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PubMed2007

Management of potential drug interactions in community pharmacies: a questionnaire-based survey in Switzerland.

OBJECTIVE: To analyze the current drug-interaction management in Swiss community pharmacies, with a particular focus on electronic systems, and to compare the results with those expressed by German general practitioners in a recent survey. METHODS: Data were collected with a postal questionnaire which was randomly sent to 500 out of 833 community pharmacies in the German part of Switzerland. RESULTS: The response rate was 57.4%, and only 24.7% pharmacists reported that they were confronted less than daily with potential drug interactions. Use of computer software to identify potential drug interactions was widespread in community pharmacies (90.2%), and the software was the primary source of information (81.2 +/- 29.6%). The quality of the interaction software was judged sensitive (identifying all dangerous interactions) by 80.5 +/- 21.5%, but specific (identifying only relevant interactions) by only 38.3 +/- 32%. Pharmacists declared a low override rate (14%) of drug interaction alerts, although unjustified alerts were reported by 60.6 +/- 33.1%. In contrast to general practitioners, pharmacists opted less often for information on the mechanism of the interaction, and more frequently for details for dose adjustment. Both groups complained about deficient information on non-interacting alternatives. CONCLUSION: The information needs of community pharmacists differed considerably from general practitioners, and pharmacists were overwhelmed by inappropriate alerts because of a lack of specificity of their drug-interaction systems. Substantial improvement of drug-interaction software systems is thus required at least in two important aspects, the suppression of inappropriate alerts and the tailoring to the needs of the user.

Adult↗
PubMed2002

International Perinatal Nephrology Symposium, 20-21 June 2001, Lausanne, Switzerland.

The 5th International Symposium on Prenatal Nephrology returned this year to Lausanne, Switzerland, after being held in the 2 previous years across the border in France (Strasbourg 1999 and Dijon 2000). The main topics presented for discussion to the approximately 80 participants (from 13 countries) dealt this year -- in English and in French -- with several aspects of acute renal failure (ARF) in the newborn. Indeed lively, friendly and interesting discussions again characterized this very constructive meeting held in ideal warm weather beside Lac Léman.

Acidosis, Renal Tubular↗
PubMed2000

Long-term responses to treatment including ritonavir or nelfinavir in HIV-1-infected children. Pediatric AIDS Group of Switzerland.

BACKGROUND: Knowledge concerning the long-term antiretroviral and immunological efficacy of protease inhibitors in children is limited. PATIENTS AND METHODS: An open-label, prospective, multicenter clinical trial was conducted over a period of 72 weeks in Switzerland. 60 HIV-1 infected children (aged 0.3-16.9 years) naive to protease inhibitors were enrolled. Ritonavir or nelfinavir and at least one new nucleoside reverse transcriptase inhibitor were introduced into the current treatment regimen. HIV-1 RNA levels and CD4 cell counts were monitored after introducing the protease inhibitor, and the tolerability and safety of the drugs were assessed. RESULTS: Dictated by chronological availability, 37 children received ritonavir and 23 nelfinavir. At baseline, children given ritonavir had higher mean plasma HIV-1 RNA levels (5.03 vs 4.63 log10 copies/ml; p = 0.001) and lower mean CD4 cell counts (277 vs 555 cells/microl; p = 0.009) than children given nelfinavir. Antiretroviral treatment (ART) naive children showed higher mean plasma HIV-1 RNA levels than non-naive (5.18 vs 4.64 log10 copies/ml; p = 0.02). The decline in plasma HIV-1 RNA levels 72 weeks after treatment with ritonavir and nelfinavir was -2.17 and -1.30 log10 copies/ml, respectively (p = 0.006) and in ART-naive vs non-naive patients -2.70 vs -1.39 log10 copies/ml (p < or = 0.01). 69% of ART-naive patients and 32% of non-naive patients achieved sustained plasma HIV-1 RNA levels < 400 copies/ml. Increases in CD4 cells were higher in ART-naive compared to non-naive patients (p < 0.04). CONCLUSION: The antiretroviral and immunologic benefits of protease inhibitors are more profound in ART-naive than in non-naive children.

Adolescent↗
PubMed1993

Need for prevention of invasive Haemophilus influenzae type b infections in Geneva, Switzerland.

Based on a retrospective study of invasive Haemophilus influenzae type b (Hib) diseases in Geneva from 1976 to 1989, we analysed the need for prevention of invasive Hib infections by vaccination in Geneva, Switzerland. The overall incidence rate among children younger than 5 years of age was 60.2/100,000 population but it was 121.5/100,000 and 92.1/100,000 in 1988 and 1989 respectively, indicating a statistically significant increase of invasive Hib infections during the study period. Of patients, 41.5% had meningitis, 36.6% epiglottitis and 21.9% had other forms of Hib infections. The occurrence was 2.1% in children under 3 months of age and 92.3% in children younger than 5 years of age. From 1984, > 21% of all new isolates were beta-lactamase-producing Hib strains. From 1976 to 1989, two children (1.1%) died from epiglottitis and 12 children with meningitis (15.8%) developed serious neurological deficits. These data emphasize the need for prevention of invasive Hib infections by vaccination in all infants in Geneva.

Adolescent↗
PubMed1990

Health and social inequities in Switzerland.

Despite standards of living and life expectancy amongst the highest in Europe, Switzerland exhibits fairly substantial social inequities in health. As regards male mortality by socio-economic group, these differentials are both marked and independent of cause of death. There is a wealth of information on morbidity and disability supporting the hypothesis that people in lower socio-economic groups tend to age faster and suffer more at younger ages. It is similarly evident that infants of low class mothers, particularly those unwed, underprivileged immigrant, are at excess risk. The Swiss results are of political and scientific interest in that they suggest that the average wealth of a community does not determine health differentials.

Adolescent↗
PubMed1994

Cerebral tuberculosis in the immunocompetent host: 8 cases observed in Switzerland.

8 cases of cerebral tuberculosis were observed between January 1985 and June 1993 at the University Hospitals of Lausanne and Geneva, Switzerland. 5 patients were foreigners and 3 were Swiss, 2 of them alcoholics. All patients were HIV seronegative. Mycobacterium tuberculosis was isolated in 7 patients and M. bovis in one patient. All patients had radiological or bacteriological signs of pulmonary tuberculosis, and 3 had miliary tuberculosis. 3 patients died, 5 were cured. The main prognostic factors were age and the degree of neurological impairment at the beginning of treatment. The epidemiological, clinical, diagnostic and therapeutic aspects of this rare and severe form of extrapulmonary tuberculosis are reviewed.

Adolescent↗
PubMed2006

High-resolution modelling of AOT40 and stomatal ozone uptake in wheat and grassland: a comparison between 2000 and the hot summer of 2003 in Switzerland.

The aim was to compare the ozone risk for agricultural crops in Switzerland during the hot and dry year 2003 with the more 'normal' situation in 2000. An improved version of the Ozone DEposition Model ODEM was used at a 2 x 2 km resolution. The distribution of the index AOT40 was compared with the accumulated stomatal ozone flux, AF(st). Averaged AOT40 at 2 m and at canopy height was much higher in 2003 than in 2000, but inter-annual differences in AF(st) for wheat and grasslands were small due to the limiting effect of low soil water contents in 2003. AOT40 suggested larger potential yield losses in wheat in 2003, while using AF(st) with a threshold of 6 nmol m(-2) s(-1) (AF(st)6) yielded similar estimates for both years. The data show that modelling of AF(st) can be used to differentiate ozone risks between regions and years at a national scale.

Crops, Agricultural↗
PubMed2004

Urban stormwater contamination by polychlorinated biphenyls (PCBs) and its importance for urban water systems in Switzerland.

Like other persistent organic pollutants (POPs), polychlorinated biphenyls (PCBs) are still present in the environment despite their almost worldwide prohibition. A study was conducted over 1 year in Switzerland to analyze the source and load of PCBs in urban stormwater and their importance in urban water systems. The mean PCB concentrations of 89 rain events were determined in five different strictly separate drainage systems (three in Lausanne and two in Geneva). The mean concentrations of PCBs in stormwater ranged from values below the detection limit (0.11-0.24 ng/l) to 403 ng/l. A model for the wet and dry deposition of PCBs based on these results estimates that their concentration in rainwater has remained practically constant (35 ng/l) over a period of 12 years. A mass balance of Swiss levels estimates a total input load of PCBs in the urban water systems at 110-125 kg/year. The contribution of stormwater is 75-94 kg/year in combined sewer systems and 23-34 kg in separate sewer systems. This mass balance illustrates that a major part of the PCB load in the environment or in WWTP sludges originates from urban stormwater. This result was confirmed by a fingerprint of PCB congeners in stormwater, which showed a pattern identical to that found in sewage sludge in combined sewer systems.

Journal Article↗
PubMed2004

Intensive lifestyle changes or metformin in patients with impaired glucose tolerance: modeling the long-term health economic implications of the diabetes prevention program in Australia, France, Germany, Switzerland, and the United Kingdom.

BACKGROUND: In the Diabetes Prevention Program (DPP), interventions with metformin (plus standard lifestyle advice) or intensive lifestyle changes (ILC) reduced the risk of developing type 2 diabetes mellitus (DM) by 31% and 58%, respectively, versus control (standard lifestyle advice only) in patients with impaired glucose tolerance (IGT). OBJECTIVE: The goal of this study was to establish whether implementing the active treatments used in the DPP would be cost-effective in Australia, France, Germany, Switzerland, and the United Kingdom. METHODS: A Markov model simulated 3 states-IGT, type 2 DM, and deceased-using probabilities from the DPP and published data. Country-specific direct costs were used throughout. RESULTS: Assuming only within-trial effects and costs of interventions, both metformin and ILC improved life expectancy versus control. Mean improvements in nondiscounted life expectancy were 0.11 and 0.22 years for metformin and ILC, respectively. Both interventions were associated with cost savings versus control in all countries except the United Kingdom, where a small increase in costs was observed in both intervention arms. When a lifetime effect of interventions was assumed, incremental improvements in life expectancy were 0.35 and 0.90 years for metformin and ILC, respectively. Results were sensitive to probabilities of developing type 2 DM, the projected long-term duration of effect of interventions after the 3-year trial period, the relative risk of mortality for type 2 DM compared with IGT, and the costs of implementing the interventions. CONCLUSIONS: Based on probabilities from the DPP and published data, in this model analysis, incorporation of the DPP interventions into clinical practice in 5 developed countries was projected to lead to an increase in DM-free years of life, improvements in life expectancy, and either cost savings or minor increases in costs compared with standard lifestyle advice in a population with IGT. Thus, financial constraints should not prevent the implementation of DM prevention programs.

Adult↗
PubMed2001

Variation of gas exchange within native plant species of Switzerland and relationships with ozone injury: an open-top experiment.

Gas exchange and ozone-induced foliar injury were intensively measured during a 6-day period in mid-August 1998 on leaves of Acer pseudoplatanus, Betula pendula, Corylus avellana, Fagus sylvatica, Fraxinus excelsior, Morus nigra, Prunus avium, Prunus serotina, Rhamnus cathartica, and Viburnum lantana at a forest nursery site in Canton Ticino, Switzerland. Plants were grown in four open plots (AA), four open-top chambers receiving carbon-filtered (CF) air, and four receiving non-filtered (NF) air. Significant variation in gas exchange (F > 12.7, P < 0.001) was detected among species with average net photosynthesis and average stomatal conductance differing by a factor of two. Species also varied significantly in foliar injury for those leaves for which we measured gas exchange (F = 39.6, P < 0.001). Fraxinus excelsior, M. nigra, P. avium, P. serotina, R. cathartica, and V. lantana showed more injury than A. pseudoplatanus, B. pendula, C. avellana, and Fagus sylvatica. Plants grown in CF chambers had significantly higher net photosynthesis (A) and stomatal conductance to water vapor (gwv), and lower foliar injury than plants grown in NF chambers and AA plots; interactions between species and ozone treatments were significant for all variables (F > or = 2.2, P < 0.05) except gwv (F = 0.7, P > 0.1). Although A and gwv decreased and foliar injury increased with leaf age, the magnitude of these changes was lower for plants grown in CF chambers than for plants grown in NF chambers and AA plots. Neither ozone uptake threshold (r = 0.26, P > 0.20) nor whole-plant injury (r = -0.15, P > 0.41) was significantly correlated with stomatal conductance across these species. It appears that the relationships between stomatal conductance and foliar injury are species-specific and interactions between physiology and environments and leaf biochemical processes must be considered in determining species sensitivity to ambient ozone exposures.

Air Pollution↗
PubMed1998

Public health importance and risk factors for cercarial dermatitis associated with swimming in Lake Leman at Geneva, Switzerland.

Fifteen cohorts of healthy bathers were recruited at four Lake Leman beaches between 3 July and 23 August 1996 to assess the public health importance of cercarial dermatitis in Geneva, Switzerland. Telephone follow-up interviews were carried out after 2-7 days. Overall, 153 bathers out of 555 reported probable cercarial dermatitis at follow-up. Median daily attack rate was 27.7% (2.2-57.7%). Of the cases, 11.1% noticed more than 30 skin lesions, 19.6% described severe itching, 50.3% used a drug treatment, 3.9% visited a doctor and 15% claimed they would reduce their bathing activities. History of cercarial dermatitis, time spent in the water, hour of the day, barometric pressure and maximum daily atmospheric temperature predicted disease occurrence in multivariate analysis. While a benign disease, cercarial dermatitis may have a negative impact on the local water recreation industry. The identification of risk factors for the disease may help produce better preventive recommendations for the bathers.

Adolescent↗
PubMed2001

Anthracycline-induced acute cardiotoxicity in adults treated for leukaemia. Analysis of the clinico-pathological aspects of documented acute anthracycline-induced cardiotoxicity in patients treated for acute leukaemia at the University Hospital of Zürich, Switzerland, between 1990 and 1996.

BACKGROUND: Acute cardiotoxicity due to anthracyclines is a rare, but life-threatening event. Interindividual sensitivity to anthracyclines is highly variable and cannot be predicted for the individual patient. PATIENTS AND METHODS: This is a retrospective study. Medical charts and autopsy reports of patients treated for acute leukemia between 1990 and 1996 at the University Hospital of Zürich, Switzerland were reviewed and searched for anthracycline-associated acute cardiotoxicity. Patients with pre-existing heart disease known to be associated with cardiotoxicity were excluded. RESULTS: Seven patients treated for leukemia with proven anthracycline-associated acute cardiotoxicity were included. In six patients the direct cause of death was acute cardiotoxicity due to the treatment. One patient recovered from cardiac failure but died a few months later from refractory leukemia. Clinical symptoms were those of a heart failure. Pathological findings were dilatative cardiac hypertrophy and pericardial effusion. Microscopically the typical findings of myocardial fibrosis and perinuclear vacuolisated myocytes were seen. CONCLUSIONS: The awareness of acute adverse effects on cardiac performance by anthracyclines faciliates early recognition and prevention of heart failure. Reliable tests are needed for the early diagnosis of subclinical myocardial damage in order to identify patients at risk.

Acute Disease↗
PubMed1970

Palaeohistory of the spruce in Switzerland.

Pollen and carbon dating suggest that the Post-Glacial spread of the spruce (Picea) in Switzerland has been influenced by human activity. This is different from the situation in the eastern Alps.

Journal Article↗
PubMed2005

Safety and efficacy of the long-term adjuvant treatment of primary intermediate- to high-risk malignant melanoma (UICC/AJCC stage II and III) with a standardized fermented European mistletoe (Viscum album L.) extract. Results from a multicenter, comparative, epidemiological cohort study in Germany and Switzerland.

BACKGROUND: Mistletoe therapy is the most frequently used complementary treatment in cancer patients in Germany and Switzerland. However, its safety and efficacy were controversially discussed, also in case of malignant melanoma (MM). OBJECTIVES: The present study should evaluate the therapeutic safety and efficacy of a long-term therapy with a standardized fermented European mistletoe (Viscum album L.) extract Iscador (FME) during post-surgical aftercare of primary intermediate to high-risk MM (UICC/AJCC stage II-III) patients and compare it with an untreated parallel control group from the same cohort. METHODS: The study was designed as a multicenter, comparative, retrolective, epidemiological cohort study with parallel groups, carried out according to the guidelines of Good Epidemiological Practice (GEP). All patients suffered from surgically treated and histopathologically confirmed primary MM in UICC/AJCC stage II-III without distant metastases. In the study group, FME was administered subcutaneously 2-3 times weekly for at least three months, while the untreated control group was merely observed ("watchful waiting"). In both groups some patients also received radio-, chemo-, and/or immunotherapy. The patients were followed until the last visit or until death. Unselected, chronologically ordered, and standardized anonymous data from medical records that satisfied the predefined eligibility criteria were included for the "per protocol" analysis. Safety was assessed by the number of patients with FME-associated adverse drug reactions (ADRs) and by the search for tumor enhancement. The primary endpoint of efficacy was the adjusted tumor-related survival. Secondary end-points were the overall-, the disease-free- and the brain metastasis-free survival. The survival results were analyzed after adjustment for baseline imbalances, treatment regimens and other potential confounders by the Cox proportional hazard regression method. RESULTS: 686 eligible patients (329 FME vs. 357 controls) from 35 centers were observed for a median aftercare of 81 vs. 52 months. The median FME therapy duration was 30 months. At baseline, both groups were comparable concerning demography, tumor history and risk factors for progression. Additional adjuvant chemotherapy was more frequent in the study group, while immunotherapy was more frequent in the control group. Eleven patients (3.3 %) developed systemic ADRs attributed to the FME-treatment, and 42 patients (12.8 %) developed local ADRs, with mild to intermediate (WHO/CTC grade 1-2) ADR severity and spontaneous resolution in most cases. In six patients the ADRs resulted in therapy termination. Life-threatening ADRs, ADR-related mortality or tumor enhancement were not observed. On the contrary, the incidence rate of lung metastases and the adjusted hazard ratio for brain metastases were significantly lower in the FME group. In the course of the study and during aftercare a total of 212 (30.9 %) patients relapsed or progressed, and 107 (15.6 %) died. A significantly longer tumor-related survival was found in the FME group when compared with the untreated controls (unadjusted tumor-related mortality rate 8.9 % vs. 10.7 %, Kaplan-Meier estimate, Log-rank test, p = 0.017), which was confirmed after adjusting for potential confounders by the tumor-related mortality hazard ratio estimate HR (95 % confidence intervals) = 0.41 (0.23-0.71), p = 0.002. The adjusted HR results of the overall survival, disease-free survival, and the brain metastases-free survival were also significantly superior in the FME group. CONCLUSION: The long-term FME treatment in patients with primary intermediate to high-risk MM appears safe. Tumor enhancement was not observed. When compared with an untreated parallel control group from the same cohort, the results of the FME treatment suggested a significant survival benefit in primary stage II-III MM patients. These results on survival warrant reconfirmation in a prospective randomized clinical trial with optimized study design and treatment conditions.

Antineoplastic Agents, Phytogenic↗
PubMed1992

[Lyme disease in Switzerland: ocular involvement].

Lyme disease is a multisystem disorder caused by the spirochete Borrelia burgdorferi, which is transmitted by a tick (Ixodes Ricinus). Lyme disease is divided into three stages (infection, dissemination and immunological reactions). Ocular manifestations are rare except for conjunctivitis and facial nerve palsy. Switzerland is an endemic zone for Lyme disease; the presence of an atypical pars planitis should prompt a search for Lyme disease.

Adult↗
PubMed1990

[Low vision services in Switzerland. The Lausanne example].

The results of an inquiry conducted at 5 university eye hospitals and 9 regional centers in Switzerland, concerning services for low-vision patients, are presented. Most of the services can help these visually handicapped people, but the type of care provided varies considerably from center to center. The authors briefly review the patients examined in Lausanne with regard to diagnosis, age, and the visual acuity of the better eye.

Adolescent↗
PubMed2006

Contextualizing cultural competence training of residents: results of a formative research study in Geneva, Switzerland.

Medical training programs need to prepare physicians to provide care to increasingly diverse patient populations. While the general concepts and approaches of clinical cultural competence are broadly relevant across contexts, the content of cultural competence training should reflect and respond to the specific needs and challenges of clinicians in their local reality. In order to better understand and respond to the needs and challenges of residents working with diverse patients in Geneva, Switzerland, depth interviews with physicians and professional medical interpreters and direct observations of consultations were combined. Cross-cultural communication difficulties were intertwined with more general difficulties related to primary care in an outpatient context, and physicians' frustrations reflected the expectations and image of medicine that they developed during their hospital-centered training. Study results point to the need to understand how cross-cultural communication challenges articulate with other aspects of the clinical context.

Clinical Competence↗
PubMed1993

Dietary factors and breast cancer risk in Vaud, Switzerland.

The relationship between dietary factors and the risk of breast cancer was investigated in a case-control study conducted in the Canton of Vaud, Switzerland as a pilot phase for a larger cooperative study within the SEARCH Programme of the International Agency for Research on Cancer (Lyon, France). A total of 107 incident, histologically confirmed cases of breast cancer and 318 controls admitted to hospital for acute, nonhormone-related, gynecological, metabolic, or neoplastic disorders were interviewed. Significant direct trends in risk were observed with total energy intake [relative risk (RR) for highest vs. lowest intake tertile = 1.9] and, after allowance for energy intake, with frequency of consumption of various types of meat (RR = 2.1 for the highest tertile), cheese (RR = 2.7), and alcohol (RR = 2.1). Significant protections, on the order of 40-60% reductions for the highest vs. lowest consumption tertile, were conferred by total green vegetable consumption, selected types of vegetables and fruits (cucumbers, onions, pears), and a summary index of beta-carotene intake (RR = 0.4 for highest consumption tertile). Thus the present study confirmed the existence of an unfavorable dietary pattern for breast cancer risk (characterized by high-calorie, selected sources of animal fat and alcohol intake). Moreover, a significant protection could be gained by consuming a diet rich in vegetables and perhaps fruits.

Adult↗