Tabakentwöhnung. 2.Teil: Empfehlungen für die tägliche Praxis

Der praktizierende Arzt muss bei jedem Raucher abklären,wie stark er von Nikotin abhängig und wie weit er bereits motiviert ist, mit Rauchen aufzuhören. Damit kann der Arzt dann gezielt intervenieren. Bei Rauchern, die noch nicht zum Aufhören entschlossen sind, wird die Intervention beschränkt bleiben, bei Rauchern hingegen, die sich zum Aufgeben entschlossen haben oder gar aktiv darauf vorbereiten, wird sie wesentlich weiter gehen. Bei Rauchern, die sich zum Aufgeben vorbereiten, erhöht eine unterstützende medikamentöse Behandlung- ikotinersatzpräparate oder Bupropion - die Chancen für einen Langzeiterfolg signifikant. Gute Kenntnisse über die richtige Dosierung, günstige Kombinationen sowie allfällige Kontraindikationen sind für eine erfolgreiche Anwendung dieser Präparate und die Vermeidung von Rückfällen wichtig. [Autoren]]]> Smoking Cessation ; Practice Guidelines as Topic oai:serval.unil.ch:BIB_FE1DBCA82FE3 2022-05-07T01:30:49Z phdthesis urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_FE1DBCA82FE3 L-canavanine, an inhibitor of inducible nitric oxide synthase, improves venous return in endotoxemic rats Fishman, Daniel Université de Lausanne, Faculté de médecine info:eu-repo/semantics/doctoralThesis phdthesis 1996 eng https://serval.unil.ch/resource/serval:BIB_FE1DBCA82FE3.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_FE1DBCA82FE30 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_FE1DBCA82FE30 info:eu-repo/semantics/restrictedAccess Restricted: indefinite embargo Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_FE1DD5022EF7 2022-05-07T01:30:49Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_FE1DD5022EF7 Transgenic mouse models for tumors of melanocytes and retinal pigment epithelium info:doi:10.1111/j.1600-0749.1999.tb00746.x info:eu-repo/semantics/altIdentifier/doi/10.1111/j.1600-0749.1999.tb00746.x info:eu-repo/semantics/altIdentifier/pmid/10231194 Beermann, F. Hunziker, A. Foletti, A. info:eu-repo/semantics/review article 1999-04 Pigment Cell Research, vol. 12, no. 2, pp. 71-80 info:eu-repo/semantics/altIdentifier/pissn/0893-5785 <![CDATA[Cutaneous and ocular melanomas are due to malignant transformation of neural crest-derived melanocytes. The rising incidence of this tumor in humans has stimulated experiments to devise suitable mouse models. In the past years, transgenic mouse lines have been generated using different oncogenes - Ha-ras, SV40 T antigen (Tag), ret - which develop benign lesions of melanocytes, melanoma, and/or eye tumors. Pigment cell tumors in humans, although rather rare, can also develop from the retinal pigment epithelium (RPE), a cell layer of neuroectodermal origin. We, therefore, established transgenic models for this ocular tumor. Regulated by the promoter of tyrosinase-related protein-1 (TRP-1), two oncogenes, ret and SV40 Tag, were targeted to the developing RPE in transgenic mice. The TRP-1/ret transgenic mice displayed microphthalmia and benign tumors of the RPE. Expression of SV40 T antigen (TRP-1/Tag) led to malignant tumors, which were invasive and metastasized to inguinal lymph node and spleen

Désaccoutumance au tabac. 1ère partie: Processus de désaccoutumance et bénéfices de l'arrêt

Le tabagisme est un problème clinique et de santé publique crucial en raison de sa prévalence élevée dans la population de patients ambulatoires et hospitaliers, et de ses conséquences majeures sur la mortalité, la morbidité et les coûts. Les conseils ciblés et non stigmatisant, ainsi que les traitements pharmacologiques (substituts nicotiniques et bupropion), sont efficaces pour promouvoir l'arrêt du tabac et ont un très bon rapport coût-efficacité._ La désaccoutumance au tabac est devenue une activité essentielle de la pratique clinique, en raison de l'importance épidémiologique et sociale des maladies liées au tabac d'une part, de l'apparition de méthodes et de produits permettant de faciliter la désaccoutumance à la nicotine d'autre part. Le risque de maladies lié au tabac est plus grand que la plupart des fumeurs ne l'imaginent. Le médecin praticien occupe une position privilégiée de conseiller et d'accompagnateur du processus de désaccoutumance vis-à-vis de ses patients._ L'aide à la désaccoutumance se base sur la connaissance du stade auquel se trouve le fumeur (indifférence, intention ou préparation) et sur la détermination de son degré de dépendance à la nicotine, évaluée en fonction de la consommation tabagique et du délai entre le réveil et la première cigarette de la journée. L'intervention médicale doit s'adapter à ces deux critères et amener le fumeur à progresser d'un stade de la désaccoutumance vers le suivant. _ L'intervention médicale en désaccoutumance représente l'activité la plus rentable dans le domaine de la prévention. La prise en charge des fumeurs doit tenir compte du processus de changement de comportement et de la dépendance nicotinique. L'arrêt du tabac est en effet un processus dynamique à travers 5 stades de motivation à cesser de fumer, ayant une probabilité croissante de devenir ex-fumeur. [auteurs]]]> Smoking Cessation fre oai:serval.unil.ch:BIB_DFF4297386F2 2022-08-13T01:31:17Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_DFF4297386F2 Clinical spectrum of tuberculous optic neuropathy. info:doi:10.1007/s12348-012-0079-5 info:eu-repo/semantics/altIdentifier/doi/10.1007/s12348-012-0079-5 info:eu-repo/semantics/altIdentifier/pmid/22614321 Davis, E.J. Rathinam, S.R. Okada, A.A. Tow, S.L. Petrushkin, H. Graham, E.M. Chee, S.P. Guex-Crosier, Y. Jakob, E. Tugal-Tutkun, I. Cunningham, E.T. Leavitt, J.A. Mansour, A.M. Winthrop, K.L. Hills, W.L. Smith, J.R. info:eu-repo/semantics/article article 2012 Journal of Ophthalmic Inflammation and Infection, vol. 2, pp. 183-189 info:eu-repo/semantics/altIdentifier/eissn/1869-5760 <![CDATA[PURPOSE: Tuberculous optic neuropathy may follow infection with Mycobacterium tuberculosis or administration of the bacille Calmette-Guerin. However, this condition is not well described in the ophthalmic literature. METHODS: Ophthalmologists, identified through professional electronic networks or previous publications, collected standardized clinical data relating to 62 eyes of 49 patients who they had managed with tuberculous optic neuropathy. RESULTS: Tuberculous optic neuropathy was most commonly manifested as papillitis (51.6 %), neuroretinitis (14.5 %), and optic nerve tubercle (11.3 %). Uveitis was an additional ocular morbidity in 88.7 % of eyes. In 36.7 % of patients, extraocular tuberculosis was present. The majority of patients (69.4 %) had resided in and/or traveled to an endemic area. Although initial visual acuity was 20/50 or worse in 62.9 % of 62 eyes, 76.7 % of 60 eyes followed for a median of 12 months achieved visual acuities of 20/40 or better. Visual field defects were reported for 46.8 % of eyes, but these defects recovered in 63.2 % of 19 eyes with follow-up. CONCLUSION: Visual recovery from tuberculous optic neuropathy is common, if the diagnosis is recognized and appropriate treatment is instituted. A tuberculous etiology should be considered when evaluating optic neuropathy in persons from endemic areas

Active screening for pulmonary tuberculosis by chest x-ray among immigrants at the Swiss border

BUT DE L'ETUDE: Evaluer le rendement du dépistage radiologique de la tuberculose pulmonaire chez les immigrés à l'entrée en Suisse. METHODE: Parmi les immigrés adultes entrés en Suisse en 2004, qui ont tous passé un contrôle radiologique, le nombre de porteurs de clichés thoracique suspects de tuberculose et la proportion de cas chez lesquels un traitement antituberculeux a été prescrit ont été évalués rétrospectivement. La fréquence des symptômes chez les immigrés atteints de tuberculose a été comparée à celle d'un groupe contrôle sans tuberculose. RESUTATS: Parmi 8995 immigrés, 8240 avaient un cliché thoracique normal, 630 étaient porteurs d'une anomalie non suspecte de tuberculose active et 125 (1.4%) montraient des signes radiologiques suspects de tuberculose. Un diagnostic final de tuberculose nécessitant un traitement a été posé dans 50 cas (11 cas à frottis et culture positifs, 16 cas à culture positive, 23 cas à culture négative), 57 présentaient des lésions cicatricielles compatibles avec une ancienne tuberculose et 18 avaient une autre affection pulmonaire ou un cliché normal au contrôle. La prévalence des plaintes n'était pas différente entre les 27 immigrés porteurs d'une tuberculose documentée (frottis+/culture+: 82%, frottis-/culture+: 75%) et les 23 immigrés atteints d'une tuberculose non documentée (frottis-/culture-: 91%), mais elle était plus élevée que chez les 57 immigrés porteurs de lésions cicatricielles (59%). La toux était plus fréquente chez les 27 tuberculeux documentés (70%) que chez 198 fumeurs sans tuberculose (37%) et chez 229 non fumeurs sans tuberculose (15%). CONCLUSIONS: Seuls 22% (27/125) des immigrés dont le cliché thoracique est suspect de tuberculose sont porteurs d'une tuberculose documentée par examen direct ou culture et 40% (50/125) nécessitent un traitement antituberculeux. Deux immigrants sur les 11 cas frottis positifs n'auraient pas été dépistés par un questionnaire. [Abstract] AIM: To assess the number of immigrants with pulmonary tuberculosis detected by chest x-ray screening at the Swiss border. METHOD: All adult immigrants entering Switzerland in 2004 were screened by chest x-ray (CXR). The number of radiological abnormalities suggestive of pulmonary tuberculosis, and the proportion requiring treatment for tuberculosis, were assessed retrospectively. The frequency of symptoms among immigrants with documented TB was compared with a sample of immigrants with a normal CXR. RESULTS: Among 8995 immigrants, 8240 had a normal CXR, 630 had some abnormality not suggestive of active TB and 125 (1.4%) had a CXR suggestive of pulmonary TB. A final diagnosis of tuberculosis requiring treatment was made in 50 (11 with positive smear and culture, 16 with positive culture and 23 with negative culture), 57 had fibrotic lesions and 18 had another disease or a normal x-ray on control. The prevalence of symptoms did not differ between 27 immigrants with documented TB (smear+/culture+: 82%, smear-/culture+: 75%), and 23 with smear-/culturetuberculosis (91%), but lower in 57 immigrants with fibrotic lesions (60%). Cough was more frequent among the 27 immigrants with documented TB (70%) than among 198 smokers without TB (37%) and among 229 non-smokers without TB (15%). CONCLUSIONS: Only 22% (27/125) of immigrants with CXR abnormalities suggestive of pulmonary tuberculosis were documented by smear and/or culture and 40% (50/125) needed antituberculous treatment. 2/11 smear-positive immigrants would not have been detected by a questionnaire on symptoms

Use of nicotine substitute prescribed at hourly plus ab libitum intake or ad libitum for heavy smokers willing to quit: a randomized controlled trial

OBJECTIVE: To assess the impact of instructional guidance in the regular use of use nicotine nasal spray (NNS) on the true use of NNS during the first three weeks of smoking cessation for heavy smokers who are willing to quit. METHODS: This randomized, open, controlled trial included 50 patients who were heavy smokers, were willing to quit, and attending an academic outpatient clinic in Western Switzerland. Patients were randomised to instruction on NNS use as "ad libitum" (administration whenever cravings appear; control group) or to use NNS when craving appears and at least every hour when awake (intervention group). Intakes were monitored using an electronic device fixed in the spray unit (MDILog) during the first three weeks of use. Self reported abstinence from smoking at six months was confirmed by expired-air carbon monoxide. Using intention-to-treat analysis, random-effect GLS regression was used to calculate the mean difference of daily doses between groups controlling for lack of independence between measures from the same individual. RESULTS: One patient was lost to follow-up. At baseline randomization, the group receiving instruction to use NNS hourly included more women, patients with previous desires to quit, and patients with more psychiatric comorbidities and less somatic complaints compared to the group instructed to use NNS with cravings (group imbalance). Both groups self-administered more than the daily recommended dosage of 8 uses. Mean daily usage was 13.6 dose/day and 11.1 dose/day for the group instructed to use NNS hourly and with cravings, respectively. Adjusting for baseline imbalance, the increased daily doses in the intervention group (hourly use) remained nonsignificant compared to ad libitum use (-0.5 dose/day; CI 95% -6.2; 5.3, from day 1 to day 7; and 2.3 dose/day; CI 95% -5.4; 10.0, from day 8 to day 21). Instructing patients to use the NNS daily had no effect on smoking cessation at six months (RR = 0.69; CI 95% 0.34; 1.39). CONCLUSION: Heavy smokers willing to quit use NNS frequently, regardless of the instructions given. Recommending the use of NNS only when craving appears for heavy smokers willing to quit seems acceptable compared to prescribing hourly administration. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00861276

Surveillance of Employees of Swiss Federal Asylum Centres for Latent Tuberculosis Infection.

BACKGROUND: Asylum seekers in Switzerland have to register in federal asylum centres (FACs) before formal permission to enter the country. Some of them may have active tuberculosis (TB), exposing fellow refugees and employees. OBJECTIVES: The aim of this study was to assess the risk of TB infection among employees of Swiss FACs. METHODS: Between 2010 and 2018, a free interferon-gamma release assay (IGRA) was offered to all employees of 8 FACs, at employment and at yearly intervals. We defined latent TB infection as IGRA conversion from negative to positive. IGRA-positive employees were referred to a medical centre for further clinical follow-up. RESULTS: 1,427 tests were performed among 737 employees (54.6% male). 403 (55%) persons were tested only once; 330 (44.5%) were tested several times; for 4 (0.5%) persons, the number of IGRA tests is unknown. Twenty employees (2.7%) had a positive IGRA at baseline, 2 (0.6%) converted from negative to positive during follow-up, resulting in an incidence of 22/10,000 person-years. We observed no case of active TB among employees. CONCLUSIONS: The prevalence of latent TB among employees to Swiss FACs and the risk of acquiring TB infection through work-related exposure are low. Yearly IGRA controls in the absence of documented TB exposure seem unnecessary

Use of Transition Probabilities to Estimate the Effect of Smoking on the Duration of Episodes of Respiratory Symptoms in Diary Data: The Swiss Study on Air Pollution and Lung Diseases in Adults (SAPALDIA)

Incompletely documented symptom episodes pose methodological problems in the analysis of diary data. The aim of this study was to develop a method of estimating the average durations of symptomatic and nonsymptomatic episodes, respectively, coping with the problem of bias due to undocumented days and censored episodes that is found in most diary studies. The authors derived their outcome variables from a Markov model using transition probabilities. To evaluate this method, the authors assessed the impact of active smoking on the duration of episodes of bronchitis symptoms and the corresponding nonsymptomatic periods, respectively, using diary data (1992-1993) obtained from 801 participants in the Swiss Study on Air Pollution and Lung Diseases in Adults. Covariate-adjusted distribution curves for the mean durations of individual episodes were estimated by Cox regression. Median values for light smokers (<10 cigarettes/day) were 60.0 sympton-free days (95% confidence interval (CI) 42.0-78.5) and 4.0 symptomatic days (95% CI 3.0-6.0), respectively, compared with medians of only 21.0 days 95% CI 16.2-29.8) for periods without bronchitis symptoms and 6.0 days (95% CI 4.9-9.0) for episodes of bronchitis symptoms in heavy smokers(≥30 cigarettes/day). The authors suggest that the Markov method is a feasible approach to the assessment of long term effects of smoking and environmental risk factors on the average duration of symptomatic and nonsymptomatic respiratory episodes. Am J Epidemiol 1998;148:600-

Clinical presentation, demographics and outcome of Tuberculosis (TB) in a low incidence area: a 4-year study in Geneva, Switzerland

<p>Abstract</p> <p>Background</p> <p>The incidence of tuberculosis (TB) in developed countries has decreased since the 1990s, reflecting worldwide efforts to identify and treat TB according to WHO recommendations. However TB remains an important public health problem in industrialized countries with a high proportion of cases occurring among subjects originating from high prevalence countries. The aim of this study was to describe clinical and social characteristics of patients with TB and their outcome in a low incidence area with a high immigration rate.</p> <p>Methods</p> <p>Four-year retrospective study based on a computerized database and subsequent review of medical records of all patients with TB followed at the outpatient section of the Division of Pulmonary Diseases, Geneva University Hospital, Switzerland.</p> <p>Results</p> <p>252 patients (84% foreigners, 25% asylum seekers) aged 38 ± 19 yrs were studied (11% co-infected with HIV). TB was intrapulmonary (TBP) in 158 cases (63%), extrapulmonary (TBE) in 137 (54%), and both in 43 cases (17%). TBP was smear (S)+/culture (C)+ in 59%, S-/C+ in 37%, S-/C- in 4%. Smoking was significantly associated with cavitary disease.</p> <p>Time from onset of symptoms to diagnosis was 2.1 ± 3.1 months. Initially, 10% were asymptomatic; 35% had no general symptoms. Despite systematic sputum analysis (induced or spontaneous), TBP was confirmed only by bronchoscopy in 38 subjects (24% of TBP). Side effects requiring changes in treatment occurred in 38 cases (11%).</p> <p>Treatment was completed in 210 (83%) patients. In 42 cases, follow up was unsuccessful; causes were: failure (n = 2; 0.8%), defaulters (n = 8; 3%), transfer out (n = 28; 11%) and death (n = 4; 1.6%). Relapse rate was 0.24 per 100 patient-years. Considering S+ TBP only, success rate was 87%.</p> <p>Conclusion</p> <p>TB in our area is predominantly a disease of young foreign-born subjects. Smoking appears as a possible risk factor for cavitary TBP. Time to diagnosis remains long. Compliance to treatment is satisfactory. Success rate for S+ TBP is within WHO objectives.</p

Follow-up of the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA 2) 1991-2003: methods and characterization of participants

Summary.: Objectives: The Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) was designed to investigate the health effects from long-term exposure to air pollution. Methods: The health assessment at recruitment (1991) and at the first reassessment (2001-3) consisted of an interview about respiratory health, occupational and other exposures, spirometry, a methacholine bronchial challenge test, end-expiratory carbon monoxide (CO) measurement and measurement for atopy. A bio bank for DNA and blood markers was established. Heart rate variability was measured using a 24-hour ECG (Holter) in a random sample of participants aged 50years and older. Concentrations of nitrogen dioxide (NO2), sulphur dioxide (SO2), ozone (O3) and particulates in ambient air have been monitored in all study areas since 1991. Residential histories collected over the 11year follow-up period coupled with GIS modelling will provide individual long-term air pollutant exposure estimates. Results: Of 9651 participants examined in 1991, 8715 could be traced for the cohort study and 283 died. Basic information about health status was obtained for 8047 individuals (86% of alive persons), 6528 individuals (70%) agreed to the health examination and 5973 subjects (62%) completed the entire protocol. Non-participants in the reassessment were on average younger than participants and more likely to have been smokers and to have reported respiratory symptoms in the first assessment. Average weight had increased by 5.5kg in 11years and 28% of smokers in 1991 had quit by the time of the reassessmen

SAPALDIA: Methods and participation in the cross-sectional part of the Swiss Study on Air Pollution and Lung Diseases in Adults

Summary: SAPALDIA-the Swiss Study on Air Pollution and Lung Diseases in Adults-focuses on the long term health effects of low to moderate levels of air pollutants as typically seen in different parts of Switzerland. The aim of the SAPALDIA cross-sectional study carried out in 1991 was to determine the prevalence of bronchial asthma, chronic bronchitis and allergic conditions in the adult population of Switzerland and to identify and to determine the respective importance of potentially influencing factors. These could be both personal (smoking habits, allergy status, family history, occupation) and environmental (outdoor and indoor pollution, aeroallergens, climate). A further aim of the cross-sectional study consisted in the identification of individuals susceptible to present symptoms during a two year observation period and to be included in the SAPALDIA follow-up study. This technical report represents the methodological documentation for the cross-sectional study of SAPALDIA. The instruments and the methods of standardisation are presented and discussed. The medical examination consisted of a computerised interview using a standardised questionnaire, the taking of a blood sample for serological tests, allergy skin testing, the measurement of endexpiratory CO and body height, and pulmonary function testing followed by methacholine challenge testing or bronchodilatation testing. The pattern of participation and the 9651 participants of the study, representing 59.3% of the sample, are described. Based on information on non-participants gained by telephone interviews and mailed short questionnaires, possible selection biases are quantified and discusse

Minimum package for cross-border TB control and care in the WHO European region: a Wolfheze consensus statement

The World Health Organization (WHO) European region estimates that more than 400,000 tuberculosis (TB) cases occur in Europe, a large proportion of them among migrants. A coordinated public health mechanism to guarantee TB prevention, diagnosis, treatment and care across borders is not in place. A consensus paper describing the minimum package of cross-border TB control and care was prepared by a task force following a literature review, and with input from the national TB control programme managers of the WHO European region and the Wolfheze 2011 conference. A literature review focused on the subject of TB in migrants was carried out, selecting documents published during the 11-yr period 2001–2011. Several issues were identified in cross-border TB control and care, varying from the limited access to early TB diagnosis, to the lack of continuity of care and information during migration, and the availability of, and access to, health services in the new country. The recommended minimum package addresses the current shortcomings and intends to improve the situation by covering several areas: political commitment (including the implementation of a legal framework for TB cross-border collaboration), financial mechanisms and adequate health service delivery (prevention, infection control, contact management, diagnosis and treatment, and psychosocial support).</br