A national measles epidemic in Switzerland in 1997 : consequences for the elimination of measles by the year 2007.

Clinical cases of measles have been reported to the Swiss Sentinel Surveillance Network (Sentinella) since June 1986 and measles infections have been monitored by the national laboratory notification system since January 1988. These two surveillance syste

[Epidemiology of toxoplasmosis in Switzerland: national study of seroprevalence monitored in pregnant women 1990-1991]. / Epidémiologie de la toxoplasmose en Suisse: étude nationale de séroprévalence menée chez les femmes enceintes en 1990-1991.

A national study was performed to assess the seroprevalence of anti-Toxoplasma gondii IgG in pregnant women at the time of delivery. The study was organized between 1990 and 1991 in 23 out of 26 Swiss cantons. 9059 women, corresponding to 11.8% of the annual total of births in those cantons, were included. The global seroprevalence of specific IgG was 46.1% (95% confidence interval: 45.0-47.1%). There was no significant difference in seroprevalence between different cantons after adjustment according to age. At the national level, the seroprevalence was 46.0% for Swiss women and 45.8% for women of other nationality (information on nationality was available only for 8382 persons). The use of a model of linear regression according to age showed that the risk of seroconversion among seronegative women during their 9 months of pregnancy was 1.21%. In addition, a certain number of data were calculated from that value to "simulate" a theoretical situation with absence of specific serological screening during pregnancy at a national level and consequently, absence of appropriate treatment. It was estimated that 548 cases of seroconversion would occur annually during pregnancy. This would lead to 183 congenital transmissions of toxoplasmosis, among which, 75% would be asymptomatic at birth. The number of expected pathologies would be: 40 cases of chorioretinitis with impared vision, 18 cases of cerebral lesions, and 2.7 cases of perinatal death. We observed positive results for specific anti-T. gondii-IgM in 1.7% of persons tested. This result can be the source of medical interpretation difficulties if the serum sample is the first done during pregnancy.

Risk factors for Campylobacter enteritis in Switzerland.

From February to December 1991, 167 sporadic cases of Campylobacter enteritis in Switzerland and 282 controls were enrolled in a case-control study using self-administered questionnaires. In the multivariate matched analysis, travel abroad was identified as the most important risk factor for an infection with Campylobacter (adjusted odds ratio [OR] = 21.2, 95% confidence interval [CI]7.6-56.2). Having foreign citizenship also increased the risk (OR = 6.7, 95% CI 1.3-34.5). Among food items consumed within five days before onset of illness, consumption of poultry liver was shown to be a risk factor (OR = 5.7, 95% CI 1.4-22.8), while the consumption of curd or cottage cheese lowered the risk (OR = 0.5, 95% CI 0.3-0.9). The unmatched analysis confirmed travel abroad and the consumption of poultry liver as risk factors and the consumption of curd or cottage cheese as being protective, and, in addition, identified the consumption of poultry as a risk factor (OR = 2.0, 95% CI 1.1-3.3). The study showed the feasibility of using self-administered questionnaires for this type of analysis. The method is logistically simple and reduces the cost of case-control studies.

The development of a German language (Berne) pain questionnaire and its application in a situation causing acute pain.

The adjectives used in the McGill Pain Questionnaire were translated into German. Nine of the 76 adjectives could not be translated satisfactorily. Accordingly, 10 new German adjectives were added by 22 physicians and psychologists, who were also asked to judge the grouping of the words and how adequately they express pain. Concordance of grouping was reached by more than 82% of the raters. The adjectives were assigned to 20 groups. In a next step 80 subjects assessed the words in each group on a visual analogue scale (VAS) with respect to intensity: for 3 of the 20 groups we found no difference in intensity between the adjectives within a group. They were not retained in the final version tested. Additionally each group was reduced to 3 adjectives by dropping the least discriminating words of each group; 17 groups of 3 words each were retained. In a third step a comparably composed group of 82 subjects rated the words in each group on VAS with respect to intensity: for each of the 17 triads there was a significant overall difference between the 3 adjectives on the VAS. In all but 4 of the 17 triads all 3 possible pairwise differences were significant as well. In spite of the significant differences of mean values there was considerable disagreement in individual intensity rankings of the 3 adjectives within the 17 groups. The validity of the German language (Berne) pain questionnaire (BPQ) was tested together with a verbal rating scale (VRS) and a VAS in a double-blind, complete cross-over study. A low osmolar (LO), a high osmolar (conventional) (HO) compound and 0.9% NaCl (placebo) (PL) were injected intra-arterially in patients with arteriovascular disease. We expected the LO compound to cause much less pain than the HO compound. The 3 conditions HO, LO and PL had significantly different effects on all 4 scales: VAS, VRS, RaW (scale of rank of words), and NoW (scale of number of words). The pairwise comparisons of PL with HO and LO resulted in significant differences also. The square of the correlation r for VAS/VRS was 0.64, for RaW/NoW 0.61, all other possible correlations were not significant. Our conclusions are: the translation of the MPQ into German was successful, and its validity could be shown. In our experiment, it differentiated acute, short lasting pain as well as the visual analogue and the verbal rating scales. The BPQ is a tool worth being examined in the laboratory and in studies of clinical pain syndromes.

Absolute bioavailability of glyceryl trinitrate from a transdermal system, assessed by digital plethysmography.

The absolute bioavailability of glyceryl trinitrate from a transdermal therapeutic system (Nitroderm TTS, 20 cm2) was assessed with a new method in 6 healthy volunteers. Instead of measuring plasma concentrations the pharmacological effects of glyceryl trinitrate were followed by digital plethysmography. Each experiment consisted of the establishment of an intravenous dose response curve which was followed by a 1-hour application of the transdermal system and a second intravenous dose response curve. The investigations were repeated after pretreatment of each subject with 0.4 mg pindolol i.v. The results show a satisfactory overall consistency of the data and indicate a release rate of 4.4 +/- SD 1.7 micrograms/min of bioavailable glyceryl trinitrate during the first hour of application of this transdermal system. This corresponds to 75 +/- 29% of the release rate obtained by analysis of residual amounts in the TTS.

Different effects of selective and nonselective beta adrenoceptor blockade on urinary catecholamine and creatinine excretion in stress.

We tested the hypothesis that (1) beta 1-selective and nonselective beta adrenoceptor blockades have a different influence on stress-induced catecholamine overshoot, and (2) beta 1-selective blockade shifts the epinephrine/norepinephrine ratio in favor of norepinephrine. Seven violinists were investigated; each performed four times in public after ingesting different beta blockers. A significantly greater urinary norepinephrine/creatinine excretion was found with selective beta blockade than with nonselective. In addition during selective beta blockade creatinine excretion decreased significantly in comparison with nonselective blockade. This might be due to a higher concentration of circulating norepinephrine, stimulating alpha receptors in the renal vasculature.

Pressured pattern or type A behavior in patients with peripheral arteriovascular disease: controlled retrospective exploratory study.

The question as to whether a specific behavior or type A pattern is limited to patients with coronary artery disease, or is found in atherosclerotic disease, in general, is explored. The interrelationship between a pattern of "pressured" behavior, assessed by open ended interviews, type A behavior, determined by the Bortner test, and peripheral atherosclerotic disease was investigated in a controlled retrospective study which compared three groups of 13 patients each: intermittent claudication (IC), intermittent claudication combined with coronary artery disease (CADIC) and a control group of patients without vascular disease (WVD). A pressured behavior pattern, assessed by interview, was found to be most prominent in the CADIC group, and least in the control group. The subjects with arteriovascular disease tended to exert more control over people compared to the WVD patients (Fisher's exact probability test, p = 0.05). The tendency to type A behavior, measured by means of the Bortner scale, also differentiated the three groups with CADIC scoring highest and WVD scoring lowest (analysis of variance, F = 3.944, p less than 0.05). IC patients present personality features of proneness to coronary disease. The pattern of "pressured" and type A behavior seem to correlate with the number of vascular areas involved in atherosclerotic disease.

Stage fright in musicians: a model illustrating the effect of beta blockers.

Stage fright was used to investigate the mode of action of beta blockers in acute anxiety and on the technical-motor performance of 22 performing string players. They received 100 mg of atenolol or placebo 6.5 hr before performing either in the presence or absence of an audience. Continuous heart rate, stage fright (especially devised rating scale), technical-motor performance (runs of fast notes, trills, vibratos), and urine catecholamine levels were assessed. Before an audience the placebo group showed a significant impairment of technical-motor performance (increase in the relative variance of repeated fast elements of movements: + 25.68%, p less than 0.01) as compared to performance with no audience present; there was a slight but not significant improvement under beta blockade (- 7.48%). Heart rate was significantly lower under beta blockade than under placebo (p less than 0.001). Urine catecholamine levels increased twice as much under beta blockade as under placebo before an audience (p less than 0.01). Beta blockade did not influence stage fright measured before performing, but reduced it (measured immediately after the concert) during the concert. We conclude that the drug was at least partially effective as shown by an improvement in technical-motor performance, and that the beneficial effects of beta blockade in stage fright only involve a peripheral site of action.

The feasibility of using an American National Board examination for the evaluation of Swiss candidates for licensure.

A test in Internal Medicine of the American National Board of Medical Examiners was given to Swiss medical students as a graduating examination. This study dealing with the feasibility of such an enterprise describes the technical procedures and investigates the problems of translation and the validity of foreign made items. Comparison of item analyses for the 369 Swiss candidates and for a sample of 370 American candidates reveals that most items are of close comparability in difficulty, discrimination and pattern of response to the distractors. In a cross-national comparison of student's responses to the items no systematic content characteristics can be found for items favouring one group or the other. Swiss experts, in judging the validity of the items for testing Swiss students, could indeed identify in advance some of the items that proved to be less valid and more difficult for their--but also the American--students. It is concluded that National Borad examination can be as valid and suited to examine Swiss candidates for licensure as it is to examine American candidates.