BACKGROUND & AIMS: :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.

背景与目标： : 与其他国家类似，心力衰竭是瑞士发病率和死亡率的主要原因。在瑞士大学医院1998年的心力衰竭患者中，入院治疗包括: 约3分之2名ACE抑制剂/AT-II阻滞剂; 约70% 名利尿剂; 约3分之1名 β 受体阻滞剂。容易获得诊断测试和有限的调查结果表明，在瑞士，心力衰竭患者的护理质量令人满意。但是，需要正在进行的研究的结果来更可靠地评估瑞士这一高危人群的诊断和治疗质量。

BACKGROUND & AIMS: BACKGROUND:The aetiology of most childhood cancers is largely unknown. Spatially varying environmental factors such as traffic-related air pollution, background radiation and agricultural pesticides might contribute to the development of childhood cancer. This study is the first investigation of the spatial disease mapping of childhood cancers using exact geocodes of place of residence. METHODS:We included 5947 children diagnosed with cancer in Switzerland during 1985-2015 at 0-15 years of age from the Swiss Childhood Cancer Registry. We modelled cancer risk using log-Gaussian Cox processes and indirect standardisation to adjust for age and year of diagnosis. We examined whether the spatial variation of risk can be explained by modelled ambient air concentration of NO2, modelled exposure to background ionising radiation, area-based socio-economic position (SEP), linguistic region, duration in years of general cancer registration in the canton or degree of urbanisation. RESULTS:For all childhood cancers combined, the posterior median relative risk (RR), compared to the national level, varied by location from 0.83 to 1.13 (min to max). Corresponding ranges were 0.96 to 1.09 for leukaemia, 0.90 to 1.13 for lymphoma, and 0.82 to 1.23 for central nervous system (CNS) tumours. The covariates considered explained 72% of the observed spatial variation for all cancers, 81% for leukaemia, 82% for lymphoma and 64% for CNS tumours. There was weak evidence of an association of CNS tumour incidence with modelled exposure to background ionising radiation (RR per SD difference 1.17; 0.98-1.40) and with SEP (1.6; 1.00-1.13). CONCLUSION:Of the investigated diagnostic groups, childhood CNS tumours showed the largest spatial variation. The selected covariates only partially explained the observed variation of CNS tumours suggesting that other environmental factors also play a role.

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BACKGROUND & AIMS: INTRODUCTION:Marfan syndrome (MFS) and related connective tissue disorders (CTDs) are increasingly recognised. Genetic testing has greatly improved the diagnostic outcome/power over the last two decades. In this study we describe a multicentre cohort of adults with MFS and related CTDs, with a particular focus on results from genetic testing. METHODS:All patients with MFS and related CTDs were identified from the databases of five centres in the canton of Zurich. Echocardiographic and clinical findings including systemic Marfan score, use of medication and genetic results were retrospectively analysed. MFS was diagnosed using the revised Ghent criteria (including FBN1 genetic testing if available); other CTDs (Loeys-Dietz syndrome) were diagnosed by genetic testing only. RESULTS:A cohort of 103 patients were identified (62 index patients, 41 relatives of family members): 96 patients with MFS and 7 patients with other CTD, 54 males (52%), median age 23 years (range 1–75). The median systemic Marfan score was 5 (range 0–18). Only 40 patients (40/103, 39%) fulfilled criteria for systemic involvement (≥7 points). A history of aortic dissection was present in 14 out of 103 patients (14%). Echocardiographic data were available for all: aortic root enlargement (Z-score ≥2 in adults, Z-score ≥3 in children) was found in 49 patients (48%) and mitral valve prolapse in 64 (62%). Genetic testing had been performed in 80 patients (78%); FBN1 mutations were present in 69 patients (86%); other pathogenic mutations could be identified in seven patients (9%); no disease-causing mutation was found in four patients, three of them fulfilling the Ghent criteria of MFS. Of the mutation-positive patients, 33 had a systemic score of ≥7 and 43 had a systemic score of ≥5. Revised Ghent criteria were fulfilled in 70 patients: in 69 patients with FBN1 mutations and 1 patient with another CTD. Recommended treatment (beta-blocker, angiotensin receptor blocker) was taken by 63% of patients. CONCLUSIONS:In this cohort a high percentage of patients fulfilling the revised Ghent criteria for MFS underwent genetic testing, often leading to or confirming the diagnosis of MFS. Other CTDs could be discriminated best by genetic testing. With respect to the diagnosis of MFS and related CTDs, the usefulness of the systemic score is limited, showing the importance of genetic testing, which enabled definitive diagnosis in 95% of tested patients. Patient education on medical treatment still has to be improved. (Trial registration no: KEK-ZH-Nr. 2013-0241).

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BACKGROUND & AIMS: OBJECTIVES:To assess, in a prospective study, the contemporary outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) in Switzerland, by evaluating peri-operative morbidity and changes in lower urinary tract symptoms (LUTS). PATIENTS AND METHODS:Between January 2000 and January 2005, 11 hospitals in Switzerland participated in the study. The hospitals were required to inform Verein Outcome (VO), an independent institution specialising in outcome measurements in the Swiss healthcare system, about patients with BPH who were scheduled for TURP. Later, the hospitals provided data on peri-operative complications in these patients. The patients' Danish Prostate Symptom Score (DAN-PSS) was obtained by VO before and 4 months after TURP (via mailed questionnaires). RESULTS:Data on peri-operative complications from 1014 patients were included in this analysis. The mean (range) age of the patients was 69 (43-91) years. The most common complication after TURP was urinary retention, in 4.5% of the patients; the overall peri-operative complication rate was 9%. In all, 468 patients returned questionnaires both before and after TURP. The mean total DAN-PSS before and 4 months after surgery was 25.2 and 6.2, respectively (P < 0.001). CONCLUSIONS:The results of this prospective multicentre study showed that the current peri-operative morbidity of TURP is lower than that reported from older large-scale trials. The independent assessment of symptom scores confirms that TURP is highly effective in alleviating bothersome LUTS due to BPH.

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BACKGROUND & AIMS: :Ciao is a website specifically designed for young people and focuses mainly on health issues. This report presents the process of setting up the site and a first evaluation undertaken by using two self-administered questionnaires administered via the website itself. It suggests that it is possible to provide young people with authoritative health information and to facilitate their access to counseling and health care facilities by having young people use such a website.

背景与目标： : Ciao是一个专门为年轻人设计的网站，主要关注健康问题。本报告介绍了建立网站的过程，并通过使用通过网站本身管理的两个自我管理的问卷进行了首次评估。它表明，有可能向年轻人提供权威的健康信息，并通过让年轻人使用这样的网站来便利他们获得咨询和保健设施。

BACKGROUND & AIMS: BACKGROUND:Polypharmacy and potentially inappropriate medication (PIM) are associated with adverse outcomes such as hospitalization, loss of productivity, and death. OBJECTIVE:This study evaluates the prevalence of polypharmacy and PIM in the adult community-dwelling population in Switzerland. METHODS:The analysis is done based on claims data from the largest health insurance in Switzerland. We calculated the number of medications submitted for reimbursement, the proportion of persons with polypharmacy, and the proportion of persons receiving PIM according to the 2003 Beers criteria and the PRISCUS list. Additionally, we estimated cost for medications and PIM, and identified the most prevalent groups of PIM according to the Anatomical Therapeutic Chemical Classification System (ATC). RESULTS:17 % of the adult community-dwelling population in Switzerland received 5 or more medications which is one of the common definitions of polypharmacy, and over 21 % of adults aged more than 65 years had a PIM according to 2003 Beers criteria or the PRISCUS list. The most prevalent classes of PIM were psycholeptics, sex hormones, psychoanaleptics, and antiinflammatory drugs. CONCLUSION:Although the present study has a number of limitations, we conclude that the prevalence of polypharmacy and PIM in Switzerland is high. A broad spectrum of interventions on the individual level as well as on the population level is urgently needed.

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BACKGROUND & AIMS: BACKGROUND:Though slowly growing, knowledge about prisoners detained for having violated an Alien Act is still marginal and most studies involve detained asylum seekers in the USA and Australia. Little is known about prevalence rates of mental health disorders in such a population. The Brief Jail Mental Health Screening BJMHS has been demonstrated in other prison populations as a valid screening for serious mental illness. AIM:The aims of this study were to describe prevalence rates for mental disorders according to ICD-10 and to validate the BJMHS for this population. METHODS:80 inmates at a detention center for prisoners having violated the Swiss Aliens Act were surveyed using the BJMHS at their admission. The results were cross validated with the WHO Composite International Diagnostic Interview (CIDI). RESULTS:When omitting disorders caused by smoking tobacco, 76% of the prisoners suffered from at least one mental disorder according to CIDI. Whereas the rates for disorders due to psychoactive substance use as well as schizophrenic and affective disorders were comparable with other prison populations, we found a specific increased reporting of phobic (14%) and post-traumatic stress disorders (23%). The BJMHS detected serious mental illness defined as schizophrenic or affective disorders with a sensitivity of 81.0% and a specificity of 74.6%. DISCUSSION:As in other prison populations prevalence rates for mental disorders were markedly above the general population. The specific pattern with high rates of phobic as well as post-traumatic stress disorders may reflect the very often traumatic backgrounds of this population. Whereas the results for the validation of the BJMHS were even better than in other similar studies and the instrument proved to be practicable and helpful to detect serious mental illness, sensitivity for a screening tool of around 80% is still too low. Additionally the fact that other serious mental disorders are not covered emphasizes the importance of other elements in the screening process, including the need to have well-trained staff, and to have a low threshold for psychiatric examination.

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BACKGROUND & AIMS: :Old and polymorbid patients with multivalvular heart disease comprise a special patient group, with high perioperative morbidity and mortality. We report the case of an 80-year-old, female, polymorbid patient with severe mitral valve regurgitation and moderate to severe aortic valve stenosis. This is the first case in Switzerland of a concomitant transapical transcatheter aortic valve implantation and mitral valve reconstruction with the NeoChord system, on a beating heart and with a minimally invasive approach through a left anterolateral thoracotomy. This case emphasises the possibility of a low-risk minimally invasive procedure on this high-risk patient-group and shows the importance of interdisciplinary discussion and cooperation in heart teams for optimal patient treatment.

背景与目标： : 老年和多瓣膜病患者是一个特殊的患者组，围手术期发病率和死亡率很高。我们报告了一名80岁的女性多病患者，患有严重的二尖瓣反流和中度至重度主动脉瓣狭窄。这是瑞士首例通过NeoChord系统，在跳动的心脏上以及通过左前外侧开胸的微创方法同时进行经心尖经导管主动脉瓣置入和二尖瓣重建的病例。该案例强调了在这个高风险患者组中进行低风险微创手术的可能性，并显示了跨学科讨论和心脏团队合作对于最佳患者治疗的重要性。

BACKGROUND & AIMS: QUESTIONS UNDER STUDY:In Switzerland controversy exists on how to summarise the evidence on the efficacy and effectiveness, as well as adverse effects, of mammography screening, and breast cancer mortality trends are often discussed in the context of the impact of mammography. PRINCIPLES/METHODS: Single-study publications, meta-analyses, and reports by international expert groups on mammography screening are reviewed. Breast cancer mortality trends from 1970-2000 are reported and discussed in the context of the Swiss screening situation. RESULTS:In Switzerland breast cancer mortality rates for female Swiss nationals aged 50-79 years fell between 1990 and 2000 by some 25% in all language regions. The data from randomised studies in large populations in several countries with well organised mammography programmes prompt the conclusion that participation in organised screening programmes with rigorous quality standards reduces breast cancer mortality. The achievable long-term reduction in breast cancer mortality ranges from 5-20% in the target population provided that appropriate diagnostic investigation and treatment are available. To achieve this in Switzerland 830 to 3300 women need to be invited to screening for ten years to prevent one death from breast cancer. The risk-benefit profile of mammography screening is likely to be less favourable if mammographies are performed outside the context of organised screening programmes. In Switzerland we are now confronted with growing regional disparities in access to screening mammography which is under systematic quality control. CONCLUSIONS:The decrease in breast cancer mortality in Switzerland is most probably due to treatment developments and changes in cause-of-death coding. Public health measures in Switzerland should aim at regulating quality control for screening mammography, monitoring mammography use and improving the information on mammography available to women. For an evidence-based decision regarding health insurance coverage of screening mammography in 2007, large gaps need to be filled. The current coexistence of systematic screening programmes and opportunistic screening, with distinct regional differences, provides a unique opportunity for research into the merits and drawbacks of the two approaches.

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BACKGROUND & AIMS: :In 1990 the Swiss National Dose Registry started a test phase of data collection and processing. The question has been raised whether this new, centralised database with its computerized, easily obtainable data on occupational radiation exposure in Switzerland can be used for radioepidemiological studies. This paper sketches the organisation of personal dosimetry in Switzerland, describes the dose registry and other dosimetric data sources and discusses their suitability and limitations for radio-epidemiological studies.

背景与目标： : 1990年，瑞士国家剂量登记处开始了数据收集和处理的测试阶段。有人提出了这个新的集中式数据库及其计算机化，易于获得的瑞士职业辐射暴露数据是否可用于放射流行病学研究的问题。本文概述了瑞士个人剂量测定的组织，描述了剂量登记和其他剂量测定数据源，并讨论了它们在放射流行病学研究中的适用性和局限性。

BACKGROUND & AIMS: BACKGROUND AND OBJECTIVES:A trend away from primary care (PC) to other specialties has been noted in Switzerland, as well as in the health-care systems of many other Western countries. The objective of the present study was to ascertain how many third-year residents graduating in 2001/02 from medical schools in German-speaking Switzerland wanted to become PC physicians (PCPs), whether this career goal was continuously followed, and how many subjects switched to or away from PC during residency. METHODS:Data reported are from the third assessment of the longitudinal Swiss physicians' career development study, begun in 2001. In 2005, at the third assessment, 515 residents (53.8% females, 46.2% males) were asked what specialty qualifications and career goals they aspired to. In addition, participants' socio-demographic, personality, and career-related characteristics as well as their life goals were addressed. RESULTS:Of n = 515 (total sample) third-year residents, 81 had not yet decided on the medical field in which they wished to specialise, while 434 had made this decision. Of the latter, only 42 (9.7%) aspired to become PCPs. Twelve of the 42 future PCPs consistently mentioned PC as a career goal from graduation throughout residency. The other 30 subjects only decided on PC during the course of their residencies. A switch away from PC was also noted in the case of 19 subjects who on graduation or after the first year of residency aspired to become PCPs, but abandoned this goal after three years of residency. Future PCPs differ from those pursuing other specialties in terms of personal and career-related characteristics, as well as in their life goals, insofar as they are less career-orientated and regard having more time outside work a priority. There are few gender-based differences between female and male future PCPs. CONCLUSION:Primary care seems to hold little attraction as a career goal for young physicians. Residency experiences would seem to have more of an effect on choice of specialty than teaching experiences during medical school. The percentage of subjects qualifying in PC is far too low to fill the need for the future generation of PCPs. In addition to efforts to incorporate PC issues into medical school curricula, structured residency programs should be established to promote PC.

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BACKGROUND & AIMS: :Sera from various Swiss population groups were tested for antibodies against the human T-cell leukemia virus type I (HTLV-I). Particle agglutination and ELISA were performed for screening; Western blot was done for confirmation. True-positive sera were found at a prevalence of 0.12% in a cohort of 846 individuals at risk for AIDS tested in 1984-1985. Prevalences of 0.35% were found among 575 HIV-I positives tested in 1987, and of 1.3% among 292 HIV-I positives of a different group tested in 1988. The 6 positives found in our study represent the first cases of HTLV-I infection, or HIV-I/HTLV-I double infection, diagnosed in Switzerland. In addition, high proportions of sera, regardless of whether they were from normal blood donors, HIV-positives, or individuals at risk for AIDS, had antibodies that reacted weakly with one or several proteins of the size of viral gag proteins. The prevalence of such antibodies in normal donors was in the range of 10 to 40%, depending on the strictness of interpretation. Competition Western blots performed with some of these sera showed that these antibodies reacted with HTLV-I, but not with HIV-I or cellular antigens, and had a lower affinity to HTLV-I proteins than the antibodies of human or goat antisera. The results indicate that these antibodies may be induced by agents immunologically related to, but different from, HTLV-I, which are highly prevalent in the Swiss population. Oligopeptide stretches with sequence homology to HTLV-I are known to exist in various normal body proteins, several infectious agents including common viruses and protozoa, but the results might also indicate the existence of additional human retroviruses. Screening of blood donors with sensitive tests for antibodies to HTLV-I might produce an unacceptably high rate of false-positive results, if stringent rules of interpretation analogous to those common in HIV screening are not used.

背景与目标： : 对来自不同瑞士人群的血清进行了针对I型人T细胞白血病病毒 (htlv-i) 的抗体测试。进行颗粒凝集和ELISA进行筛选; 进行Western blot进行确认。在1984-1985年测试的846名有艾滋病风险的个体队列中，发现真阳性血清的患病率为0.12%。在1987年测试的575例HIV-I阳性中发现0.35% 例，在不同组测试1988年的292例HIV-I阳性中发现1.3% 例。在我们的研究中发现的6个阳性代表了在瑞士诊断的第一例htlv-i感染或HIV-I/htlv-i双重感染的病例。此外，无论是来自正常献血者，HIV阳性还是有艾滋病风险的个体，高比例的血清都具有与病毒gag蛋白大小的一种或几种蛋白质反应弱的抗体。这种抗体在正常供体中的流行率在10至40% 的范围内，这取决于解释的严格程度。对其中一些血清进行的竞争性Western印迹显示，这些抗体与htlv-i反应，但与HIV-I或细胞抗原不反应，并且对htlv-i蛋白的亲和力低于人或山羊抗血清的抗体。结果表明，这些抗体可能是由与htlv-i免疫相关但不同的试剂诱导的，htlv-i在瑞士人群中非常普遍。寡肽与htlv-i具有序列同源性，已知存在于各种正常体蛋白中，包括常见病毒和原生动物在内的几种感染原，但结果也可能表明存在其他人类逆转录病毒。如果不使用类似于HIV筛查中常见的严格解释规则，则对献血者进行htlv-i抗体敏感测试的筛查可能会产生不可接受的高假阳性结果。

BACKGROUND & AIMS: OBJECTIVE:Public engagement and science communication are growing as an important forum in the design and dissemination of research. The B!RTH programme is a partnership that uses theatre in combination with scientific expert panel discussions to raise awareness about the global inequality in women's health and access to healthcare. As part of this project, we assessed the views and experiences of audiences participating in B!RTH events. DESIGN:We conducted a multi-site mixed-methods survey using paper-based questionnaires. SETTINGS:Data were collected at four B!RTH theatre and science events: Dublin (Ireland), Edinburgh (Scotland), Geneva (Switzerland) and Liverpool (England) after the performance of four plays and three expert panel discussions. PARTICIPANTS:All audience members. METHODS:Descriptive analysis was conducted for the responses to the closed-ended survey questions, and thematic analysis was used for written free text provided. RESULTS:The estimated response rate was 42%; 363 members of the audiences responded. Most respondents had been emotionally moved by the performances (92.8%) and felt challenged and provoked (80.7%). Many respondents (73.6%) agreed that their eyes had been opened by new ideas. Five themes emerged from the free-text analysis: (1) an expression of thanks and positive feedback on the content and performance of the plays, (2) the benefit of and innovative use of art and science, (3) personal feelings in response to the plays and panel discussions, (4) the need for action and (5) suggestions for use of the plays and panel discussions in schools and universities to 'bring to life the human story behind the statistics'. CONCLUSIONS:The B!RTH programme highlights how art and science can be used in partnership and is an effective tool to engage the public, to deliver key messages and to raise awareness about inequalities in global maternal and reproductive healthcare issues.

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BACKGROUND & AIMS: :An examination of suicide rates in Switzerland during the period when domestic gas was detoxified indicated that, not only did the use of domestic gas for suicide decline, but so did the overall suicide rate, indicating that people did not switch to alternative methods for suicide, contrary to a claim made by the late Erwin Stengel.

背景与目标： : 对瑞士国内煤气解毒期间自杀率的调查表明，不仅国内煤气用于自杀的使用率下降了，总体自杀率也下降了，这表明人们没有转向替代自杀方法，与已故欧文·斯坦格尔的主张相反。