Spatial and temporal changes in soil water and groundwater chemistry in the Studibach catchment

Stream chemistry depends strongly on the flow pathways to the stream and the chemistry of the inflowing water. Changes in stream chemistry during rainfall events are assumed to reflect variations in solute concentrations with depth below the surface because shallower flow pathways become more important during rainfall events. Many studies have looked at the relative contribution of soil water and groundwater to streamflow but the spatial and temporal variability in their chemical composition is rarely assessed. This thesis addresses the lack of knowledge on the spatial and temporal variability in the stable isotope composition and solute concentrations in soil- and groundwater in pre-alpine headwater catchments. Samples were taken before and after four rainfall events in autumn of 2021 at seven different sites at four depths: 12.5, 20 and 30 cm below the surface and from the groundwater. In addition, samples were taken from precipitation and stream water. The samples were analysed for their isotopic composition and anion and cation concentrations. The results of the sampling showed that the spatial variability of the dissolved substances was large and for almost all elements larger than the temporal variability. There was no consistent change in mean concentration from before, to after the four rainfall events in the soil or the groundwater and changes over time were very small. The correlations between the mean concentration and the topographic wetness index or the slope was weak. Only the correlation between the mean solute concentration and the groundwater level was slightly better (R2: 0.01-0.66). The change in concentration with depth below the soil surface depended on the source of the solute. For some solutes, the concentrations stayed relatively constant (e.g. lead), for others it decreased (e.g. deuterium, potassium) or increased (nitrate, calcium). Stream chemistry reacted strongly during all sampled rainfall events. Stormflow always had slightly to significantly higher concentrations than precipitation or baseflow, which indicated that new source areas of soil water and groundwater with different solute concentrations contributed to the stormflow. The concentration changes in the soil- and groundwater with depth was reflected in stream chemistry for the majority of the solutes. Only for Mg was there an unexpected change in the stream water, as it went down with an increased water level, while the concentrations in the soil were higher near the surface. This indicates that in addition to shallower flow paths contributing to streamflow during events, other areas must start to contribute as well. The results of this thesis broaden the understanding on the intricate changes in concentration in the soil-, ground- and stream water in headwater catchments. The thesis proves that a better understanding of hydrochemistry in the soil is useful for hydrological studies of headwater catchments and that making assumptions on the spatial variations in concentration solely on stream chemistry is difficult and can cause many uncertainties. The large spatial variation in solute concentrations and changes in hydrological connectivity also affect stream chemistry. Sampling of soil water and groundwater at several locations in the catchment is therefore needed to assess the spatial variability in solute chemistry

Needs and use of drug information sources in community pharmacies: a questionnaire based survey in German-speaking Switzerland

Methods: Postal survey to a random sample of 223 (26% out of 859) community pharmacies from the German-speaking part of Switzerland. The 48-item questionnaires were processed automatically with the Cardiff TELEform®-Software. In addition, a telephone-survey to a random sample of 20 non-responders was performed in order to test for non-response bias. Results: A total of 108 pharmacists (response rate 48%) reported that the official Swiss drug reference book is still the most popular source of drug information used to solve all kinds of drug related problems. The Internet as a source of drug information is of minor importance, even though 88% of the pharmacies have Internet access. Deficits in drug information were reported for paediatrics, phytotherapy, drugs during pregnancy/lactation and for therapy guidelines. According to 35% of the pharmacists, the importance of offering drug information to customers will increase in the future. Most of the pharmacists are not afraid that Internet pharmacies would replace them. Conclusions: The results show that the majority of the community pharmacists are only partially satisfied with the sources of drug information currently available. The Internet still plays a minor role for solving drug-related problems in daily practice, even though the available infrastructure makes the community pharmacies able to use the Internet more frequently. The pharmacists need more websites tailored to their needs. The pharmacists have clear visions about possible future developments. They do, however, have to adopt quickly to the changes ahead in order to remain competitiv

Management of potential drug interactions in community pharmacies: a questionnaire-based survey in Switzerland

Objective: To analyze the current drug-interaction management in Swiss community pharmacies, with a particular focus on electronic systems, and to compare the results with those expressed by German general practitioners in a recent survey. Methods: Data were collected with a postal questionnaire which was randomly sent to 500 out of 833 community pharmacies in the German part of Switzerland. Results: The response rate was 57.4%, and only 24.7% pharmacists reported that they were confronted less than daily with potential drug interactions. Use of computer software to identify potential drug interactions was widespread in community pharmacies (90.2%), and the software was the primary source of information (81.2 ± 29.6%). The quality of the interaction software was judged sensitive (identifying all dangerous interactions) by 80.5 ± 21.5%, but specific (identifying only relevant interactions) by only 38.3 ± 32%. Pharmacists declared a low override rate (14%) of drug interaction alerts, although unjustified alerts were reported by 60.6 ± 33.1%. In contrast to general practitioners, pharmacists opted less often for information on the mechanism of the interaction, and more frequently for details for dose adjustment. Both groups complained about deficient information on non-interacting alternatives. Conclusion: The information needs of community pharmacists differed considerably from general practitioners, and pharmacists were overwhelmed by inappropriate alerts because of a lack of specificity of their drug-interaction systems. Substantial improvement of drug-interaction software systems is thus required at least in two important aspects, the suppression of inappropriate alerts and the tailoring to the needs of the use

The differential risk of oral contraceptives: the impact of full exposure history*

Previous discussions have indicated that the small increases of risk of venous thromboembolism (VTE) associated with newer combined oral contraceptives (third generation, containing desogestrel and gestodene) may be attributed to bias due to cohort effects. In a case-control analysis, this may produce an overestimate of risk of newer preparations. In 10 centres in Germany and the UK, the Transnational Study analysed data from 502 women aged 16-44 years with VTE, and from 1864 controls matched for 5-year age group and region. Information on lifetime exposure history from all subjects was added to the dataset used in previous analyses and entered into a Cox regression model with time-dependent covariates. Based on 17 622 continuous exposure episodes comprising 47 914 person-years of observation, the adjusted hazard ratio (equivalent to odds ratio, OR) of VTE for the comparison of current users of third-generation versus current users of second-generation (primarily levonorgestrel compounds) combined oral contraceptives was 0.8 (0.5 to 1.3). The OR obtained in standard case-control analysis had been 1.5 (1.1 to 2.1). Adjustment for past exposures includes more information and appears more valid than the standard cross-sectional analysis. Using this approach, the Transnational Study data show no evidence for an increased risk of VTE with third- compared with second-generation combined oral contraceptive

Prospective Epidemiological Observations on the Course of the Disease in Fibromyalgia Patients

OBJECTIVES: The aim of the study was to carry out a survey in patients with fibromyalgia (FM), to examine their general health status and work incapacity (disability-pension status), and their views on the effectiveness of therapy received, over a two-year observation period. METHODS: 48 patients diagnosed with FM, according to the American College of Rheumatology (ACR) criteria, took part in the study. At baseline, and on average two years later, the patients underwent clinical investigation (dolorimetry, laboratory diagnostics, medical history taking) and completed the Fibromyalgia questionnaire (Dettmer and Chrostek [1]). RESULTS: 27/48 (56%) patients participated in the two-year follow-up. In general, the patients showed no improvement in their symptoms over the observation period, regardless of the type of therapy they had received. General satisfaction with quality of life improved, as did satisfaction regarding health status and the family situation, although the degree of pain experienced remain unchanged. In comparison with the initial examination, there was no change in either work-capacity or disability-pension status. CONCLUSIONS: The FM patients showed no improvement in pain, despite the many various treatments received over the two-year period. The increase in general satisfaction over the observation period was believed to be the result of patient instruction and education about the disease. To what extent a population of patients with FM would show similar outcomes if they did not receive any instruction/education about their disorder, cannot be ascertained from the present study; and, indeed, the undertaking of a study to investigate this would be ethically questionable. As present, no conclusions can be made regarding the influence of therapy on the primary and secondary costs associated with FM

Prospective evaluation of the capillaroscopic skin ulcer risk index in systemic sclerosis patients in clinical practice: a longitudinal, multicentre study.

Nailfold capillaroscopy (NC) is an important tool for the diagnosis of systemic sclerosis (SSc). The capillaroscopic skin ulcer risk index (CSURI) was suggested to identify patients at risk of developing digital ulcers (DUs). This study aims to assess the reliability of the CSURI across assessors, the CSURI change during follow-up and the value of the CSURI in predicting new DUs. This multicentre, longitudinal study included SSc patients with a history of DUs. NC images of all eight fingers were obtained at baseline and follow-up and were separately analysed by two trained assessors. Sixty-one patients were included (median observation time 1.0 year). In about 40% of patients (assessor 1, n = 24, 39%; assessor 2, n = 26, 43%) no megacapillary was detected in any of the baseline or follow-up images; hence the CSURI could not be calculated. In those 34 patients in whom CSURI scores were available from both assessors (26% male; median age 57 years) the median baseline CSURI was 5.3 according to assessor 1 (IQR 2.6-16.3), increasing to 5.9 (IQR 1.3-12.0) at follow-up. According to assessor 2, the CSURI diminished from 6.4 (IQR 2.4-12.5) to 5.0 (IQR 1.7-10.0). The ability of a CSURI ≥ 2.96 category to predict new DUs was low (for both assessors, positive predictive value 38% and negative predictive value 50%) and the inter-assessor agreements for CSURI categories were fair to moderate. In this study, around 40% of patients could not be evaluated with the CSURI due to the absence of megacapillaries. Clinical decisions based on the CSURI should be made with caution. Current Controlled Trials, ISRCTN04371709 . Registered on 18 March 2011