214 schoolchildren, 40 pregnant women and 30 breast-fed newborns. Iodine was also measured in 30 breast milk samples. In schoolchildren, goiters of WHO grades Ia/Ib/II were found by palpation in 10.6/2.3/ 0.9%. By contrast, only two of the children had a sonographic thyroid volume exceeding the 97 percentile of the WHO, which underlines the difficulty of estimating the size of small goiters by palpation. Mean thyroid volume at 6/7/9/ 10/11 years of age was 2.1/2.2/3.3/3.3/3.1 ml, which is well within the normal range suggested by the WHO. Mean urinary iodine in schoolchildren (118 +/- 49 micrograms per gram creatinine) and in pregnant women (193 +/- 113 micrograms per gram creatinine) is within required limits, albeit with a decrease since 1988. In breast milk (7.8 +/- 5.9 micrograms/dl) and in urine of newborns (6.6 +/- 3.3 micrograms/dl) iodine values are below the Swedish reference values but well above values found in iodine deficient areas. We conclude that the iodine supply in schoolchildren and pregnant women is just sufficient and in newborns slightly below recently recommended limits. Compared to 1988 the iodine supply to schoolchildren is diminishing. The discrepancy between the rather low iodine content in breast milk despite a normal iodine supply during pregnancy remains to be explained.

Breast Feeding↗
PubMed1977

[African sleeping sickness in Switzerland (trypanosomiasis rhodesiensis)].

The fatal course of a case of African trypanosomiasis in Switzerland is reported. The feeling of sickness after an African trip is a diagnostic pointer. An infected fly bite and enlargement of lymphatic nodes or even symptoms of involvement of the central nervous system increase the suspicion. The diagnosis may be established simply by microscopic examination of a blood film. Because of the possibility of severe complications due to the sickness itself or due to toxicity of specific drugs, patients should be treated in hospital. Immediate contact with an Institute for tropical diseases seems to be advisable in every case.

Female↗
PubMed1977

[Frequent cases of agranulocytosis due to clozapin (leponex) in eastern Switzerland].

Two personally observed cases of severe agranulocytosis within 3 months, one of them fatal, could be attributed to the new dibenzodiazepine derivative Clozapine (Leponex). Clozapine, a very effective neuroleptic for the treatment of acute and chronic schizophrenia, has been found before to induce agranulocytosis of the metabolic type, as phenothiazines are known to do. An inquiry in al Swiss medical departments and mental hospitals revealed a total of 20 cases of Clozapine induced agranulocytosis in some 50% of institutions responding. 9 of these were observed in Eastern Switzerland. This time-space clustering recalls the "finnish epidemic" of 1975 in Southern Finland. Possible explanations for this phenomenon are discussed. Calculations of the incidence suggest a higher rate of agranulocytosis induced by Clozapine than has been assumed for the phenothiazines. Clozapine should therefore be restricted to schizophrenic patients and initially (6 weeks) be given only on a stationary basis under regular blood controls.

Adult↗
PubMed1997

Health behaviours and psychosocial adjustment of migrant adolescents in Switzerland.

BACKGROUND: Except for that of skilled and professional personnel, labour migration has practically ceased in Europe since the mid-1970s, and many of those who migrated as single males now have families in host countries. In Switzerland, among school-attending adolescents both of whose parents were born outside the country, some three quarters are children of labour migrants. Our hypothesis is that these adolescents present particular adjustment difficulties attributable to low socio-economic status and double cultural affinity. OBJECTIVE: To compare Swiss and labour-migrant adolescents in attitudes towards health risks, psychological adjustment and family relationships. METHOD: As part of the Swiss Multicentric Adolescent Survey on Health, an anonymous self-administered questionnaire was distributed in school classes among a national representative sample of 9300 fifteen- to twenty-year-olds. The subsample of labour-migrant youth includes 1200 adolescents both of whose parents are from Italy, Spain, Portugal, Turkey or former Yugoslavia. RESULTS: Bivariate analyses show significant differences between Swiss and labour-migrant adolescents in health concepts and health behaviour (notably, sexual behaviour and substance use), general well-being and family relationships. Only alcohol consumption and drink-driving behaviour place migrant adolescents at a lower risk than their Swiss peers. When sociodemographic variables are controlled in multivariate analysis, less favourable perceptions of the future, more marks risk behaviours, symptoms of depression, and difficult relationships with parents all appear to be strongly associated with migrant status. CONCLUSION: The findings of this study reflect the negative effects of lack of social stability and of clear opportunities and positive perspectives on the health and psychosocial adjustment of migrant adolescents.

Acculturation↗
PubMed1997

[Cost effectiveness of ACE inhibition in therapy of chronic heart failure in Switzerland: evaluation based on the SOLVD study].

BACKGROUND AND OBJECTIVES: Morbidity and mortality data in Switzerland underline the socioeconomic importance of heart failure. In the SOLVD study (Study on Left Ventricular Dysfunction), cardiovascular morbidity and mortality were reduced with the ACE inhibitor enalapril in patients with heart failure. The economic implications of this treatment were analyzed in a retrospective economic analysis from the perspective of Swiss third party payers. PATIENTS AND METHODS: Source of the economic analysis was the SOLVD study data. This prospective study was placebo-controlled, double-blind and had a mean follow-up of 3.45 years (41.4 months), involving 2569 patients with heart failure, mainly in NYHA classes II and III. Costing data for treatment with enalapril, the per diem charges for hospitalization and the average length of hospital stay were retrieved from published national sources. The costs of in- and output were calculated and compared for the two treatment groups in a cost-efficacy analysis. RESULTS: Additional treatment with enalapril resulted in an additional cost of 2.5 million Swiss francs. These incremental costs were, however, offset by reduced hospital costs (CHF 6.45 million savings) in the enalapril group. For the complete treatment cohort of the SOLVD study, the net savings were approximately 4.26 million Swiss francs. CONCLUSIONS: From the clinical point of view, treatment with ACE inhibitors leads to a reduction in the progression of heart failure and reduced cardiovascular morbidity and mortality. With respect to health economics, it can be demonstrated that treatment with enalapril does not only offer clinical benefits, but that these also translate into impressive economic savings of CHF 3315 per patient.

Adult↗
PubMed1997

[Molecular sex determination in skeletal remains of premature and newborn infants of the Aegerten, Switzerland, burial field].

The morphological and morphometrical analyses of skeletal remains usually give reliable access to the gender of mature individuals while the analyses of skeletal remains of immature individuals allocate only 70-90% of the individuals. However, the use of modern techniques like the Polymerase Chain Reaction (PCR) enables a sex identification also if fragmentary material or skeletal remains of children are investigated. The present study reconstructs the sex ratio of about 120 stillborn and neonate individuals of the burial place Aegerten, Switzerland. The morphometrical sex determination of the children suggests a large excess (about 60%) of female individuals. This finding was compared to the molecular sex identification. In order to perform a molecular sex identification aDNA was extracted from bone samples of the stillborn and neonate individuals. A standard phenol/chloroform extraction and a purification with a silica powder were carried out. Finally, the aDNA samples were amplified with a primer system for the amelogenin gene, that is located on the human sex chromosomes.

Bone and Bones↗