[General hepatitis B vaccination in Switzerland: what is the attitude of vaccinating physicians?]. / Generelle Hepatitis-B-Impfung in der Schweiz: Was halten die impfenden Arzte davon?

The purpose of this study is to assess Swiss physicians' knowledge on hepatitis B, their perception of parental information concerning this infection, their attitude towards planned universal vaccination, and their agreement with different universal immunisation scenarios. Vaccination scenarios were assessed in the following groups: infants, children at school entry, children aged 11 to 13, and children aged 14 to 16. Furthermore, scenarios involving the immunisation of school-aged children included the administration of the vaccine doses by the child's private physician or by the school health officer. Questionnaires were mailed to members of the Swiss Society of Pediatrics (n = 994), to a random sample of family physicians (n = 1000), to internists practicing general medicine (n = 500), and to chief medical officers of school health services in nine major Swiss cities. Physicians reported that they were sufficiently well informed on the serious potential sequelae of hepatitis B and the efficacy of vaccine prevention, but insufficiently informed on its epidemiology. They do not fundamentally disagree with the introduction of universal immunisation and think that parents are not aware of the potential long term dangers associated with this infection. Pediatricians and general practitioners believe that vaccinating infants at the cost of three extra injections would not be accepted by their peers and parents, and that immunising older children in their office would be feasible though difficult. School health officers believe that the immunisation of children aged 14 to 16 within the school health setting would be feasible. Universal vaccination of older children and adolescents is the scenario that best fits Switzerland's needs, perceptions and present circumstances.

[Basal bolus therapy in adolescent diabetic patients]. / Die Basis-Bolus-Therapie beim adoleszenten Diabetiker.

Between April 1986 and December 1987 30 adolescent patients with type 1 diabetes were changed from a conventional twice daily insulin regimen to the basal-bolus system, using pen-injectors. Actually, 26 patients are still using the new system. A comparison was made over a three-year period with a group of 26 patients on conventional therapy matched for age, sex and diabetes duration. A questionnaire was sent to the pen-injectors for subjective evaluation of the new system. The insulin dose remained unchanged. The incidence of hypoglycemic coma in the control group (4.3 per year/26 patients) was similar to the one in the pen-injector group prior to installation of the new system (4.0 per year/26 patients) and increased, but not significantly, on the new system (8.9 per year/26 patients). In both groups, the relative body weight increased significantly, the increase being greater in the pen-injectors (p = 0.001) than in the controls (p = 0.042); however, the difference of weight gain between the two groups was not significant. Fasting plasma cholesterol and triglycerides did not change. Glycosylated hemoglobin (Hb-A1 corrected for Hb-F) dropped significantly in the pen-injectors three months after installation of the new system (p = 0.026), but reached the preceding level already after six months. In the controls, the Hb-A1 remained constant over the three years. Greater flexibility in lifestyle, easier handling and better subjective diabetes control were the main advantages mentioned by the patients on the new system. Negative statements were the necessity for multiple injections, the high frequency of blood glucose control and strongly increased problems with weight control.(ABSTRACT TRUNCATED AT 250 WORDS)