"Social and Preventive Medicine” - past achievements and future challenges

No Abstrac

Dietary Nitrates, Nitrites, and N-Nitroso Compounds and Cancer Risk: a Review of the Epidemiologic Evidence

Experimental animal studies have shown N-nitroso compounds (NOC) to be potent carcinogens. Epidemiologic evidence of the carcinogenic potential of dietary NOC and precursor nitrates and nitrites in humans remains inconclusive with regard to the risk of stomach, brain, esophageal, and nasopharyngeal cancers. Inadequate available data could obscure a small to moderate effect of NO

Die Epidemiologie der Risikofaktoren für kardiovaskuläre Krankheiten in der Schweiz = Epidémiologie des facteurs de risque des maladies cardio-vasculaires en Suisse

[Contient] Introduction = Einführung - Programme national suisse de recherche sur la prévention des maladies cardio-vasculaires: l'examen de santé initial / B. Junod, F. Gutzwiller - Rauchgewohnheiten in vier Schweizer Städten / C. Schucan, T. Abelin - Distribution du chlolestérol plasmatique dans quatre villes suisses / H. Micheli - Ernährungsverhalten, Verzehrsgewohnheiten und Massenindex in vier Schweizer Städten / G. Ritzel - Epidemiologie des Blutdrucks in vier Schweizer Städten / F. Gutzwiller - Körperliche Aktivität und Leistungsfähigkeit in vier Schweizer Städten / H. Howald - Prévalence de l'exposition aux facteurs de risque des maladies cardio-vasculaires dans quatre villes suisses (Nyon, Vevey, Aarau, Soleure) / J. Alexander, B. Junod

Die mittlere Lebenserwartung in der Schweizhistorischer und internationaler Hintergrund und einige Gedanken zur zukünftigen Entwicklung

Zusammenfassung: Altersspezifische Sterbedaten sind sensible Gradmesser für die Lebenschancen einer Bevölkerung. Aus den in der Schweiz seit 1876/80 rund alle 10 Jahre berechneten Sterbetafeln lassen sich die mittlere Lebenserwartung und die Überlebens- bzw. Sterbewahrscheinlichkeiten für beliebige Altersstufen und Beobachtungszeiten bestimmen. Die Überlebenskurven haben sich kontinuierlich rektangularisiert, doch verlief der Rückgang der Mortalität nicht uniform: Bis weit ins 20. Jahrhungdert hinein war die Zunahme der mittleren Lebenserwartung v.a. durch einen raschen Rückgang der Säuglings- und Kindersterblichkeit bedingt; erst nach 1930 fiel auch die sinkende Mortalität bei den Erwachsenen stärker ins Gewicht, bei den über 60jährigen sogar erst nach 1960. Im internationalen Vergleich hat sich die günstige Position der Schweiz erst nach 1950 herausgebildet, v.a. wegen einer niedrigen Sterblichkeit in den höchsten Altersklassen. Für die kommenden Jahrzehnte rechnet man mit einer nochmaligen deutlichen Steigerung der mittleren Lebenserwartung, trotz der in letzer Zeit ungünstigen Entwicklung bei den jüngeren Erwachsenen. Die Zahl der über 65- und erst recht der über 80jährigen wird bis 2020 stark anwachsen, selbst wenn sich die Bevölkerungsszenarien von 1995 als zu optimistisch erweisen sollte

Some observations on the assessment of preventive technologies

The articles in this issue of the International Journal of Technology Assessment in Health Care (IJTAHC) have explored the assessment of preventive health technologies. When considered together, these technologies provide an interesting contrast with the health care technologies that are usually evaluated on these pages. Disease prevention and its twin, health promotion, are usually practiced on a well population. Thus, many persons have the technology applied to them but only a fraction of these would have acquired the condition being prevented. Often the intervention is applied to populations rather than to individuals. The unit cost for preventive technologies is usually far less than that of diagnostic or therapeutic technologies. However, when multiplied by the larger population to be involved in the prevention program, the total costs can be considerable. In concluding this section on prevention, we would like to examine some of the larger areas of difference between preventive and other health technologies illustrated by the papers assembled her

A Meta-Analysis of Acupuncture for Chronic Pain

Patel M (Route de Saint-Loup 4, 1290 Versoix, Switzerland), Gutzwiller F, Paccaud F and Marazzi A. A meta-analysis of acupuncture for chronic pain. International Journal of Epidemiology 1989, 18: 900-906. Results of 14 randomized controlled trials of acupuncture for chronic pain were pooled in a meta-analysis and analysed in three subgroups according to site of pain; and in two subgroups each according to type to trial, type of treatment, type of control, ‘blindness' of participating agents, trial size, and type of journal in which results were published. While few individual trials had statistically significant results, pooled results of many subgroups attained statistical significance in favour of acupuncture. Various potential sources of bias, including problems with blindness, precluded a conclusive finding although most results apparently favoured acupunctur

Culture, risk factors and mortality: can Switzerland add missing pieces to the European puzzle?

BACKGROUND: The aim was to compare cause-specific mortality, self-rated health (SRH) and risk factors in the French and German part of Switzerland and to discuss to what extent variations between these regions reflect differences between France and Germany. METHODS: Data were used from the general population of German and French Switzerland with 2.8 million individuals aged 45-74 years, contributing 176 782 deaths between 1990 and 2000. Adjusted mortality risks were calculated from the Swiss National Cohort, a longitudinal census-based record linkage study. Results were contrasted with cross-sectional analyses of SRH and risk factors (Swiss Health Survey 1992/3) and with cross-sectional national and international mortality rates for 1980, 1990 and 2000. RESULTS: Despite similar all-cause mortality, there were substantial differences in cause-specific mortality between Swiss regions. Deaths from circulatory disease were more common in German Switzerland, while causes related to alcohol consumption were more prevalent in French Switzerland. Many but not all of the mortality differences between the two regions could be explained by variations in risk factors. Similar patterns were found between Germany and France. CONCLUSION: Characteristic mortality and behavioural differentials between the German- and the French-speaking parts of Switzerland could also be found between Germany and France. However, some of the international variations in mortality were not in line with the Swiss regional comparison nor with differences in risk factors. These could relate to peculiarities in assignment of cause of death. With its cultural diversity, Switzerland offers the opportunity to examine cultural determinants of mortality without bias due to different statistical systems or national health policies