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Biomedical subjects

F Gutzwiller

Publications and source records attributed to F Gutzwiller.

At least 19 recordsLinked to original sources
PubMed1998

[Socioeconomic aspects of the changed mortality rate of coronary disease in Switzerland 1988-1993].

Mortality from ischemic heart disease (ICD 410-414) is changing. Remarkable decreases have been observed in the age groups from 35-64 years, while overall mortality (all age groups) has remained approximately stable. In Switzerland this has meant a gain of some 4700 life years in the period 1988 to 1993 in the working population (35-64 years). The object of this study was to assess the associated change in indirect costs (productivity losses) due to premature death, using the human capital approach. The indirect costs were CHF 519 million (CHF 7.5 million per 100,000 population) in 1993. This represents approximately half of all indirect costs (and 25% of the total costs generated by the disease). Compared with the year 1988, a decrease in productivity losses due to premature death was observed amounting to CHF 46 million (-11%) in constant Swiss francs. Society benefits from this decrease in indirect costs, a desirable development hardly ever mentioned.

Coronary Disease↗
PubMed1998

[Prevention in medical practice--principles and concepts].

This article presents the major concepts and definitions for preventive activities in the physician's office. Major activities concern primary and secondary prevention measures. Examples both for primary prevention and secondary prevention (list of screening measures according to the new health insurance law) are presented.

Health Promotion↗
PubMed1998

Quality assessment in gynecology and obstetrics. Projects and experience in Switzerland.

The first steps in quality assessment of results of performance in gynecology and obstetrics were taken by the Swiss Association of the OB/GYN Clinics of the Swiss Society of Obstetrics and Gynecology in the 1980's. Currently, medical data of more than 800,000 patients are available, allowing a good comparison of the quality of results. Concerned that purchasing coverage for health services was made exclusively on the basis of cost, resulting in lower public health quality, the Swiss Society of OB/GYN set up a Board of Quality Assessment in 1995. Not only the quality of results, but also the quality of indications, structures and processes are considered by using a modified Donabedian model. Moreover, standardized patient information forms have been worked out for 15 gynecological and five obstetrical operations. Since hysterectomy is the most common major gynecological operation in Switzerland, the evaluation of the quality of the indications is of substantial interest. Guided by the RAND Appropriateness Method, criteria for quality assessment with respect to appropriateness and necessity of hysterectomy have been drawn up. Swiss guidelines and 125 different clinical scenarios are defined by a panel of 22 OB/GYN experts. The aim of this project is to offer an interactive second opinion system, called "Swiss Guidelines for Hysterectomy", and anonymous self-assessment of quality. Appropriateness and necessity of medical procedures have to be defined by medical professionals providing a proper balance between the patient's desires and financial demands.

Female↗
PubMed1998

Dietary nitrates, nitrites, and N-nitroso compounds and cancer risk: a review of the epidemiologic evidence.

Experimental animal studies have shown N-nitroso compounds (NOC) to be potent carcinogens. Epidemiologic evidence of the carcinogenic potential of dietary NOC and precursor nitrates and nitrites in humans remains inconclusive with regard to the risk of stomach, brain, esophageal, and nasopharyngeal cancers. Inadequate available data could obscure a small to moderate effect of NOC.

Animals↗
PubMed1997

[Effect of medicamentous cholesterol control on resources utilization in public health--significance of the Scandinavian Simvastatin Survival Study (4-S Study) for cost control in Swiss health management conditions].

Upward spiralling health care expenditures have triggered the need to assess the cost-effectiveness of medical interventions. Specifically, interventions in primary and secondary prevention represent an important field of research. A resource utilization analysis was performed on the basis of the recently published Scandinavian Simvastatin Survival Study. It could be shown that treatment with simvastatin compared to placebo leads to a reduction in patient costs of CHF 8.4 million. This represents a reduction of CHF 3770.- per patient. The effective daily treatment costs can thus be calculated at CHF 1.11, which is equivalent to 36% of the actual acquisition cost per day. These results support the notion that secondary coronary prevention is not only justified from a clinical but also from an economic point of view.

Adult↗
PubMed1997

[The nutritional status in Switzerland--consequences for prevention].

Diet is of importance in the prevention of most chronic diseases. Dietary habits are measured regularly in most countries. In Switzerland data on groups and individuals are available, but a comprehensive dietary survey is still lacking. Since World War II an overall decrease in foods rich in complex carbohydrates and an increase in foods rich in fat available per capita of the population has been observed. Data on individuals show that 30%, i.e. 39% of men and 22% of women, in Switzerland are over-weight (BMI < or = 25). The percentages of energy intake as fat and sugar are higher, and the percentage of energy intake as complex carbohydrates lower than recommended. 7% of women and 6% of men consume hazardous amounts of alcohol (men > or = 60 g/day, women > or = 20 g/day). Marginal vitamin deficiencies are observed in various population groups for the vitamins B1, B2, B6, folic acid and vitamin C. Due to the fortification of salt and the widespread use of American wheat rich in selenium, iodine and selenium intake can be considered adequate. An insufficient intake of calcium is demonstrated in the elderly and an insufficient intake of calcium and iron in women. As a consequence of this nutritional situation, the first national nutritional guidelines have recently been published in Switzerland.

Adult↗
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

[Passive smoking in the workplace: a survey in the Zurich University Hospital].

The consequences of involuntary smoking are well documented. We conducted a survey among all employees of the University Hospital, Zurich, to assess their smoking habits and feelings about restrictions or a ban on smoking. In March 1995, a questionnaire was mailed to all 5230 hospital employees, 2620 (50.1%) completed forms were sent back. 76% of all staff are confronted with cigarette smoke during their worktime. 83% of these employees are distressed by tobacco smoke, and 43% feel that involuntary smoking affects their health. 19% of all employees are smokers. 19% of these are distressed by smokers at work themselves, whereas 13% feel that they are discriminated against by non-smokers. Restriction to designated smoking rooms (68%) or a ban on smoking (27%) would be supported by 95% of all employees. Even 89% of the smokers support smoking restrictions. These results show that there is a considerable demand for a smoke-free working environment among university hospital staff.

Adult↗
PubMed1996

HIV prevention in developed countries.

HIV prevention in developed countries is marked by impressive successes and dismal failures. The successes point the way to what works; the failures highlight obstacles that must be overcome. Successes include important behavioural changes among gay and bisexual men, antiviral use to prevent vertical transmission, and securing the safety of the blood supply. New strategies are needed to reach the residual of individuals continuing with unsafe practices (a special hazard in high-prevalence areas); to reach young people who are beginning to engage in sexual relations and injection drug use; and to overcome political opposition to prevention strategies.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[Thrombolysis following myocardial infarct. European Secondary Prevention Study].

For evaluation of the management of patients with acute myocardial infarction, all cases of ten Zurich hospitals (278, 184 men and 94 women) in the period from 1 January to 31 March 1993 were analyzed retrospectively. 223 patients were released from hospital, 55 died. A follow-up was done 6 months after the patient's discharge by means of a questionnaires to the family doctor (return rate: 65.9%). 48.5% of patients were referred to hospital within the first 6 h. after onset of symptoms, 64% within the first 12 h. 28% (n = 76) of the patients received a thrombolytic therapy, of which 91% (n = 69) got streptokinase and 9% (n = 7) got tissue plasminogen activator. In 81% of the cases the thrombolytic therapy was done within the first hour in hospital, in accumulated 97% of the cases within two hours. In the age group under 65 years (39% of the patients, n = 109), 48 patients received thrombolysis (odds ratio [OR] = 1.0). In the age group between 65 and 74 years (24.5 % of the patients, n = 68), 19 patients received thrombolysis (OR: 0.49; 95% CI: 0.42-0.99; p < 0.05), and in the age group over 74 years (36.5% of the patients, n = 101), 9 patients were received thrombolysis (OR: 0.12; 95% CI: 0.05-0.28; p < 0.0001). 31% of the patients (n = 46) received a coronary angiography, 15% (n = 22) had coronary angioplasty, and 11% (n = 1) received coronary bypass surgery. There is evidence that there should be more importance attached to early hospitalization, if acute myocardial infarction is suspected. Thereby age alone should be considered as a contraindication for thrombolytic therapy. The issue of assumed underuse of thrombolytic therapy should be investigated all over Switzerland.

Acute Disease↗
PubMed1996

[Quality management and quality assurance: terminology of a structural change in medicine].

The topic of quality assurance and management gains increasing interest by society, medical professionals, carriers of health expenses and government. In this review the most important terms borrowed from industry and management will be critically explained to persons employed in Health Systems in particular. Beside numerous novel quality terms, closer attention is paid to the Donabedian model, extended by indicational quality, audits, tracer systems, ISO models, technology assessment, total quality management, new control mechanisms in health care and costs. In the context of structural changes in society and medicine the new aspects of quality are featured as a real chance for a 'healthy' Public System and not as a threat.

Accreditation↗
PubMed1996

[Evaluation of the smoking cessation course (1984-1990) of the Cancer and Lung Society of canton Zurich].

The present study is to evaluate the smoking cessation therapy of the working team of the Cancer Association and Lung Association of the State of Zurich. Roughly 1/3 of all 913 participants of the therapy from 1984 to July 1990 have responded to the survey. Of these 1/3, more than a quarter did not smoke any more one year after the therapy. An antismoking program with a 1-year smoking cessation rate of 20 to 30% is considered successful in professional circles. The smoking cessation rate of all 913 therapy participants is probably below the 27% obtained in as much as the share of the successful ones among those replying, by experience is bigger than the share of those failling. Also the more precise inquiry in the first 7 therapies of 1990 confirms these findings. There the rate of success is barely 15% after 1 to 1 1/2 year. It cannot be ascertained whether the smoking cessation rate of all therapy courses is that high or only at the time after the program restructurations at the beginning of 1990. Only a precise achievement control can guarantee a consequent and continuous therapy evaluation within the next years.

Adolescent↗
PubMed1996

Safer sex behavior and alcohol consumption. Research Group of the Swiss HIV Prevention Study.

To test the hypothesis that safer sex procedures are less consistently observed by persons under the influence of alcohol, data from the Swiss human immunodeficiency virus (HIV) Prevention Study (HIPS) were evaluated. HIPS is a large prospective cohort study involving 724 HIV-negative and mainly heterosexual subjects who entertain casual sexual contacts. Of the 724 participants, 36% reported that they had had sex while under the influence of alcohol. Of this group, 31% indicated that safer sex procedures were neglected owing to the influence of alcohol. No significant differences with regard to unprotected sexual intercourse were found between subjects who combine sex and alcohol and those who do not. The same was found to be true among subjects with different levels of general alcohol consumption. However, a significant correlation was found between the intensity of alcohol consumption (i.e., the quantity of alcohol intake per sitting) and the incidence of unprotected sexual intercourse. These findings show that the relationship between alcohol consumption and safer sex is complex; they also emphasize the need for preventive efforts to reinforce safer sexual behavior, for example through individual counseling of persons at risk for HIV-infection.

Adolescent↗
PubMed1996

Why did Swiss citizens refuse to ban tobacco advertising?

A ban on tobacco advertising is one of the major tools to promote tobacco control. Swiss citizens recently refused to modify the Swiss Constitution to ban tobacco advertising. This case study shows how a strong alliance among the tobacco industry, the state, the media, and sports and cultural activities planners made it difficult for people to make an informed decision. The promoters of the ban were unable to provide counter-arguments to the mostly fallacious claims made by the opponents regarding the likely health and economic impact of this ban. A comparison to successful campaigns in Canada and New Zealand provides insight regarding factors missing in the Swiss campaign which might have been useful in obtaining support from Swiss citizens.

Adolescent↗
PubMed1995

[Cholesterol: blood level and control by Swiss physicians].

The high coronary heart disease morbidity and mortality and the economic costs have led to intensive prevention efforts in Switzerland, where the management of multiple risk factors plays a prominent role. An important risk factor is hypercholesterolemia, one of the main causes in the development of human atherosclerosis. However, the eminence of this risk factor is not yet sufficiently established in the awareness of many physicians. Inappropriate public discussions of the problem have caused confusion among patients and physicians. Therefore, the purpose of the Cholesterin Informations Program of the Swiss Heart Foundation is to work out a far-reaching and objective information strategy for experts and the general population, based on scientific knowledge, as a contribution to promoting the health of the Swiss population.

Adult↗