[Acceptance and feasibility of medical telemonitoring plus individual teleconsultation -A two years research and development project at the University Hospital Zurich]. / Akzeptanz und Machbarkeit von medizinischem Telemonitoring plus individueller Teleberatung - 2 Jähriges Forschungs- und Entwicklungsprojekt am Universitätsspital Zürich.

The research and development project "Long Independent Living Assistant (LILA)'; which is financially supported by the Commission for Technology and lnnoyation (KTI}, is based on the results and experiences of many years of the Medical Online Consultation Service at the University Hospital Zurich.The focus is on development and provision of a comprehensive, telemedicine service. Citizens and patients should be provided more safety at home and the family doctor should be supported by the service. Core elements of the project include the telemonitoring of vital signs combined with an individual teleconsultation via telephone, email and video. Technically, the. service is supported by a web-based documentation and communication platform with an integrated patient record. In a one-year planning phase, individual interviews and group discussions were conducted with the participants of the study. The results are continuously incorporated into the concept. The subsequent pilot phase analyzed the developed tetemedical approach and leads to further improvements. The aim of the study is the evaluation of the needs, feasibility and acceptance of telemedicine services from the perspective of the user, taking into account their social environment~

[Telemedicine and the ageing population]. / Telemedizin in der älteren Bevölkerung.

Telemedicine aims to create new forms of health care delivery by the use of information and communication technologies (ICT),for example, to improve the access to health care for patients in rural regions. There is a need for assistive technologies and innovative technological solutions due to the demographic change. Population trends of western societies show concurrently an ageing population and the wish of elderly people to live at home as long as possible while there is a tendency that older people live in greater distances to their kin nowadays. More complex diseases and multimorbidity urge improved interconnectedness between different health care professionals. Hence, different health systems pursue e-health strategies with the aim to implement electronic patient records (EPR) and similar technological solutions as a first approach to tackle those challenges. Telemedicine represents an open and evolving concept which is subject to a regular process of further development as a consequence of accelerated technological progress. The increased articulated demand for patient centered health care is one driver for the use of telemedicine. In the context of the trend of shorter hospital stays technological solutions can provide an opportunity for better support and care at home to reduce health risks and improve caregiving quality after hospital discharges. Despite the still prevalent reservations of elderly people about the use of ICT research shows that acceptance and the willingness to use technical devices is increasing. The article describes different aspects of telemedicine in the context of the aging population: definitions, an overview of trends and various fields of use with specific practical examples. A synoptic view of research results of evaluations of telemedicine applications regarding their effectiveness and cost-benefit analysis complement the paper.

[Telemedicine for the elderly- opportunities are increasing, critical factors have to be tackled!]. / Telemedizin für Ältere - Chancen mehren, kritische Punkte angehen!

An autonomous life and quality .of life are essential objectives for the use of telemedicine among the elderly population. To make aging in place possible the elderly peoples' homes have to be embedded in an integrated health and aged care system. In addition to this, it is necessary to create coproduction with the patients and their relatives. However, to meet those targets it is required to achieve enormous rethinking and widely acceptance of telemedicine among all health care professionals. Medical institutions have to undergo vast changes towards a patient-centered health care delivery and an increased intersectoral and interdisciplinary collaboration. Political will for fair and just allocation processes is essential to avoid a potential digital divide among the population, e.g. for socioeconomic disadvantaged population groups or people living in rural areas. Therefore,flanking preparing measures and continuous support through easily accessible contact persons are essential. According adaptations of financial models and an extension of health insurance benefits will be necessary.

Italianity is associated with lower risk of prostate cancer mortality in Switzerland.

PURPOSE: Different prostate cancer mortality rates observed in European countries may depend on cultural background. We aimed at exploring variation in prostate cancer mortality in the language regions of Switzerland as a function of "Italianity", a proxy for adherence to an Italian lifestyle. METHODS: We used data of the Swiss National Cohort, a census-based record linkage study, consisting of census (1990 and 2000) and mortality (until 2008) data. 1,163,271 Swiss and Italian nationals 40+-year old were included. Multivariate age-standardized prostate cancer mortality rates and hazard ratios (HR) from Cox proportional hazards regression analysis were performed. Italianity was defined by an individual's nationality, place of birth and principal language, resulting in a score of 0-3 points. RESULTS: Age-standardized prostate cancer mortality rates (per 100,000 person-years) were lowest in the Italian-speaking region of Switzerland (66.7 vs. 87.3 in the German-speaking region). Both Italian nationality and/or place of birth were significantly associated with lower mortality. There was a graded inverse association between mortality rates and increasing Italianity score. Individuals with the highest level of Italianity had a HR of 0.67 (95 % CI 0.59-0.76) compared to those with an Italianity score of zero. Results were similar when looking at language regions separately. CONCLUSIONS: The strong and consistent association between Italianity and prostate cancer mortality suggests protective properties of an Italian lifestyle. Further research is required in order to determine which factors specific for Italian culture are responsible for the lower prostate cancer mortality.

The combined effect on survival of four main behavioural risk factors for non-communicable diseases.

OBJECTIVE: To quantify and illustrate the combined effects of WHO's four behavioural risk factors for non-communicable diseases (NCDs) on mortality. METHODS: Participants (n=16,721) were part of two Swiss population studies conducted between 1977 and 1993. Smoking status, alcohol consumption, physical activity and diet were assessed at baseline. With record linkage in 2008, up to 31years of follow-up with 3,533 deaths could be recorded. Mortality was assessed with Cox proportional hazard models for each risk factor and their combinations. Ten-year survival probabilities for 65- and 75-year-olds were estimated with Weibull regression models. RESULTS: Hazard ratios for the combination of all four risk factors compared to none were 2.41 (1.99-2.93) in men and 2.46 (1.88-3.22) in women. For 65-year-olds, the probability of surviving the next 10years was 86% for men with no risk factors and 67% for men with four. In women, the respective numbers were 90% and 77%. In 75-year-olds, probabilities were 67% and 35% in men, and 74% and 47% in women. CONCLUSIONS: The combined impact of four behavioural NCD risk factors on survival probability was comparable in size to a 10-year age difference and bigger than the gender effect.

Impact of different domains of physical activity on cause-specific mortality: a longitudinal study.

OBJECTIVE: The aim of this paper is to examine the associations between different domains of physical activity and all-cause, cardiovascular disease (CVD) and cancer mortality. METHODS: Participants (n=17,663, aged 16-92 years) of two general population health studies conducted between 1977 and 1993 in Switzerland were included. Physical activity was assessed at baseline in the domains of commuting to work, work-related physical activity, and leisure-time physical activity (including leisure-time activity level and sport activity). A median follow-up time of 20.2 years was obtained with anonymous record linkage providing 3878 deaths (CVD: 1357; cancer: 1351). Adjusted Cox proportional hazard models were calculated. RESULTS: There were no significant associations between commuting and work-related physical activities, respectively, and mortality. Leisure-time activity level was associated with all-cause mortality in men [adjusted hazard ratio (HR) 0.75, 95% confidence intervals (CI) 0.63-0.89] and women [HR 0.82 (0.74-0.91)], with CVD mortality in women only [HR 0.79 (0.67-0.94)] and with cancer mortality in men only [HR 0.63 (0.47-0.86)]. Sport activity was associated with all-cause, CVD and cancer mortality in men [HR ranged between 0.76 (0.63-0.92) and 0.85 (0.76-0.95)], but not in women. CONCLUSIONS: These results underline the public health relevance of physical activity for the prevention of CVD and cancer, especially regarding leisure-time physical activity.

Public health significance of four cardiovascular risk factors assessed 25 years ago in a low prevalence country.

BACKGROUND: The individual and combined effect of cardiovascular disease (CVD) risk factors (RFs) on CVD mortality varies between populations. Our aim was to examine this association and its public health impact in Switzerland, a country with comparably low CVD mortality. METHODS: We included 9853 men and women aged 25-74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CArdiovascular disease) study (1983-1992) and were followed up for survival until 2008. Adjusted Cox regression was used to calculate CVD mortality hazard ratios (HR). CVD-RFs were obesity (body mass index ≥ 30 kg/m(2)), smoking (≥ 1 cig/d), high blood pressure (≥ 140 or ≥ 90 mmHg), and total: high-density lipoprotein cholesterol ratio (≥ 5.0). Besides age and sex, models were adjusted for diet, physical activity, educational class, marital status, and the respective other CVD-RFs. RESULTS: After adjustment for age and sex, the HR of CVD death was for obesity 1.86 (95% CI 1.50-2.31), for smoking 1.63 (95% CI 1.32-2.01), for high blood pressure 1.42 (95% CI 1.16-1.73), and for high cholesterol ratio 1.30 (95% CI 1.06-1.60). Adjustment for other covariates moderately attenuated estimates. CVD-RFs had an independent and synergistic effect and accounted for 43.0% of population attributable risk. The presence of all four compared to zero CVD-RFs was associated with a 9.6 years shorter expected survival for a man aged 50. CONCLUSIONS: Most CVD deaths could be avoided by prevention of four traditional CVD-RFs. Reduction of smoking prevalence and avoidance of weight gain in the population are the most effective measures. Particular attention should be dedicated to persons with multiple CVD-RFs.

Healthy migrants but unhealthy offspring? A retrospective cohort study among Italians in Switzerland.

BACKGROUND: In many countries, migrants from Italy form a substantial, well-defined group with distinct lifestyle and dietary habits. There is, however, hardly any information about all-cause mortality patterns among Italian migrants and their offspring. In this paper, we compare Italian migrants, their offspring and Swiss nationals. METHODS: We compared age-specific and age-standardized mortality rates and hazard ratios (adjusted for education, marital status, language region and period) for Swiss and Italian nationals registered in the Swiss National Cohort (SNC), living in the German- or French-speaking part of Switzerland and falling into the age range 40-89 during the observation period 1990-2008. Overall, 3,175,288 native Swiss (48% male) and 224,372 individuals with an Italian migration background (57% male) accumulated 698,779 deaths and 44,836,189 person-years. Individuals with Italian background were categorized by nationality, country of birth and language. RESULTS: First-generation Italians had lower mortality risks than native Swiss (reference group), but second-generation Italians demonstrated higher mortality risks. Among first-generation Italians, predominantly Italian-speaking men and women had hazard ratios (HRs) of 0.89 (95% CI: 0.88-0.91) and 0.90 (0.87-0.92), respectively, while men and women having adopted the regional language had HRs of 0.93 (0.88-0.98) and 0.96 (0.88-1.04), respectively. Among second-generation Italians, the respective HRs were 1.16 (1.03-1.31), 1.06 (0.89-1.26), 1.10 (1.05-1.16) and 0.97 (0.89-1.05). The mortality advantage of first-generation Italians decreased with age. CONCLUSIONS: The mortality risks of first- and second-generation Italians vary substantially. The healthy migrant effect and health disadvantage among second-generation Italians show characteristic age/sex patterns. Future investigation of health behavior and cause-specific mortality is needed to better understand different mortality risks. Such insights will facilitate adequate prevention and health promotion efforts.

Obesity but not overweight is associated with increased mortality risk.

The association between body mass index (BMI) and survival has been described in various populations. However, the results remain controversial and information from low-prevalence Western countries is sparse. Our aim was to examine this association and its public health impact in Switzerland, a country with internationally low mortality rate and obesity prevalence. We included 9,853 men and women aged 25-74 years who participated in the Swiss MONICA (MONItoring of trends and determinants in CArdiovscular disease) study (1983-1992) and could be followed up for survival until 2008 by using anonymous record linkage. Cox regression models were used to calculate mortality hazard ratios (HRs) and to estimate excess deaths. Independent variables were age, sex, survey wave, diet, physical activity, smoking, educational class. After adjustment for age and sex the association between BMI and all-cause mortality was J shaped (non-smokers) or U shaped (smokers). Compared to BMI 18.5-24.9, among those with BMI ≥ 30 (obesity) HR for all-cause mortality was 1.41 (95% confidence interval: 1.23-1.62), for cardiovascular disease (CVD) 2.05 (1.60-2.62), for cancer 1.29 (1.04-1.60). Further adjustment attenuated the obesity-mortality relationship but the associations remained statistically significant. No significant increase was found for overweight (BMI 25-29.9). Between 4 and 6.5% of all deaths, 8.8-13.7% of CVD deaths and 2.4-3.9% of cancer deaths could be attributed to obesity. Obesity, but not overweight was associated with excess mortality, mainly because of an increased risk of death from CVD and cancer. Public health interventions should focus on preventing normal- and overweight persons from becoming obese.