Is the ebb of asthma due to the decline of allergic asthma? A prospective consultation-based study by the Swiss Sentinel Surveillance Network, 1999-2005

Objective. There are conflicting views on time trends of asthma and atopy during the last 10-15 years. Additional confusion is caused by the term of asthma which is a unifying name for different phenotypes. Asthma has been a topic for investigation to the Swiss Sentinel Surveillance Network (SSSN) since 1989. The objective of the actual study was to determine the influence of the allergic and non-allergic components of asthma on time trends from 1999 to 2005. Methods. Primary care physicians participating in the SSSN were guided by diagnostic criteria for asthma. Rates of asthma episodes per 1000 consultations were calculated for all, for first and subsequent asthma episodes and for allergic and non-allergic asthma. Allergic asthma was defined as asthmatic manifestations in conjunction with eczema and/or hay fever. The smoothed time trend and its 95% confidence intervals were determined using generalized additive models with a loess smoother adjusting for seasonality. Results. Consultations for allergic asthma have decreased between 1999 and 2005. Looking at different age groups, asthma associated with hay fever was reported with decreasing frequency in all age groups, whereas when associated with eczema, the other used marker of allergic asthma, slightly increased among young children. Conclusions. The decrease of consultations for asthma is most probably due to the allergic component of asthma. Diagnostic shift over time and ready available medications probably contributed to this phenomenon. Our findings indicate a real decline of allergic asthma. Practice recommendations. Consultations for asthma have decreased over recent years. The decrease of consultations for asthma is most probably due to the allergic component of asthma. Diagnostic shift over time and available medications probably contributed to this phenomenon. Strength of Recommendation Taxonomy (SORT) rating: strength of recommendation = C, level of evidence = 

Marginal bone loss 1 year after implantation: a systematic review for fixed and removable restorations

This systematic review analyses the difference of the mean marginal bone loss (MBL) 1 year after implantation depending on the fixation of the restoration. 889 publications on controlled clinical trials were identified, and based on inclusion and exclusion criteria, 22 studies were selected. Related to fixed restorations, the lowest MBL was 0.05±0.67 mm and the highest 1.37±0.5 mm. The MBL for removable restorations ranged from 0.13±0.35 mm to 1.03±0.65 mm. Three studies analyzed the MBL around implants of overdentures in the lower jaw. The estimate for this restoration type was 0.476 mm (95% CI: -0.305 to 1.258). 19 randomized controlled studies dealt with restorations which were fixed to the implants. The estimate for the mean MBL was 0.459 mm (95% CI: 0.325-0.593). There was a decrease in 1-year implant survival with an increase of 1 mm MBL (-0.083%; 95% CI: -0.179 to 0.0123;; p; =0.083) in fixed restorations. The difference in MBL between fixed and removable restorations was 0.363 mm (95% CI: -0.319 to 1.044;; p; =0.279). This systematic review indicates that implants with fixed and with removable restorations lead to comparable MBL

Trend in active transportation to school among Swiss school children and its associated factors: three cross-sectional surveys 1994, 2000 and 2005

BACKGROUND: Giving the rising trend in childhood obesity in many countries including Switzerland, strategies to increase physical activity such as promoting active school travel are important. Yet, little is known about time trends of active commuting in Swiss schoolchildren and factors associated with changes in walking and biking to school. METHODS: Between 1994 and 2005, information about mobility behaviour of children aged 6-14 years was collected within three Swiss population based national travel behaviour surveys. Mode of transport to school was reported for 4244 children. Weighted multivariate logistic regression analyses were used to assess active school travel time trends and their influencing factors. RESULTS: More than 70% of Swiss children walked or biked to school. Nevertheless, the proportion of children biking to school decreased (p = 0.05, linear trend), predominately in urban areas, and motorized transportation increased since 1994 (p = 0.02). Distance to school did not change significantly over time but availability of bikes decreased (p < 0.001) and number of cars per household increased (p < 0.001). The association between survey year and bike use was significantly modified by living in an urban area (OR (95%CI): 1.0, 0.63 (0.44-0.90), 0.71 (0.49-1.03), respectively for 1994, 2000 and 2005) and by distance to school (OR (95%CI): 1.0, 0.65 (0.40-1.05), 0.50 (0.23-0.79) for the same years and for children who lived more than a mile away from school). CONCLUSIONS: Programs to encourage safe biking and to limit car use as mode of transport to school are warranted to stop this tren

Smoking cessation in workplace setting: quit rates and determinants in a group behaviour therapy programme

To capitalise on the opportunities that the smoking ban legislation in Switzerland offers for the prevention of tobacco-related diseases, a smoking cessation programme in a workplace setting was developed and implemented in companies across the language and cultural regions of Switzerland. Our goal was to identify factors associated with relapse into smoking that may be overcome during training sessions or that should be considered for the optimisation of future interventions.; Between 2006 and 2012, 1287 smokers aged 16 to 68 years voluntarily attended smoking cessation training at their workplace. The intervention was based on a cognitive behavioural group therapy combined with individual proactive telephone counselling. The evaluation consisted of three anonymised questionnaires (pre- and postintervention, and 12-month follow-up). In this prospective cohort study, we investigated the association of smoking quit rates with training and participant characteristics, including withdrawal symptoms, by use of multilevel logistic regression analysis with a random intercept for training courses.; The self-reported abstinence rate was 72.4% at the end of the training, and 18.6% 1 year later. The risk of relapse during the training was positively associated with the number of years and daily cigarettes smoked, and negatively with increased appetite, sleeping troubles and satisfaction with learned techniques. Failed abstinence within the first year was associated with younger age, higher numbers of daily smoked cigarettes and unsuccessful recent quit attempts.; Our evaluation suggests that younger and more addicted smokers attending smoking cessation trainings may need additional support to achieve long lasting abstinence rates. Offering smoking cessation training in a workplace setting can achieve reasonable long-term quit rates, but a subset of employees needs additional support at the group or personal level.; Group behaviour therapy could be an effective method to achieve long-term smoking abstinence. The workplace is an important setting to reach and encourage a large number of smokers to participate in a smoking cessation programme, but only few studies investigated its potential. The findings of this study of a modern real-life workplace-based smoking cessation programme endorse the effectiveness and viability of cognitive behavioural group therapy. This group-level intervention at the workplace may be insufficient for young and heavy smokers, as well as women with increased appetite after cessation, who potentially benefit from re-intervention and additional individual level counselling

Sleeping hearts: 12 years after a follow up study on cardiac findings due to sleeping sickness

Both American Trypanosomiasis (Chagas disease) and Human African Trypanosomiasis (HAT) are diseases caused by single-celled flagellate protozoan parasites. While cardiac complications such as conduction problems and heart failure are very common in Chagas disease there is little known about the long-term effects of Human African Trypanosomiasis (HAT) on cardiac sequelae in Sub-Saharan Africa, where heart failure has become an increasing problem and growing burden. In the context of clinical trials conducted between 2004 and 2005 in the Democratic Republic of the Congo (DRC), the prevalence of HAT related signs and symptoms and an ECG were evaluated prior to the initiation of treatment. The object of this follow-up study in 2017 was to assess the prevalence of cardiac sequelae in the same 51 first stage and 18 second stage HAT patients 12-13 years after their treatment by conducting a clinical examination and an ECG. A control group matched by age (± 5 years), sex and whenever possible form the same village was enrolled. There were no significant differences in the prevalence of cardiac symptoms and in ECG findings between patients and their controls at the time of the follow-up evaluation. Repolarization changes disappeared or improved in 24.7% of HAT patients and were even less frequent than in the control group. Peripheral low voltage was the only parameter that increased over time in HAT patients and in three patients, new conduction problems in the ECG (ventricular bigeminy, RBBB, and bifascicular block) could be found, although none of these findings was clinically significant. However, the appearance of these conduction problems might represent an early indication of a HAT related cardiomyopathy or ongoing subclinical infection. This hypothesis would be supported by the findings of an older study in which antibodies (IFAT) against trypanosomiasis in 27% of Cameroonian patients with dilated cardiomyopathy compared to 2% in normal controls had been observed

Relative validation of a food frequency questionnaire to estimate food intake in an adult population

Background: Scientifically valid descriptions of dietary intake at population level are crucial for investigating diet effects on health and disease. Food frequency questionnaires (FFQs) are the most common dietary tools used in large epidemiological studies. Objective: To examine the relative validity of a newly developed FFQ to be used as dietary assessment tool in epidemiological studies. Design: Validity was evaluated by comparing the FFQ and a 4-day weighed food record (4-d FR) at nutrient and food group levels, Spearman’s correlations, Bland–Altman analysis and Wilcoxon rank sum tests were used. Fifty-six participants completed a paper format FFQ and a 4-d FR within 4 weeks. Results: Corrected correlations between the two instruments ranged from 0.27 (carbohydrates) to 0.55 (protein), and at food group level from 0.09 (soup) to 0.92 (alcohol). Nine out of 25 food groups showed correlations > 0.5, indicating moderate validity. More than half the food groups were overestimated in the FFQ, especially vegetables (82.8%) and fruits (56.3%). Water, tea and coffee were underestimated (–14.0%). Conclusions: The FFQ showed moderate relative validity for protein and the food groups fruits, egg, meat, sausage, nuts, salty snacks and beverages. This study supports the use of the FFQ as an acceptable tool for assessing nutrition as a health determinant in large epidemiological studies

Assessment of intensity, prevalence and duration of everyday activities in Swiss school children: a cross-sectional analysis of accelerometer and diary data

BACKGROUND: Appropriately measuring habitual physical activity (PA) in children is a major challenge. Questionnaires and accelerometers are the most widely used instruments but both have well-known limitations. The aims of this study were to determine activity type/mode and to quantify intensity and duration of children's everyday PA by combining information of a time activity diary with accelerometer measurements and to assess differences by gender and age. METHODS: School children (n = 189) aged 6/7 years, 9/10 years and 13/14 years wore accelerometers during one week in winter 2004 and one in summer 2005. Simultaneously, they completed a newly developed time-activity diary during 4 days per week recording different activities performed during each 15 min interval. For each specific activity, the mean intensity (accelerometer counts/min), mean duration per day (min/d) and proportion of involved children were calculated using linear regression models. RESULTS: For the full range of activities, boys accumulated more mean counts/min than girls. Adolescents spent more time in high intensity sports activities than younger children (p < 0.001) but this increase was compensated by a reduction in time spent playing vigorously (p = 0.04). In addition, adolescents spent significantly more time in sedentary activities (p < 0.001) and accumulated less counts/min during these activities than younger children (p = 0.007). Among moderate to vigorous activities, children spent most time with vigorous play (43 min/day) and active transportation (56 min/day). CONCLUSION: The combination of accelerometers and time activity diaries provides insight into age and gender related differences in PA. This information is warranted to efficiently guide and evaluate PA promotion

Acute phase proteins and white blood cell levels for prediction of infectious complications in status epilepticus

ABSTRACT: INTRODUCTION: Infections in status epilepticus (SE) patients result in severe morbidity making early diagnosis crucial. As SE may lead to inflammatory reaction, the value of acute phase proteins and white blood cells (WBC) for diagnosis of infections during SE may be important. We examined the reliability of C-reactive protein (CRP), procalcitonin (PCT), and WBC for diagnosis of infections during SE. METHODS: All consecutive SE patients treated in the ICU from 2005 to 2009 were included. Clinical and microbiological records, measurements of CRP and WBC during SE were analyzed. Subgroup analysis was performed for additional PCT measurements in the first 48 hours of SE. RESULTS: 22.5% of 160 consecutive SE patients had infections during SE. Single levels of CRP and WBC had no association with the presence of infections. Their linear changes over the first three days after SE onset were significantly associated with the presence of infections (p=0.0012 for CRP, p=0.0137 for WBC). Levels of PCT were available for 31 patients and did not differ significantly in patients with and without infections. Sensitivity of PCT and CRP was high (94% and 83%) and the negative predictive value of CRP increased over the first three days to 97%. Specificity was low, without improvement for different cut-offs. CONCLUSIONS: Single levels of CRP and WBC are not reliable for diagnosis of infections during SE, while their linear changes over time significantly correlated with the presence of infections. In addition, low levels of CRP and PCT rule out hospital-acquired infections in SE patient

Geographic distribution, age pattern and sites of lesions in a cohort of buruli ulcer patients from the mapé basin of cameroon

Buruli ulcer (BU), a neglected tropical disease of the skin, caused by Mycobacterium ulcerans, occurs most frequently in children in West Africa. Risk factors for BU include proximity to slow flowing water, poor wound care and not wearing protective clothing. Man-made alterations of the environment have been suggested to lead to increased BU incidence. M. ulcerans DNA has been detected in the environment, water bugs and recently also in mosquitoes. Despite these findings, the mode of transmission of BU remains poorly understood and both transmission by insects or direct inoculation from contaminated environment have been suggested. Here, we investigated the BU epidemiology in the Mapé basin of Cameroon where the damming of the Mapé River since 1988 is believed to have increased the incidence of BU. Through a house-by-house survey in spring 2010, which also examined the local population for leprosy and yaws, and continued surveillance thereafter, we identified, till June 2012, altogether 88 RT-PCR positive cases of BU. We found that the age adjusted cumulative incidence of BU was highest in young teenagers and in individuals above the age of 50 and that very young children (>5) were underrepresented among cases. BU lesions clustered around the ankles and at the back of the elbows. This pattern neither matches any of the published mosquito biting site patterns, nor the published distribution of small skin injuries in children, where lesions on the knees are much more frequent. The option of multiple modes of transmission should thus be considered. Analyzing the geographic distribution of cases in the Mapé Dam area revealed a closer association with the Mbam River than with the artificial lake

Associations between dietary patterns and post-bronchodilation lung function in the SAPALDIA cohort

Background: Chronic obstructive pulmonary disease (COPD) is not restricted to smokers. Dietary habits may contribute to the disease occurrence. Epidemiological studies point to a protective effect of fruit and vegetable intake against COPD. Objective: To investigate the associations between dietary patterns and parameters of lung function related to COPD in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). Methods: Data were included from the second follow-up assessment of the SAPALDIA cohort in 2010-2011 using a food frequency questionnaire. Principal component factor analysis was used to derive dietary patterns, whose association with FEV1, FEV1/FVC, FEF2575, and COPD was investigated by applying multivariate regression analyses. Results: After adjustment for potential confounders, the “prudent dietary pattern” characterised by the predominant food groups vegetables, fruits, water, tea and coffee, fish, and nuts was positively associated with FEV1 (increase of 40 mL per SD, p < 0.001). Also for factor 3 (“high-carbohydrate diet”), we found a significant positive association with FEV1 (with an increase per SD of 36 mL, p = 0.006). Conclusions: The main results are consistent with a protective effect of a diet rich in fruits, vegetables, fish, and nuts against age-related chronic respiratory disease. If confirmed in prospective cohorts, our results may guide nutritional counselling towards respiratory health promotion