Could the North American opioid crisis hit Switzerland?
No abstract available.
No abstract available.
Hereditary alpha-tryptasemia (HAT) is an autosomal dominant genetic trait affecting 4% to 6% of the general population. Hereditary alpha-tryptasemia is caused by an excess of alpha tryptase encoding TPSAB1 copy numbers on one parenteral allele, most often duplications or triplications, leading to elevated levels of basal serum tryptase. There might be a gene dosage effect between the number of additional TPSAB1 copies, the level of basal serum tryptase and the severity of clinical symptoms, including atopic, cutaneous, gastrointestinal, musculoskeletal, autonomic and neuropsychiatric manifestations. Hereditary alpha-tryptasemia is a potential risk factor for severe anaphylactic reactions. The prevalence of hereditary alpha-tryptasemia is higher in patients with systemic mastocytosis. In the diagnostic workup of patients with anaphylactic reactions and symptoms of mast cell mediator release after measurement of basal serum tryptase, it is therefore essential to screen for both the KIT D816V activating point mutation and hereditary alpha-tryptasemia by droplet digital polymerase chain reaction. Such a diagnostic approach can identify patients with hereditary alpha-tryptasemia, which may allow the avoidance of further diagnostic workup with bone marrow examination. Moreover, it can identify patients at high risk of anaphylactic reactions. So far, no targeted therapy for hereditary alpha-tryptasemia is available. Treatment for symptom control consists of H1- and H2-blockers, leukotriene antagonists and cromoglicic acid. Urticaria and anaphylaxis are especially successfully treated with the monoclonal anti-IgE-antibody omalizumab in patients with hereditary alpha-tryptasemia. H1-blockers and steroids are sufficient in emergencies. As hereditary alpha-tryptasemia is a hereditary condition, first-degree relatives with anaphylactic reactions or symptoms of mast cell mediator release should be tested for hereditary alpha-tryptasemia after measurement of basal serum tryptase.
BACKGROUND: Self-reported health-related quality of life is an established prognostic tool in stable outpatients. However, its prognostic relevance in patients presenting with an acute onset of symptoms such as acute dyspnoea is largely unknown.
METHODS: This major unmet clinical need was addressed in a secondary analysis of a prospective study, enrolling patients presenting with acute dyspnoea to the emergency departments of two university hospitals in Switzerland. Self-reported health-related quality of life was obtained at presentation with the use of the generic EQ-5D tool and directly compared to the objective risk prediction marker N-terminal pro-B-type natriuretic peptide (NT-proBNP). The primary endpoint was all-cause mortality within 90 and 720 days. Cox proportional hazard regressions were performed with age, sex, history of heart failure, systolic blood pressure, haemoglobin, estimated glomerular filtration rate and NT-proBNP as predictors. Prognostic accuracies were calculated with the use of area under the receiver operating characteristics curve (AUC).
RESULTS: Among 1144 eligible patients (median age 74 years, 42% women, 52% acute heart failure), 7% died within 90 days and 28% within 720 days after presentation to the emergency department. The EQ-5D index was strongly associated with mortality. In adjusted Cox regression analyses, the hazard ratios of the EQ-5D index for 90- and 720-day mortality were 7.8 (95% confidence interval [CI] 3.4–17.9) and 5.0 (95% CI 3.3–7.6), respectively. Prognostic accuracies of the EQ-5D index for 90- and 720-day mortality were 0.68 and 0.65, and comparable to the prognostic accuracy of NT-proBNP (both AUCs: 0.69, p-value for comparison 0.915 and 0.121).
CONCLUSIONS: Self-reported health-related quality of life assessed by the generic EQ-5D tool provides moderate-to-high prognostic accuracy in patients presenting with acute dyspnoea to the emergency department and may aid physicians in risk stratification.
Trial registration: https://clinicaltrials.gov NCT01831115.
INTRODUCTION: The Swiss Society of Paediatrics currently recommends the growth references of the World Health Organization (WHO), while the Paediatric Endocrinology Centre Zurich (PEZZ) has proposed alternative growth references. Specialists and researchers also use International Obesity Task Force (IOTF) references to define overweight and obesity. We investigated the fit of anthropometric measurements from schoolchildren in the canton of Zurich to these three growth references and assessed the prevalence of overweight, obesity and short stature across the three references.
METHODS: We analysed data from 3755 children aged 6–17 years in the cross-sectional LuftiBus in the School (LUIS) study, collected in the period 2013–2016 in the canton of Zurich. We calculated z-scores of height, weight and body mass index (BMI) based on WHO, PEZZ and IOTF references. We compared the mean and distribution of z-scores to the expected standard normal distribution using the Anderson-Darling test. We classified overweight, obesity and severe obesity based on cutoff values given by the three references. We defined short stature as <3rd percentile of height for age.
RESULTS: The mean z-scores in LUIS were 0.56 for height, 0.28 for weight and 0.06 for BMI based on WHO references; 0.15 for height, 0.06 for weight and −0.01 for BMI based on PEZZ references; and 0.19 for BMI based on IOTF references. The Anderson-Darling test showed that children in LUIS fit worse to WHO and IOTF than to PEZZ references. The WHO classified fewer children as overweight than PEZZ and IOTF references (WHO: 8%; PEZZ: 15%; IOTF: 13%) but more children as obese or severely obese (6%; 4%; 3%). The WHO defined fewer children as being of short stature than PEZZ references (1% vs 3%).
CONCLUSIONS: Our findings suggest that anthropometric data of schoolchildren in Zurich (LUIS) differ notably from WHO and IOTF references potentially leading to misclassification of overweight, obesity and short stature. Thus it would be timely to develop new nationally representative growth references for Switzerland.
STUDY AIMS: Routinely collected health data are increasingly used for research; however important anamnestic details may be missing from medical records. We compared physician documentation of paediatric exercise-induced respiratory symptoms in clinical notes with parental questionnaire responses for the same children.
METHODS: We analysed data from the Swiss Paediatric Airway Cohort (SPAC), a multicentre observational study of children treated in Swiss outpatient pulmonology clinics. We included children aged 6 to 17 years who were referred to a paediatric pulmonologist for evaluation of exercise-induced respiratory symptoms. Features of exercise-induced respiratory symptoms recorded by physicians were extracted from outpatient clinic letters transmitted to the referring physician, while parent-reported exercise-induced respiratory symptom data was collected from a standardised questionnaire completed at Swiss Paediatric Airway Cohort enrolment. We calculated agreement between physician-documented and parent-reported exercise-induced respiratory symptom characteristics using Cohen’s and Fleiss’s kappa.
RESULTS:Of 1669 children participating in the Swiss Paediatric Airway Cohort (2017–2019), 193 (12%) met the inclusion criteria, of whom 48% were girls. Physicians provided detailed information on exercise-induced respiratory symptoms in 186 (96%) outpatient clinic letters. Documented characteristics included: type of physical activity triggering exercise-induced respiratory symptoms (69%), location of exercise-induced respiratory symptoms in chest or throat (48%), respiratory phase of exercise-induced respiratory symptoms (45%) and timing of exercise-induced respiratory symptoms during or after exercise (37%). Previous bronchodilator use (94%) and its effect on exercise-induced respiratory symptoms (88%) were consistently documented by physicians. The clinic letters for children diagnosed with dysfunctional breathing more often contained detailed exercise-induced respiratory symptom characteristics than those diagnosed with asthma. The level of agreement between physician-documented and parent-reported exercise-induced respiratory symptoms was moderate for use of bronchodilators (κ = 0.53) and poor-to-fair for all other features (κ = 0.01–0.36).
CONCLUSION: This study highlights that outpatient clinic letters may lack some details on exercise-induced respiratory symptom characteristics – information that parents could provide. A standardised and detailed method for documenting paediatric respiratory symptoms in the coordinated data infrastructure may enhance future analyses of routinely collected health data.
BACKGROUND: Ward rounds carried out by interprofessional teams are an important element of patient-centred care in the field of internal medicine. This quantitative and qualitative study aimed to assess patient satisfaction with interprofessional ward rounds.
METHODS: This mixed-methods observational study evaluated patient satisfaction with ward rounds in a hospital setting. A total of 211 hospitalised patients from four different hospitals were assessed between 25 August and 8 September 2023. Quantitative data were collected using a visual analogue scale (VAS) from 0 to 10 with satisfaction scores at or below the median VAS defined as the primary endpoint. A median split was applied to categorise patients into groups for comparison. We examined associations between ward round-related factors and satisfaction. Additionally, a qualitative assessment was conducted using open-ended interviews to explore patients’ perception of ward rounds. The study adhered to standards for reporting qualitative research.
RESULTS: Of the 211 patients analysed (participation rate 59.3%), the median satisfaction score was 8 points. Lower satisfaction was significantly less frequent among patients who reported high comprehensibility (i.e. information was understandable) of their current medical situation (adjusted odds ratio [OR] 0.55, 95% confidence interval [CI] 0.45–0.69; p <0.001). Similarly, being involved in medical discussions was associated with higher satisfaction (adjusted OR for lower satisfaction 0.39, 95% CI 0.30–0.52; p <0.001). Qualitative analysis revealed that patients wish to be accurately informed about the current medical situation (31.3%) and be actively involved in ward round discussions (31.3%). Overall, patients preferred interprofessional ward rounds; however one main concern was insufficient transfer of information between the professions.
CONCLUSIONS: This study provides important insights from the patient perspective regarding elements of patient-centred care during the medical ward round. Active involvement of patients and information transfer were key issues that may further improve the patient experience and patient satisfaction with care.
STUDY AIMS: Physician well-being is related to productivity and quality of care. The well-being of general internists (physicians who provide most primary care services) has never been comprehensively examined in Switzerland. In this survey, we assessed the well-being of Swiss general internists and its relationship to personal and work-related factors.
METHODS: In November 2022, we conducted a national survey among members of the Swiss Society of General Internal Medicine. We evaluated the association between personal and work-related factors and reduced well-being (Physician Well-Being Index ≥4 points) using multivariable logistic regression.
RESULTS: The response rate was 21% (1672/8111 members). Among the respondents whose data was analysed, 44% (710/1624) were women and 76% (1234/1613) primarily worked in an out-patient setting. Overall, 33% (543/1621) reported reduced well-being and 54% (876/1623) felt burnt out. Older age was associated with a lower likelihood of reduced well-being (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.96–0.98, per year) while being female was associated with a higher likelihood of reduced well-being (aOR 1.33, 95% CI 1.03–1.72). Factors associated with reduced well-being included working in an outpatient setting (aOR 1.76, 95% CI 1.24–2.51), having ≤2.5 personally rewarding working hours/day (aOR 2.18, 95% CI 1.63–2.90), long weekly working hours (aOR 1.02, 95% CI 1.01–1.03, per hour) and dissatisfaction with income (aOR 2.42, 95% CI 1.78–3.30).
CONCLUSIONS: A third of Swiss general internists reported having a reduced well-being and approximately half felt burnt out. Female sex and several work-related factors such as working in an out-patient setting, long working hours, few personally rewarding work hours, and income dissatisfaction were related to having a reduced well-being.
BACKGROUND: The prevalence of cancer is rising continuously worldwide. Relatives play an important role in caring for cancer patients and are at the same time affected by the illness and treatment of their loved ones. They have often been referred to as a forgotten group. Advances in digital technology offer various opportunities to enhance the well-being of and care for relatives.
OBJECTIVES: The aim of the study was to investigate the utility of a mobile application to support the relatives of palliative cancer patients in Switzerland, the potential content elements of such an app, and its optimal functional and structural design.
METHOD: Using a purposive sampling strategy, three focus group discussions were conducted at the University Hospital of Bern. The 15 participants included both relatives and experts. Data was analysed using content structuring qualitative content analysis according to Kuckartz and Rädiker.
RESULTS: Statements from the focus groups were summarised in four main categories. These included statements from participants about the need for and potential benefits of an app, such as resource gains or easier access to care. Statements regarding possible content components of the app, such as tools for professional support and coordination or the provision of information, were also summarised. Statements were also included on the necessary functional features and the structural embedding of the app.
CONCLUSIONS: The results indicate a need for a caregivers app in Switzerland. The app should reduce gaps in care, focus on family members, and strengthen their empowerment and access to resources. In terms of content, bundled information, low-threshold support offers, coordination tools, and self-care options should be guaranteed. The modular and simply structured app should be designed in a needs-oriented manner to be used safely throughout Switzerland.
OBJECTIVE: Epidural steroid infiltration has been used for decades as symptomatic pain therapy. To record and evaluate treatment response to epidural steroid infiltration, patient-reported outcome data were collected from patients receiving interlaminar or transforaminal epidural steroid infiltration with dexamethasone-21-palmitate (Lipotalon®).
METHODS: This retrospective study included patient-reported outcome data from 212 patients who received treatment with translaminar or transforaminal epidural steroid infiltration at University Hospital Basel between July 2019 and April 2022. To evaluate pain and quality of life after treatment, the Numeric Rating Scale (NRS), Pain and Enjoyment of Life and General Activity (PEG) scale, European Quality of Life 5 Dimensions Questionnaire (EQ-5D-5L) and Oswestry Disability Index (ODI) were assessed prior to and at 7 days, one month and three months after treatment.
RESULTS: There was a significant decrease in back pain on the NRS at 7 days and 3 months post-intervention compared to admission: 6.07 (SD 2.27) at admission, 4.52 (SD 2.26) at 7 days and 4.21 (SD 2.69) at 3 months (all p-values <0.001). Similarly, a significant decrease could be reported for leg pain: 5.59 (SD 2.72) at admission, 3.89 (SD 2.64) at 7 days and 3.58 (SD 2.84) at 3 months (all p-values <0.001). The mean PEG scale was 6.34 (SD 1.84) at admission, 4.52 (SD 2.15) at 7 days and 3.93 (SD 2.6) at 3 months (all p-values <0.001). The mean ODI score also improved significantly: 35.67 (SD 15.75) at admission, 28.24 (SD 16.11) at 7 days and 25.17 (SD 16.22) at 3 months (all p-values <0.002). The mean EQ-5D-5L score did not differ significantly during the observation period.
CONCLUSIONS: Dexamethasone-21-palmitate may be a potential treatment alternative to traditional water-soluble steroids. However, further controlled trials are necessary to confirm the efficacy and safety of this treatment.
STUDY AIMS: Wheelchair athletes may be at risk of urinary tract infections, especially those with spinal cord injury. A urinary tract infection can lead to a loss of training hours and reduced performance in athletes. We assessed the self-reported occurrence of urinary tract infections and the impact of urinary tract infections on training and performance in elite wheelchair athletes. We also evaluated the prophylactic measures used, as reported by the athletes.
METHODS: Data were collected from September 2022 to August 2023 at an institute specialised in examining wheelchair athletes. All wheelchair athletes active in international and/or national competitions who attended one of the routine checkups at the institute during the study period were included. The number of self-reported urinary tract infections during the previous 12 months was collected, including symptoms associated with urinary tract infections, prophylaxis, and impact on training and performance. The method of bladder voiding was assessed by catheter use, either “Yes” (intermittent and indwelling) or “No” (no catheter use at all).
RESULTS: Eighty-one athletes were included (mean ± standard deviation age 35±11 years; 24 females; 67 with spinal cord injury; 56 using a catheter). Prophylaxis was used by 38 (47%) athletes; the most common was natural supplements, including cranberry juice and D-mannose. Thirty-six (44%) athletes had had at least one urinary tract infection during the previous 12 months. Athletes were more likely to have had at least one urinary tract infection if they had spinal cord injury (34 [94%] vs 2 [6%] athletes, p = 0.013) or were using a catheter (32 [89%] vs 4 [11%] athletes, p = 0.001). A urinary tract infection resulted in 4±6 lost training days and impaired performance.
CONCLUSION: Urinary tract infections are common in elite wheelchair athletes and have a negative impact on training volume and performance. About half of the athletes use prophylaxis. Athletes with spinal cord injury or who use a catheter are especially at risk of urinary tract infections.
INTRODUCTION AND OBJECTIVES: In Switzerland, little is known about farmers’ wellbeing. Based on cross-sectional baseline data from the Swiss agricultural health cohort FarmCoSwiss, we carried out a study to investigate farmers’ flourishing i.e. complete wellbeing and ability to thrive – to our knowledge, the first study worldwide to do so –, to descriptively compare it to the general population and to explore its association with farm characteristics and occupational hazards.
METHODS: Of 1480 self-registered adult farmers recruited as a Swiss-wide convenience sample, 947 individuals (63.9%) signed the informed consent form, and 872 answered the online questionnaire in German, French or Italian at baseline between November 2022 and August 2023. The questionnaire obtained information on, among others, the primary outcome flourishing as assessed by the Secure Flourish Index (SFI) with its six subdomains Happiness and life satisfaction, Mental and physical health, Meaning and purpose, Character and virtue, Close social relationships, and Financial and material stability, each assessed on a scale from 0 to 10. Participants additionally answered questions on the primary predictors farm characteristics and 20 pre-selected occupational hazards classified into five domains (physical, chemical, biological, psychosocial and environmental). Participants assessed the hazards in terms of exposure frequency (Likert scale from 1 to 5) and perceived health harmfulness (Likert scale from 1 to 4). First, farmer’s mean SFI was descriptively compared to mean SFI in the general adult population using the data of 7220 participants from the 2023 follow-up of the population-based COVCO-Basel cohort established in Basel-Stadt and Basel-Landschaft cantons. Second, zero-one inflated beta regression models were constructed to investigate the age- and sex-adjusted association of mean SFI values (overall; domain-specific) with the farming system (non-organic or organic), the production system (animal husbandry or crop cultivation), farm size (five categories) as well as the exposure to, and perception of, occupational hazards (sum of respective Likert scales).
RESULTS: Mean SFI values were between 7 and 8, in both FarmCoSwiss and COVCO-Basel. Descriptively comparing these two samples, farmers showed lower flourishing overall (7.44, SD = 1.41; COVCO: 7.70, SD = 1.30) and in the four domains Happiness and life satisfaction (7.39, SD = 1.87; COVCO: 7.91, SD = 1.55), Mental and physical health (7.03, SD = 1.73; COVCO: 7.68, SD = 1.53), Close social relationships (7.66, SD = 2.08; COVCO: 7.94, SD = 1.73) and Financial and material stability (7.06, SD = 2.45; COVCO: 7.33, SD = 2.69). Farmers reported being most frequently exposed to biological hazards (66.2% often/always exposed), but psychosocial hazards were perceived as the most harmful to health (51.9% judging them as rather/very harmful). Exposure to psychosocial hazards was negatively associated with overall flourishing and its six subdomains. In the domains Happiness and life satisfaction, Mental and physical health, and Meaning and purpose, organic farming was associated with higher flourishing. In the domain Close social relationships, organic farming was associated with lower flourishing. The largest association was observed for farm size. Farmers with the smallest farms (<5 ha) scored low in the Financial and material stability domain, with a decrease in mean SFI (logit scale) of 1 as compared to farmers with the largest farms (>50 ha).
CONCLUSION: Our findings suggest a potentially lower overall flourishing among farmers as compared to a sample from the general population, with small farm size and exposure to psychosocial hazards being of particular concern, but organic farming having potential benefits. The study underscores the need for longitudinal research of farmers’ wellbeing to maintain a thriving agricultural workforce.
BACKGROUND: Due to the limited sensitivity of conventional lung function tests in detecting small airway abnormalities, cancer treatment-related pulmonary toxicity may be underdiagnosed. It has been suggested that the nitrogen multiple-breath washout test (N2MBW) might be more sensitive in detecting small airway abnormalities in childhood cancer survivors.
OBJECTIVE: The Pulmonary Early Assessment of the Lung in Paediatric Cancer Patients (SWISS-PEARL) study aims to assess the prevalence and development of early pulmonary toxicity at baseline and longitudinally in paediatric cancer patients using spirometry, body plethysmography, diffusing capacity for carbon monoxide (DLCO), N2MBW and magnetic resonance imaging (MRI) and to identify treatment-related pulmotoxic risk factors.
METHODS: This prospective, multicentre, cohort study at the University Children’s Hospitals of Basel, Bern, Lausanne and Zurich, is enrolling patients aged ≥4 and <22 years at study entry exposed to at least one of the following cancer treatments: chest radiation, chemotherapy or targeted agents, haematopoietic stem cell transplantation and/or thoracic surgery. Participants perform comprehensive lung function testing at baseline (i.e. within 28 days of the start of systemic cancer treatment) and during four follow-up visits until two years after the end of intensive treatment. Respiratory symptoms are also assessed at each time point, and MRI is planned at one and two years post-treatment.
RESULTS: Since May 2022, we have recruited 44 patients and performed 134 lung function tests at baseline. Mean age at diagnosis was 12 years (range 4–18). The most common cancer diagnoses were leukaemia (41%) and lymphoma (23%). Pulmonary assessment was feasible and of good quality in 43/44 (98%) patients for at least one test at baseline; only 4 patients dropped out after baseline measurements.
CONCLUSION: This study will assess the potential development of early pulmonary dysfunction during and post-treatment. Findings from the SWISS-Pearl study may help inform future guidelines for pulmonary surveillance in paediatric cancer patients.