Erfassung von körperlicher Aktivität bei kardiologischen Patienten

Ausgangslage: Die körperliche Aktivität zählt zu den bedeutendsten kardiovaskulären Schutzfaktoren. Für kardiologische Patienten der Deutschschweiz existiert bisher kein validierter Fragebogen zur Erfassung der körperlichen Aktivität. Zielsetzungen: Das Ziel der vorliegenden Arbeit war es, in einem ersten Schritt mittels qualitativer Verfahren einen neuen Aktivitätsfragebogen zu erstellen und diesen in einem zweiten Schritt zu validieren. Methoden: Anhand von persönlichen Interviews mit 4 Patienten und 3 Therapeutinnen sowie anhand der Ergebnisse der Telefoninterviews mit 250 Patienten mit Z. n. Myokardinfarkt wurde ein neuer Fragebogen zur körperlichen Aktivität erstellt. Im Rahmen der Pre-Tests wurde der Fragebogen bei 10 kardiologischen Patienten ein erstes Mal eingesetzt und überarbeitet. In die Validierungsstudie wurden 48 Patienten der Kardiovaskulären Prävention und Rehabilitation des Universitätsspitals Bern eingeschlossen. Hierbei wurde der mittels Fragebogen retrospektiv erhobene Energieverbrauch mit den Messwerten des kombinierten Herzfrequenz- und Beschleunigungsmessers (Actiheart) verglichen. Des Weiteren wurden die Resultate zum Energieverbrauch den mittels Bewegungstagebuch erfassten Energieverbrauchswerten gegenübergestellt. Die Retest-Reliabilität wurde bei 33 Patienten geprüft, welche innerhalb von durchschnittlich drei Wochen den Fragebogen erneut ausgefüllt hatten. Ergebnisse: Die Korrelation zwischen dem Fragebogen und dem Actiheart betrug (Pearson’s) r=0.407 (p=0.004). Die mittlere Differenz zwischen dem mittels Fragebogen erhobenen Energieverbrauch und dem mittels Actiheart erhobenen Energieverbrauch lag bei 1.05 ± 4.79 MET-Stunden pro Tag. Der Retest wies eine Korrelation von (Pearson’s) r=0.624 (p<0.001) auf, mit einer mittleren Differenz zwischen den Fragebögen von 0.06 ± 3.70 MET-Stunden pro Tag. Die Korrelation zwischen dem Fragebogen und dem Bewegungstagebuch lag bei (Pearson’s) r=0.412 (p=0.004), wo hingegen keine Korrelation zwischen dem Tagebuch und dem Actiheart festgestellt werden konnte. Schlussfolgerungen: Die Validität und Reliabilität des Fragebogens bei Patienten der kardiologischen Rehabilitation (Phase II und III) fielen akzeptabel aus und sind vergleichbar mit den Resultaten anderer Fragebögen, welche bei älteren Probanden bereits weltweit eingesetzt werden. Background: Physical activity is known to play an important role in protecting against cardiovascular disease. In the German-speaking part of Switzerland a validated questionnaire recording physical activity in cardiac patients has been lacking until now. Purpose: The aim of this study was to create and validate a German physical activity questionnaire for patients attending a cardiac rehabilitation program. Methods: A questionnaire on physical activity was created based on personal interviews with 4 patients and 3 sports therapists along with the results of telephone interviews with 250 myocardial infarction patients. It was preliminarily tested on 10 cardiac patients and revised accordingly. To validate the questionnaire, 48 patients were recruited from the Cardiovascular Prevention and Rehabilitation Unit at the University Hospital in Berne. Retrospective data collected from the questionnaire on energy expenditure were compared with the results of the combined heart rate and movement monitor, Actiheart. Furthermore, both results on energy expenditure were each compared with those from the patients’ physical activity diary. Test-retest reliability was examined with 33 patients who completed the questionnaire again within three weeks on average. Results: The correlation between the questionnaire and the Actiheart was (Pearson’s) r = 0.407 (P = 0.004). The mean difference between the results derived from the questionnaire and those from the Actiheart was 1.05 ± 4.79 MET (metabolic equivalent) hours per day. The retest showed a correlation of (Pearson’s) r = 0.624 (P < 0.001) with a mean difference between the questionnaires of 0.06 ± 3.70 MET-hours per day. The correlation between the questionnaire and the physical activity diary was (Pearson’s) r = 0.412 (P = 0.004), however no correlation was found between the diary and the Actiheart. Conclusion: The questionnaire was shown to be moderately valid and reliable for patients in cardiac rehabilitation and is comparable with other questionnaires used in older patients

Temporal Patterns of Alcohol Consumption and Alcohol-Related Road Accidents in Young Swiss Men: Seasonal, Weekday and Public Holiday Effects

Aims To assess seasonal, weekday, and public holiday effects on alcohol-related road accidents and drinking diaries among young Swiss men. Methods Federal road accident data (35,485 accidents) from Switzerland and drinking diary data from a large cohort of young Swiss men (11,930 subjects) were analysed for temporal effects by calendar week, weekday and public holiday (Christmas, New Years, National Day). Alcohol-related accidents were analysed using rate ratios for observed versus expected numbers of accidents and proportions of alcohol-related accidents relative to the total number. Drinking diaries were analysed for the proportion of drinkers, median number of drinks consumed, and the 90th percentile's number of drinks consumed. Results Several parallel peaks were identified in alcohol-related accidents and drinking diaries. These included increases on Fridays and Saturdays, with Saturday drinking extending until early Sunday morning, an increase during the summer on workdays but not weekends, an increase at the end of the year, and increases on public holidays and the evening before. Conclusions Our results suggest specific time-windows that are associated with increases in drinking and alcohol-related harm. Established prevention measures should be enforced during these time-windows to reduce associated peak

Eingriffe und Behandlungen von Nutz­tieren durch Nicht-Tierärzte: quo vadis?

English Interventions and treatments of farm animals by non-veterinarians: quo vadis? The increasing professionalization and the cost pressure on farms combined with a decreasing availability of veterinary expertise procures the demand for treatments and interventions performed by non-veterinarians. A current survey resulting in 56 responses of food animal practitioners showed that a majority delivered pour-on anthelmintics, drugs for oral application and ointments after respective instruction to farmers. Udder injectors, antimicrobials and vaccines were handled more restrictively, but even hormones were committed by more than half of the veterinarians to livestock owners. In respect to interventions, most practitioners supported that farmers perform functional foot trimming, administration of boli, inseminations, dehorning and castrations of calves. By contrast, many veterinarians refused that farmers apply intravenous injections, insert a trocar or treat sole ulcers. In respect to the future development, implications of non-veterinarian interventions on animal welfare, consumer protection and drug safety have to be considered. Indispensable are qualification and skills of the person performing interventions which can be acquired by certificated training courses. Moreover, a basic conception and taking responsibility in particular for application of veterinary drugs is mandatory – in this respect, at present marked deficits exist among many farmers. Based on the current legal situation, several interventions can be delegated to non-veterinarians, but the technical responsibility for the proper implementation is due to the veterinarian. This includes an evaluation of interventions and treatments on a regular basis together with the farmer. On this basis, the assessment of clinical symptoms as well as the initial treatment can be useful and appropriate to ensure a rapid therapy especially in animals suffering from factorial diseases. Having in mind profound differences in respect to the competence of non-veterinarians, general procedures to deliver drugs and to delegate interventions have to be rejected. Advanced diagnostic procedures and the prescription of veterinary drugs remain an exclusive mission of the veterinarian. Keywords: Animal welfare, consumer protection, drug safety, interventions by non-veterinarians, livestock production Deutsch Eingriffe und Behandlungen von Nutz­tieren durch Nicht-Tierärzte: quo vadis? Die fortschreitende Professionalisierung und der Kostendruck auf landwirtschaftlichen Betrieben führen in Verbindung mit einer zumindest regional abnehmenden Verfügbarkeit tierärztlicher Expertise zu der Forderung, dass Behandlungen und Eingriffe bei Nutztieren vermehrt auch durch Nicht-Tierärzte* vorgenommen werden dürfen. Eine aktuelle Umfrage mit Rückmeldungen von 56 Nutztierpraxen ergab, dass die Mehrheit Pour-on-Anthelmintika, oral zu verabreichende Präparate und Wundsalben an Tierhalter abgibt. Mit Euterinjektoren, Antibiotika und Impfstoffen wird restriktiver umgegangen, doch selbst Hormone werden nach Einweisung von mehr als der Hälfte der Tierärzte an Landwirte abgegeben. Hinsichtlich von Eingriffen befürwortete die Mehrzahl der Praktiker die Durchführung der funktionellen Klauenpflege, die Eingabe von Boli, das Enthornen von Kälbern, das Kastrieren sowie die Besamung durch Nicht-Tierärzte. Hingegen sprachen sich die meisten Praktiker dafür aus, dass intravenöse Injektionen, das Einsetzen eines Trokars sowie das Ausschneiden eines Klauengeschwürs ausschliesslich durch Tierärzte durchgeführt werden. Im Hinblick auf die zukünftige Entwicklung gilt es, die Implikationen für Tierschutz, Konsumentenschutz und Arzneimittelsicherheit zu berücksichtigen. Unabdingbar sind stets die Fähigkeit und Fertigkeit des Durchführenden, die an den Nachweis der Sachkunde gebunden sind. Zudem sind ein fachliches Grundverständnis und die Übernahme von Verantwortung insbesondere im Hinblick auf den Einsatz von Tierarzneimitteln notwendig. Zwar kann der Bestandestierarzt aufgrund der aktuellen Gesetzeslage durchaus Massnahmen delegieren, übernimmt dann jedoch die fachliche Verantwortung für die Qualität der jeweiligen Interventionen. Zudem erfordert das Delegieren zwingend die regelmässige retrospektive Auswertung der Art und Anzahl von Behandlungen, sowie gemäss Tierarzneimittelverordnung die Überwachung des korrekten Tierarzneimitteleinsatzes. Unter dieser Prämisse kann die Befunderhebung in einem klar definierten Rahmen unter Einhaltung der gesetzlichen Vorgaben mit anschliessender Erstbehandlung durch den Landwirt in der Praxis insbesondere bei Faktorenkrankheiten sinnvoll sein, um die schnellstmögliche Versorgung erkrankter Tiere sicherzustellen. Angesichts der erheblichen Unterschiede bzgl. der fachlichen Kompetenz unter Nicht-Tierärzten sind pauschale Regelungen abzulehnen. Die weiterführende Diagnostik sowie die Verschreibung von Tierarzneimitteln müssen grundsätzlich eine exklusive Aufgabe des Bestandestierarztes bleiben. Schlüsselwörter: Arzneimittelsicherheit, Behandlung durch Laien, Konsumentenschutz, Nutztierhaltung, Tierschutz Français Interventions et traitements des animaux de rente par les non-vétérinaires: quo vadis? La professionnalisation progressive et la pression des coûts sur les exploitations agricoles, combinées à une disponibilité d’expertise vétérinaire décroissante au moins au niveau régional, font que de plus en plus de traitements et d’interventions sur le bétail peuvent être effectués par des non-vétérinaires. Une enquête récente portant sur les réponses de 56 cabinets pour animaux de rente a révélé que la plupart d’entre eux remettent des anthelminthiques pour-on, des médicaments à administrer par voie orale et des onguents aux propriétaires d’animaux. On est plus restrictif avec les injecteurs intra-mammaires, les antibiotiques et les vaccins, mais même des hormones sont remises aux agriculteurs après instruction par plus de la moitié des vétérinaires. En termes d’interventions, la majorité des praticiens soutiennent la réalisation de soins fonctionnels des onglons, l’administration de boli, l’écornage des veaux, la castration et l’insémination par des non-vétérinaires. En revanche, la plupart des praticiens considèrent que les injections intraveineuses, la mise en place d’un trocart et le traitement d’un ulcère de la sole doivent être effectués par des vétérinaires. En ce qui concerne l’évolution future, il est important de prendre en compte les implications pour le bien-être des animaux, la protection des consommateurs et la sécurité en matière de médicaments. Il est essentiel que l’exécutant ait la compétence nécessaire ainsi que la capacité de prouver qu’il possède une expertise. En outre, une compréhension de base du sujet et la prise de responsabilité, notamment en ce qui concerne l’utilisation de médicaments vétérinaires, sont nécessaires. Bien que le vétérinaire puisse déléguer des actes en raison de la situation juridique actuelle, il assume ensuite la responsabilité professionnelle de la qualité des interventions réalisées. En outre la délégation nécessite impérativement une évaluation rétrospective régulière du type et du nombre des traitements ainsi qu’un contrôle du bon usage des médicaments vétérinaires conformément à l’Ordonnance sur les médicaments vétérinaires. Sous cette prémisse, le recueil des commémoratifs dans un cadre clairement défini et conformément aux exigences légales avec un traitement initial par l’agriculteur peut être, dans la pratique, judicieux, en particulier dans les maladies factorielles pour assurer le traitement le plus rapide possible des animaux malades. Compte tenu des différences considérables en termes de compétence professionnelle parmi les non-vétérinaires, des réglementations forfaitaires devraient être rejetées. Les diagnostics plus approfondis et la prescription de médicaments vétérinaires doivent en principe rester une tâche exclusive du vétérinaire. Mots-clés: sécurité des médicaments, traitement par des profanes, protection des consommateurs, élevage, protection des animaux. Italiano Interventi e trattamenti eseguiti da non-veterinari sugli animali da reddito: quo vadis? La crescente professionalizzazione e la pressione sui costi nelle aziende agricole abbinate a una diminuzione, per ora regionale, di competenze veterinarie sfociano in una domanda di trattamenti e interventi veterinari sugli animali da reddito prodigati da non-veterinari. Un recente sondaggio con risposte ricevute da 56 prassi veterinarie per animali da reddito ha rilevato che la maggior parte degli intervistati procuravano ai detentori degli animali formulazioni pour-on di prodotti antielmintici, di preparati per via orale e di unguenti per le ferite. Un uso più restrittivo si trova negli iniettori della mammella, negli antibiotici e nei vaccini e anche gli ormoni vengono procurati agli allevatori, dietro istruzioni, da più della metà dei veterinari. Per quel che concerne gli interventi come la cura degli zoccoli, somministrazione di boli, inseminazioni, decornazioni e castrazioni di vitelli, la maggior parte dei professionisti si schiera dalla parte dei non-veterinari. Per contro molti veterinari hanno rifiutato che gli allevatori effettuino iniezioni endovenose, inserimenti di trocar e rimozioni di ulcere dello zoccolo. In previsione degli sviluppi futuri bisogna tener presente le implicazioni degli interventi prodigati da non-veterinari sulla protezione degli animali, sulla protezione dei consumatori e sulla sicurezza dei medicamenti. Indispensabili sono delle qualifiche e delle competenze che la persona che esegue gli interventi deve dimostrare. Inoltre sono indispensabili conoscenze professionali e l’assunzione delle responsabilità in particolare per quel che riguarda l’uso di medicamenti veterinari. Anche se il veterinario è autorizzato legalmente a delegare certi interventi a non-veterinari, egli deve sempre assumerne la responsabilità professionale per la qualità di tutti i trattamenti. Questa delega richiede inoltre obbligatoriamente una valutazione periodica retrospettiva del tipo e della quantità di trattamenti e, in conformità all’Ordinanza sui medicamenti veterinari, il controllo di un uso corretto dei medicamenti veterinari. In tale ottica, può avere senso di effettuare una valutazione dei sintomi in un quadro chiaramente definito, e nel rispetto dei requisiti di legge, con un trattamento iniziale da parte dell’allevatore, in particolare nel caso di malattie multifattoriali, al fine di garantire una rapida cura degli animali. Considerando le differenze in competenze tecniche tra i non-veterinari è necessario respingere le regolamentazioni generali. In ogni caso la diagnosi definitiva e la prescrizione dei medicamenti veterinari devono essere di competenza esclusiva dei veterinari. Parole chiavi: sicurezza dei medicamenti, trattamenti da parte di non-veterinari, protezione dei consumatori, allevamento di animali da reddito, protezione degli animal

The Impact of COVID-19 on Mental Healthcare Utilization in Switzerland Was Strongest Among Young Females—Retrospective Study in 2018–2020

Objectives: To provide a thorough assessment of the impact of the COVID-19 pandemic on the utilization of inpatient and outpatient mental healthcare in Switzerland. Methods: Retrospective cohort study using nationwide hospital data (n &gt; 8 million) and claims data from a large Swiss health insurer (n &gt; 1 million) in 2018–2020. Incidence proportions of different types of psychiatric inpatient admissions, psychiatric consultations, and psychotropic medication claims were analyzed using interrupted time series models for the general population and for the vulnerable subgroup of young people. Results: Inpatient psychiatric admissions in the general population decreased by 16.2% (95% confidence interval: −19.2% to −13.2%) during the first and by 3.9% (−6.7% to −0.2%) during the second pandemic shutdown, whereas outpatient mental healthcare utilization was not substantially affected. We observed distinct patterns for young people, most strikingly, an increase in mental healthcare utilization among females aged &lt;20 years. Conclusion: Mental healthcare provision for the majority of the population was largely maintained, but special attention should be paid to young people. Our findings highlight the importance of monitoring mental healthcare utilization among different populations

The roles of stress-activated Sty1 and Gcn2 kinases and proto-oncoprotein homologue Int6/eIF3e in responses to endogenous oxidative stress during histidine starvation

In fission yeast, Sty1 and Gcn2 are important protein kinases regulating gene expression in response to amino acid starvation. The translation factor subunit eIF3e/Int6 promotes the Sty1-dependent response by increasing the abundance of Atf1, a transcription factor targeted by Sty1. While Gcn2 promotes expression of amino acid biosynthesis enzymes, the mechanism and function for Sty1 activation and Int6/eIF3e involvement during this nutrient stress is not understood. Here we show that mutants lacking sty1+ or gcn2+ display reduced viabilities during histidine depletion stress in a manner suppressible by the antioxidant, N-acetyl cysteine, suggesting that these protein kinases function to alleviate endogenous oxidative damage generated during nutrient starvation. Int6/eIF3e also promotes cell viability by a mechanism involving stimulation of the Sty1 response to oxidative damage. In further support of these observations, microarray data suggests that, during histidine starvation, int6Δ increases the duration of Sty1-activated gene expression linked to oxidative stress due to the initial attenuation of Sty1-dependent transcription. Moreover, loss of gcn2 induces the expression of a new set of genes not activated in wild-type cells starved for histidine. These genes encode heatshock proteins, redox enzymes and proteins involved in mitochondrial maintenance, in agreement with the idea that oxidative stress is imposed onto gcn2Δ cells. Furthermore, the early Sty1 activation promotes a rapid Gcn2 activation on histidine starvation. These results suggest that Gcn2, Sty1, and Int6/eIF3e are functionally integrated and cooperate to respond to oxidative stress that is generated during histidine starvation

Systematic analysis of therapeutic patterns and healthcare use during 12 months before inflammatory bowel disease-related hospitalization in Switzerland

BACKGROUND AND AIMS Given the lack of data, we aimed to systematically analyze therapeutic patterns and health resource utilization in the year before inflammatory bowel disease (IBD)-related hospitalization. METHODS Based on claims data of the Helsana health insurance group, therapy patterns and health resource utilization were assessed, and costs reimbursed by mandatory basic health insurance were calculated during a one-year period before an index hospitalization between 1 January 2013 to 31 December 2015. RESULTS We analyzed 344 IBD patients (140 ulcerative colitis [40.7%], 204 Crohn's disease [59.3%]). Drug regimens applied in the year before index hospitalization were as follows: no IBD drugs (43.6% ulcerative colitis, 43.1% Crohn's disease); 5-ASA (45.7% ulcerative colitis, 19.1% Crohn's disease); local steroids (17.9% ulcerative colitis, 17.6% Crohn's disease); systemic steroids (38.6% ulcerative colitis, 29.4% Crohn's disease); immunomodulators (10.7% ulcerative colitis, 18.1% Crohn's disease); biologics (10% ulcerative colitis, 24% Crohn's disease); and calcineurin inhibitors (2.1% ulcerative colitis, 1.5% Crohn's disease). Forty-five percent of ulcerative colitis patients and 31.4% of Crohn's disease patients had no diagnostic procedures [computed tomography (CT), MRI, radiograph, sonography, colonoscopy, and calprotectin] in the year before hospitalization. Total annual health care costs before index hospitalization was EUR 4060 (interquartile range (IQR) 2360-7390) for ulcerative colitis and EUR 4900 (IQR 1520-14 880) for Crohn's disease patients, respectively. CONCLUSIONS Over 40% of ulcerative colitis and Crohn's disease patients did not receive any treatment in the year before index hospitalization. Efforts should be launched to timely diagnose and adequately treat IBD outpatients

Health Care Utilisation and Transitions between Health Care Settings in the Last 6 Months of Life in Switzerland.

BACKGROUND:Many efforts are undertaken in Switzerland to enable older and/or chronically ill patients to stay home longer at the end-of-life. One of the consequences might be an increased need for hospitalisations at the end-of-life, which goes along with burdensome transitions for patients and higher health care costs for the society. AIM:We aimed to examine the health care utilisation in the last six months of life, including transitions between health care settings, in a Swiss adult population. METHODS:The study population consisted of 11'310 decedents of 2014 who were insured at the Helsana Group, the leading health insurance in Switzerland. Descriptive statistics were used to analyse the health care utilisation by age group, taking into account individual and regional factors. Zero-inflated Poisson regression model was used to predict the number of transitions. RESULTS:Mean age was 78.1 in men and 83.8 in women. In the last six months of life, 94.7% of the decedents had at least one consultation; 61.6% were hospitalised at least once, with a mean length of stay of 28.3 days; and nursing home stays were seen in 47.4% of the decedents. Over the same time period, 64.5% were transferred at least once, and 12.9% experienced at least one burdensome transition. Main predictors for transitions were age, sex and chronic conditions. A high density of home care nurses was associated with a decrease, whereas a high density of ambulatory care physicians was associated with an increase in the number of transitions. CONCLUSIONS:Health care utilisation was high in the last six months of life and a considerable number of decedents were being transferred. Advance care planning might prevent patients from numerous and particularly from burdensome transitions

Follow-up ileocolonoscopy is underused in Crohn’s disease patients after ileocecal resection despite higher total and inpatient health-care costs compared to controls

Background: Postoperative recurrence is frequently observed after ileocecal resection in Crohn's disease (CD) patients. Since 2010, endoscopy within 1 year is considered the gold standard for its diagnosis. However, if and how frequent such endoscopies are performed in clinical practice remains unknown. Methods: We analyzed 1-year follow-up data on CD patients who underwent ileocecal resection between 2012 and 2014 and compared them with hospitalized, non-resected CD controls. Data were extracted from the Helsana database. Helsana is one of the largest Swiss health insurance companies providing coverage for 1.2 million individuals. Results: A total of 645 CD patients were identified with ≥1 hospitalization between 2012 and 2014 and a follow-up of 1 year. Of these, 79 (12.2%) underwent ileocecal resection. Although endoscopy rates increased over time and were higher in patients with resection versus controls (p = 0.029), in only 54.4% a 1-year follow-up ileocolonoscopy was performed. Postoperative prophylaxis with anti-tumor necrosis factor or azathioprine was prescribed in 63.3%. Female sex and age >60 years were independent predictors for not receiving prophylaxis (odds ratio [OR] 0.36, p = 0.048, and OR 0.2, p = 0.022). Patients with resection had significantly lower numbers of rehospitalizations (1.2 vs. 1.8, p = 0.021), with resection being an independent negative predictor for number of rehospitalizations in a Poisson regression model (incident risk ratio 0.64, p = 0.029). However, disease-related surgery was more often the cause for rehospitalization after resection versus controls (47.6 vs. 22.1%, p = 0.015). Total and inpatient health-care costs were higher in these patients. Conclusion: Endoscopies are underused after ileocecal resection. This contrasts current guidelines. Physicians should be aware of this underuse and perform follow-up examinations more often

Binomial model on transition occurrence as part of the zero-inflated Poisson regression model on the number of transitions in the last 6 months of life (n = 10751).

<p>Odds ratios for HSA are not listed in the model.</p