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The study aims to describe couples' changes in sexuality after non-metastatic breast cancer from a longitudinal perspective. Our research question was: how do couples experience the cancer-induced change in sexual frequency and what are the reasons evoked to explain this kind of change over time? Forty heterosexual couples participated in a semi-structured interview three months and two years after surgery. A reflexive thematic analysis was conducted on a specific question about sexuality from a larger interview guide. The results showed that couples follow multiple trajectories regarding sexuality after the onset of oncological treatment. Most couples experienced temporary or more lasting changes, mainly associated with altered body image and pain. Some stopped having sexual activities at the beginning of treatment but resumed sexuality two years later; others were unable to restore sexuality. However, some couples stayed sexually active all along the cancer journey, showing that cessation of any sexual activity is not inevitable. Sexuality represents a significant long-term issue for breast cancer survivors and their partners. Prompt treatment can prevent sexual difficulties from crystallizing, while preserving the individual well-being and the quality of the couple's relationship. Health professionals should be aware of the need to screen early for sexual changes, while reevaluating the couple's situation regularly during care. [ABSTRACT FROM AUTHOR]

Growing evidence suggests that experiences with police are associated with a range of negative mental health problems among youth. This study examined the impact of negative police contact on changes in adolescent internalizing problems, measured by anxiety and depression. Six waves of data from a longitudinal study in Zurich, Switzerland were used in order to assess the direct relations between first reported police contact in the years prior to the survey moment and internalizing problems at the time of the survey and follow-up waves. The sample consists of a cohort of youth (max n = 1353, 49.4% females) spanning ages 11 to 24 (mean age and SD at each wave = 11.32 (0.37), 13.67 (0.36), 15.44 (0.36), 17.45 (0.37), 20.58 (0.38), 24.46 (0.38)). Specifically, difference-in-differences techniques for multiple time periods were employed to assess the average treatment effects for the treated population (first contact with police) compared to those who were never treated (never had contact). Across all models, police contact did not lead to an increase in internalizing problems. These results diverge from previous studies mostly conducted in the United States, and possible explanations including differences in historical contexts of policing, juvenile justice, health care, and dosage of intrusive contacts are discussed. [ABSTRACT FROM AUTHOR]

Background: Endotoxin adsorption is a promising but controversial therapy in severe, refractory septic shock and conflicting results exist on the effective capacity of available devices to reduce circulating endotoxin and inflammatory cytokine levels. Methods: Multiarm, randomized, controlled trial in two Swiss intensive care units, with a 1:1:1 randomization of patients suffering severe, refractory septic shock with high levels of endotoxemia, defined as an endotoxin activity ≥ 0.6, a vasopressor dependency index ≥ 3, volume resuscitation of at least 30 ml/kg/24 h and at least single organ failure, to a haemoadsorption (Toraymyxin), an enhanced adsorption haemofiltration (oXiris) or a control intervention. Primary endpoint was the difference in endotoxin activity at 72-h post-intervention to baseline. In addition, inflammatory cytokine, vasopressor dependency index and SOFA-Score dynamics over the initial 72 h were assessed inter alia. Results: In the 30, out of 437 screened, randomized patients (10 Standard of care, 10 oXiris, 10 Toraymyxin), endotoxin reduction at 72-h post-intervention-start did not differ among interventions (Standard of Care: 12 [1–42]%, oXiris: 21 [10–51]%, Toraymyxin: 23 [10–36]%, p = 0.82). Furthermore, no difference between groups could be observed neither for reduction of inflammatory cytokine levels (p = 0.58), nor for vasopressor weaning (p = 0.95) or reversal of organ injury (p = 0.22). Conclusions: In a highly endotoxemic, severe, refractory septic shock population neither the Toraymyxin adsorber nor the oXiris membrane could show a reduction in circulating endotoxin or cytokine levels over standard of care. Trial registration ClinicalTrials.gov. NCT01948778. Registered August 30, 2013. https://clinicaltrials.gov/study/NCT01948778 [ABSTRACT FROM AUTHOR]

Summary: This registry-based study of 3068 patients with osteoporosis compared the anti-fracture effectiveness of denosumab versus bisphosphonates. Denosumab was associated with significantly greater risk reduction than alendronate or ibandronate for vertebral and any fractures. No difference in fracture risk reduction was found between zoledronate and denosumab. Purpose: To analyse the fracture risk of patients with osteoporosis receiving bisphosphonates or denosumab in a real-world setting. Methods: This registry-based cohort study evaluated patients taking denosumab, bisphosphonates or both sequentially. Fractures were analysed using rates, rate ratios and hazard ratios (HR), including both therapies as time-varying co-variates. Fracture risk hazards were adjusted (aHR) for baseline T-Scores and trabecular bone score (TBS) and were additionally analysed with inverse probability treatment weighting. Results: A total of 3068 patients (89% female; median age at treatment onset, 69 years [63 to 76]) received denosumab (median duration 2.8 years, [2.2 to 4.7]), bisphosphonates (3.4 years, [2.1 to 5.7]) or both sequentially. Thus, 11,078 subject-years were assessed for bisphosphonates (41% alendronate, 36% ibandronate, 23% zoledronate) and 4216 for denosumab. Moreover, 48,375 subject-years were observed before treatment onset, in addition to 2593 years of drug holidays. A total of 1481 vertebral fractures (435 under therapy), 1508 non-vertebral fractures (499 under therapy) and 202 hip fractures (67 under therapy) occurred after age 50. The risks of vertebral, non-vertebral and hip fractures were significantly lower under all bisphosphonates, denosumab and drug holidays than before treatment onset (all p < 0.001). After adjusting for age, baseline T-scores and TBS, denosumab was associated with lower risk than alendronate or ibandronate for vertebral fractures (aHR 0.47 (0.35 to 0.64) and 0.70 [0.53 to 0.91], p < 0.001 and p = 0.009, respectively) and any fractures (aHR 0.62 [0.51 to 0.76] and 0.77 [0.64 to 0.92], p < 0.001 and p = 0.004). With propensity weighting, denosumab was associated with a lower hip fracture risk compared to alendronate (HR 0.54 [0.29 to 0.98], p = 0.044). No difference in fracture risk reduction (vertebral, non-vertebral or hip) was found between zoledronate and denosumab. Conclusions: When adjusting for disease severity, denosumab was associated with significantly greater risk reduction than alendronate and ibandronate for vertebral fractures. No difference in fracture risk reduction was found between zoledronate and denosumab. [ABSTRACT FROM AUTHOR]

Purpose Neck pain is common among office workers and leads to work productivity loss. This study aimed to investigate the effect of a multi-component intervention on neck pain-related work productivity loss among Swiss office workers. Methods Office workers, aged 18–65 years, and without serious neck-related health problems were recruited from two organisations for our stepped-wedge cluster randomized controlled trial. The 12-week multi-component intervention included neck exercises, health-promotion information, and workplace ergonomics. The primary outcome of neck pain-related work productivity loss was measured using the Work Productivity and Activity Impairment Questionnaire and expressed as percentages of working time. In addition, we reported the weekly monetary value of neck pain-related work productivity loss. Data was analysed on an intention-to-treat basis using a generalized linear mixed-effects model. Results Data from 120 participants were analysed with 517 observations. At baseline, the mean age was 43.7 years (SD 9.8 years), 71.7% of participants were female (N = 86), about 80% (N = 95) reported mild to moderate neck pain, and neck pain-related work productivity loss was 12% of working time (absenteeism: 1.2%, presenteeism: 10.8%). We found an effect of our multi-component intervention on neck pain-related work productivity loss, with a marginal predicted mean reduction of 2.8 percentage points (b = −0.27; 95% CI: −0.54 to −0.001, p = 0.049). Weekly saved costs were Swiss Francs 27.40 per participant. Conclusions: Our study provides evidence for the effectiveness of a multi-component intervention to reduce neck pain-related work productivity loss with implications for employers, employees, and policy makers. Trial Registration ClinicalTrials.gov, NCT04169646. Registered 15 November 2019—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04169646. [ABSTRACT FROM AUTHOR]

Refugees face various nutritional challenges during and after migration. This cross-sectional, mixed-methods study seeks to investigate the prevalence of undernutrition and obesity among refugees in Geneva, and to identify barriers to healthy eating. Anthropometric measurements of 354 adult refugees were collected between 2017 and 2019 by trained nurses and dietitians. Seven focus group discussions totaling 51 participants, refugees and social workers, investigated conceptions and needs regarding diet. The mean Body Mass Index is 24.6 ± 4.8 kg/m2. Women are disproportionately affected by obesity compared to men (p < 0.001). Weight gain post-migration is correlated positively with length of stay in Geneva (p < 0.001). Major obstacles to healthy eating are economic and linguistic. For participants, cooking workshops and free physical activities are highly needed interventions. Post-migration lifestyle interventions should be implemented to prevent weight gain in this population. Such interventions must be multi-level, to overcome structural, social and behavioral barriers to healthy eating. [ABSTRACT FROM AUTHOR]

Purpose The Work Rehabilitation Questionnaire (WORQ) is a patient-reported instrument to assess work related functioning in vocational rehabilitation (VR) and work, based on the International Classification of Functioning, Disability and Health (ICF) core set for VR. The objective of this study was to cross-culturally adapt WORQ to French and to evaluate its psychometric properties. Methods The cross-cultural adaptation followed a dual-panel approach. Psychometrics was examined in one VR-centre in the French speaking part of Switzerland. Test–retest reliability was analyzed with intraclass correlation coefficient (ICC), internal consistency was assessed with Cronbach's alpha. Construct validity was determined by convergence to the self-reported general functioning scale and the Hospital Anxiety and Depression Scales (HADS). The association of patient's return-to-work expectation within 6-months and having a case manager was examined. The usability of WORQ-French was tested in 10 VR patients. Results Eighty-nine patients with musculoskeletal injuries were included. WORQ-French showed excellent internal consistency (0.968) and a high test–retest reliability (0.935). WORQ-French was positively associated with self-reported general functioning (r = 0.662) and both HADS scales (r = 0.56–0.57). Neither the patient's return-to-work expectation nor having a case manager were significantly correlated with WORQ-French. Usability in terms of understandability of questions and response options was found to be good. Seven patients rated the length of WORQ-French as good, while two found the instrument a little too long and one found it too long. Conclusions WORQ French is a valid, reliable, and easy to administer instrument to assess self-reported work functioning given our study setting and sample characteristics. [ABSTRACT FROM AUTHOR]

Background Return to work with or after a chronic disease is not a very well understood process, influenced by a variety of personal, professional, societal and medical factors. The aim of this study is to identify predictors for return to work 12 months after a solid organ transplant applying a bio-psycho-social model. Methods This study is based on patients included in the Swiss Transplant Cohort Study, a national prospective multicentre cohort, who underwent a first solid organ transplant (kidney, liver, heart, lung). Bio-psycho-social factors were tested and predictors of return to work identified using logistic regression models. Results Among the 636 patients included in the study, 49.8% (317) were employed 12 months post-transplant. The major predictor for returning to work 12 months posttransplant was pre-transplant employment status (OR 10.8). Accordingly, the population was stratified in employed and not employed pre-transplant groups. Age, self-perceived health (6 months post-transplant) and the transplanted organ were significantly associated with post-transplant employment status in both groups. Return to work was influenced by education, depression (6 month post-transplant) and waiting time in the employed pre-transplant group and by invalidity pension in the not employed pre-transplant group. Conclusion Employment status pre-transplant being highly associated with employment status post-transplant, the process promoting return to work should be started well before surgery. Biomedical, psychological and social factors must be taken into account to promote return to work in transplanted patients. [ABSTRACT FROM AUTHOR]

Purpose To develop a multidimensional scale to asses psychosocial beliefs—the Yellow Flag Questionnaire (YFQ)—aimed at guiding interventions for workers with chronic musculoskeletal (MSK) pain. Methods Phase 1 consisted of item selection based on literature search, item development and expert consensus rounds. In phase 2, items were reduced with calculating a quality-score per item, using structure equation modeling and confirmatory factor analysis on data from 666 workers. In phase 3, Cronbach’s α, and Pearson correlations coefficients were computed to compare YFQ with disability, anxiety, depression and self-efficacy and the YFQ score based on data from 253 injured workers. Regressions of YFQ total score on disability, anxiety, depression and self-efficacy were calculated. Results After phase 1, the YFQ included 116 items and 15 domains. Further reductions of items in phase 2 by applying the item quality criteria reduced the total to 48 items. Phase factor analysis with structural equation modeling confirmed 32 items in seven domains: activity, work, emotions, harm & blame, diagnosis beliefs, co-morbidity and control. Cronbach α was 0.91 for the total score, between 0.49 and 0.81 for the 7 distinct scores of each domain, respectively. Correlations between YFQ total score ranged with disability, anxiety, depression and self-efficacy was.58,.66,.73, −.51, respectively. After controlling for age and gender the YFQ total score explained between R2 27% and R2 53% variance of disability, anxiety, depression and self-efficacy. Conclusions The YFQ, a multidimensional screening scale is recommended for use to assess psychosocial beliefs of workers with chronic MSK pain. Further evaluation of the measurement properties such as the test-retest reliability, responsiveness and prognostic validity is warranted. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the intention to use pre-exposure prophylaxis (PrEP) when available and to identify predictors of the intention to use PrEP among men who have sex with men (MSM) living in Switzerland. The theoretical model drew on the Unified Theory of Acceptance and Use of Technology and considered additional variables related specifically to PrEP, HIV protection and the resources of MSM.Subject and methods: For data collection, we used an anonymous, standardized self-administered online questionnaire. In 2015, we gathered a convenience sample of 556 HIV-negative MSM living in Switzerland. We analyzed the data using descriptive and bivariate statistics and used structural equation modeling to test the hypothesized model.Results: Predictors of respondents’ moderate intention to use PrEP were performance expectancy, effort expectancy, perceived social influence, concerns about using PrEP, attitudes toward condom use, negative experiences of condom use and age. These variables were predicted by HIV protection-related aspects and resources.Conclusion: The findings provide insights into the complex dynamic underlying the intention to use PrEP. [ABSTRACT FROM AUTHOR]

Peer victimization has been identified as a risk factor for depressive symptoms. The current study investigated the longitudinal interplay among social support, peer victimization and depressive symptoms in early adolescence. We specifically investigated the promotive and protective role of parental and friendship support on the longitudinal relationship between victimization and depressive symptoms. A total of 960 Swiss adolescents (49% female, M 13.2 years) completed an electronic questionnaire four times, with 6-month intervals. Trivariate cross-lagged models with latent longitudinal moderations were computed. The analyses confirmed that peer victimization was positively associated with changes in depressive symptoms, and depressive symptoms were positively associated with changes in victimization. Furthermore, bidirectional longitudinal associations between both parental and friendship support and depressive symptoms were found, while neither parental nor friendship support was found to be longitudinally associated with peer victimization. Further, neither parental nor friendship support moderated the longitudinal relationship between victimization and depressive symptoms. Thus, the present results suggested that parental and friendship support were promotive factors for adolescents' well-being, while neither parental, nor friendship support buffered the effect of victimization on depressive symptoms, thereby yielding no evidence for their longitudinal protective effect. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the prevalence, the change, and the determinants of change in polypharmacy in a population-based sample. Methods: Baseline (2003-2006) and follow-up (2009-2012) data are from 4679 participants aged between 35 and 75 years (53.5% women, mean age 52.6 ± 10.6 years) from the population of Lausanne, Switzerland. Polypharmacy was defined by the regular use of ≥5 drugs. Four categories of change were defined: never (no polypharmacy at baseline and follow-up), initiating (no polypharmacy at baseline but at follow-up), maintaining, or quitting. Results: Polypharmacy increased from 7.7% at baseline to 15.3% at follow-up. Cardiovascular drugs were the most prescribed medicines at baseline and follow-up. Gender, age, obesity, smoking, previously diagnosed hypertension, or diabetes or dyslipidemia were significantly and independently associated with initiating and maintaining polypharmacy. Conclusion: In a population-based sample, prevalence of polypharmacy doubled over a 5.6-year period. The main determinants of initiating polypharmacy were age, overweight and obesity, smoking status, and previously diagnosed cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Objective: Though the association between physical frailty and health is well established, little is known about its association with other domains of quality of life (QoL). This study investigated the association between physical frailty and multiple domains of QoL in community-dwelling older people. Design: Cross-sectional study. Setting and participants: Data of the 2011 annual assessment of 927 older people (age 73-77 years) from the Lc65+ cohort study were used. Measurements: Physical frailty was assessed by Fried's five criteria: 'shrinking'; 'weakness'; 'poor endurance, exhaustion'; 'slowness'; and 'low activity'. QoL was assessed using 28 items yielding a QoL score and seven domain-specific QoL subscores (Feeling of safety; Health and mobility; Autonomy; Close entourage; Material resources; Esteem and recognition; and Social and cultural life). Low QoL (QoL score or QoL subscores in the lowest quintile) was used as dependent variable in logistic regression analyses adjusted for age and sex (model 1), and additionally for socioeconomic (model 2) and health (model 3) covariates. Results: Physical frailty was associated with a low QoL score, as well as decreased QoL subscores in all seven specific domains, even after adjusting for socio-economic covariates. However, when performing additional adjustment for health covariates, only the domain Health and mobility remained significantly associated with physical frailty. Among each specific Fried's criteria, 'slowness' had the strongest association with a low QoL score. Conclusion: Physical frailty is associated with all QoL domains, but these associations are largely explained by poor health characteristics. Longitudinal studies are needed to better understand temporal relationships between physical frailty, health and QoL. [ABSTRACT FROM AUTHOR]

Purpose: The Nutrition Societies in Germany, Austria, and Switzerland recommend a daily intake of 20 µg vitamin D for adults when endogenous synthesis is absent. The current study aimed to elucidate whether this vitamin D dose impacts cardiovascular risk markers of adults during the winter months. Methods: The study was conducted in Halle (Saale), Germany (51 northern latitude) as a placebo-controlled, double-blinded, randomised trial (from January to April). A total of 105 apparently healthy subjects (male and female, 20-71 years old) were included. Subjects were randomly allocated to two groups. One group received a daily 20-µg vitamin D dose ( n = 54), and the other group received a placebo ( n = 51) for 12 weeks. Outcome measures included blood pressure, heart rate, concentrations of renin, aldosterone, serum lipids and vascular calcification markers, and haematologic variables such as pro-inflammatory monocytes. Results: Blood pressure and systemic cardiovascular risk markers remained unchanged by vitamin D supplementation, although serum 25-hydroxyvitamin D increased from 38 ± 14 to 73 ± 16 nmol/L at week 12. The placebo and vitamin D groups did not differ in their final cardiovascular risk profile. Conclusion: Daily supplementation of 20 µg vitamin D during winter is unlikely to change cardiovascular risk profile. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the demographics, injury patterns, and outcomes following major trauma between Alpine skiing, snowboarding, and sledding winter sports. Methods: An international population-based prospective trauma database (TraumaRegister DGU) was analyzed for demographic data, types and severity of injuries [body regions, Injury Severity Score (ISS)], early physiology [Glasgow Coma Scale (GCS), blood pressure, body temperature], rescue modality, surgical care, length of stay, and major complications (shock, multiple organ failure mortality). Participating countries included Germany, Austria, Switzerland, Finland, Slovenia, Belgium, Luxembourg, and The Netherlands. Results: A total of 243 winter sport athletes with major trauma were identified (1993-2012), and subjects were divided into Alpine skiers ( n = 174), snowboarders ( n = 29), and sledders ( n = 40). Athletes were predominantly male and presented hypothermic at emergency room arrival, despite a large proportion of air rescue (77 %). Alpine skiing was associated with higher injury severity (ISS 20.8 ± 14.0, p = 0.010) when compared with snowboarding (ISS 18.7 ± 14.0) and sledding (ISS 13.8 ± 9.5). Snowboarding was associated with the highest pre-hospital intubation rate (40.9 %, p = 0.007), despite comparable GCS values and prevalence of loss of consciousness at scene. The injury patterns were different between the three groups. Skiing was associated with head (47.1 %), chest (40.2 %, p = 0.047), and spinal injuries (40.9 %, p = 0.022). Snowboarding was associated with the highest percentage of upper extremity trauma. Sledders had the highest prevalence of facial and lower extremity trauma. Conclusions: Alpine skiing, snowboarding, and sledding result in different injury patterns and affect various age groups. Our data suggest an increased risk for chest and spinal injuries in Alpine skiers. Due to high-energy injury mechanisms, all three winter sports involve a risk of severe multiple trauma. While all athlete groups required a high rate of emergency surgery procedures, the observed in-hospital mortality from winter sports remains low. [ABSTRACT FROM AUTHOR]

Background: Vesicoureteral reflux (VUR) is a frequent cause of chronic kidney disease (CKD) in children. Using blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI), we measured cortical and medullary oxygenation in children with CKD due to VUR and compared the results to those obtained on healthy controls. Method: The study population comprised 37 children (19 with CKD due to VUR and 18 healthy age-matched controls). BOLD-MRI was performed before and after furosemide treatment. MR images were analyzed with the region-of-interest (ROI) technique to assess the mean R2* values (=1/T2*) of the cortex and medulla of each kidney and with the concentric object (CO) technique that divides renal parenchyma in 12 equal layers. Results: R2* values were significantly lower (corresponding to higher oxygenation) in the cortex and medulla of kidneys of children with CKD due to VUR than in those of the healthy controls (cortex 16.4 ± 1.4 vs. 17.2 ± 1.6 s, respectively; medulla 28.4 ± 3.2 vs. 30.3 ± 1.9 s, respectively; P < 0.05), and furosemide-induced changes in medullary R2* were smaller in the former than in the latter (−5.7 ± 3.0 vs. −6.9 ± 3.4 s, respectively; P < 0.05). Similar results were found with the CO technique. In children with a history of unilateral reflux ( n = 9), the non-affected contralateral kidneys presented similar R2* values as the diseased kidneys, but their response to furosemide was significantly larger (−7.4 ± 3.2 vs. −5.7 ± 3.0, respectively; P = 0.05). Conclusions: Chronic kidney disease due to VUR is not associated with kidney tissue hypoxia in children. The significantly larger furosemide-induced decrease in medullary R2* levels in the healthy group and unaffected contralateral kidneys of the VUR group points towards more intense renal sodium transport in these kidneys. [ABSTRACT FROM AUTHOR]

Background: Little is known about health-related quality of life (HRQoL) and mental health of parents having children with a history of hemolytic uremic syndrome (HUS). Methods: This study included 63 mothers and 58 fathers of a cohort of 63 HUS-affected children. At assessment, the mean time since a child experienced an acute episode of HUS was 6.4 years. Parental HRQoL, mental health and posttraumatic stress disorder (PTSD) were assessed with standardized self-report questionnaires. Medical data were extracted from patients' hospital records. Results: The HRQoL and mental health of both the mothers and fathers were not impaired compared to normative data. However, a shorter time since a child's acute HUS episode was a significant predictor of lower HRQoL among the mothers, while no such effect was found among the fathers. Two fathers (3 %), but no mothers, met the criteria for a diagnosis of HUS-related full PTSD; one father (2 %) and four mothers (6 %) met the criteria for a diagnosis of HUS-related partial PTSD. Conclusions: Our study shows that most parents of our study sample were doing well in terms of HRQoL and mental health, although a small number met the criteria for full or partial PTSD diagnosis due to their child's HUS. We therefore recommend that healthcare providers pay special attention to parents regarding PTSD symptoms during the clinical follow-up of a HUS-affected child since some parents may benefit from psychological support. [ABSTRACT FROM AUTHOR]

Purpose: Glomerular hyperfiltration has been suggested as a possible mechanism linking obesity and chronic kidney disease (CKD), independently of classical risk factors. We explored the association of overweight and obesity with glomerular hyperfiltration in a large sample of the Swiss adult population, accounting for several confounders including dietary factors. Methods: Data from a 2010 to 2012 cross-sectional population-based survey in Switzerland were used. Creatinine clearance (CrCl) was determined from 24-h urine collection; CrCl > 140 ml/min was used to define glomerular hyperfiltration. Participants were categorized into lean (<25 kg/m), overweight (25-29.9 kg/m) and obese (≥30 kg/m) according to body mass index (BMI). Results: A total of 1339 participants were included in the analysis [median (IQR) age 49.4 (34.3-63.5) years, 48.9 % men]. The prevalences of overweight and obesity were 32.2 and 14.2 %, respectively. Median CrCl was 102[84-121] ml/min in lean, 110 [87-136] ml/min in overweight and 124 [97-150] ml/min in obese participants ( p < 0.001). The prevalence of glomerular hyperfiltration increased across BMI categories (10.4, 20.8 and 34.7 %, respectively; p < 0.001). This positive association remained significant after adjusting for age, sex, hypertension, diabetes, smoking and dietary factors (sodium and protein intakes): odds ratio [95 %CI] 2.39 [1.52-3.76] ( p < 0.001) for overweight versus lean and 4.10[2.31-7.27] ( p < 0.001) for obesity versus lean. Conclusions: BMI categories and glomerular hyperfiltration are positively associated, independently of other known CKD risk factors and dietary confounders, suggesting that glomerular hyperfiltration may represent an early renal phenotype in obesity. Our observations confirm the significant association of glomerular hyperfiltration with sodium and protein intakes and identify sodium intake as an important modifying factor of the association between hyperfiltration and obesity. [ABSTRACT FROM AUTHOR]

Purpose: Obesity is a global epidemic affecting around 10 % of 5- to 17-year olds. With the causes for obesity being multifactorial, a better understanding of the influencing factors is essential for effective treatment and prevention programs. The aim of this study was therefore to identify specific risk factors for overweight and obesity in children in Switzerland. Methods: A nationally representative sample of children aged 6-12 years was recruited ( n = 2724). Height and weight were measured to calculate BMI (kg/m). In addition, a questionnaire was distributed to all children asking about their physical activity, media consumption, and dietary habits as well as some parental factors. Results: The prevalence of overweight and obesity in boys was 11.8 and 7.5 %, respectively, and in girls, it was 11.9 and 5.7 %. In univariate analyses, a number of parental, dietary, and activity factors were shown to be associated with BMI category. Based on a multinomial logistic regression, parent nationality and media consumption were the most important factors predicting obesity in boys, while in girls it was parental education, nationality, and physical activity. Conclusion: We have demonstrated that parental nationality and education play an important role in the development of childhood obesity, together with media consumption and physical activity. However, risk factors are also different according to child gender. Thus, an important target group for the treatment and prevention of childhood obesity in Switzerland are immigrant families, and the problem needs to be tackled differently in boys and girls as their risk factors are not the same. [ABSTRACT FROM AUTHOR]

Purpose: More than 95 % of the body carnitine is located in skeletal muscle, where it is essential for energy metabolism. Vegetarians ingest less carnitine and carnitine precursors and have lower plasma carnitine concentrations than omnivores. Principle aims of the current study were to assess the plasma and skeletal muscle carnitine content and physical performance of male vegetarians and matched omnivores under basal conditions and after l-carnitine supplementation. Results: Sixteen vegetarians and eight omnivores participated in this interventional study with oral supplementation of 2 g l-carnitine for 12 weeks. Before carnitine supplementation, vegetarians had a 10 % lower plasma carnitine concentration, but maintained skeletal muscle carnitine stores compared to omnivores. Skeletal muscle phosphocreatine, ATP, glycogen and lactate contents were also not different from omnivores. Maximal oxygen uptake (VOmax) and workload ( P) per bodyweight (bicycle spiroergometry) were not significantly different between vegetarians and omnivores. Sub-maximal exercise (75 % VOmax for 1 h) revealed no significant differences between vegetarians and omnivores (respiratory exchange ratio, blood lactate and muscle metabolites). Supplementation with l-carnitine significantly increased the total plasma carnitine concentration (24 % in omnivores, 31 % in vegetarians) and the muscle carnitine content in vegetarians (13 %). Despite this increase, P and VOmax as well as muscle phosphocreatine, lactate and glycogen were not significantly affected by carnitine administration. Conclusions: Vegetarians have lower plasma carnitine concentrations, but maintained muscle carnitine stores compared to omnivores. Oral l-carnitine supplementation normalizes the plasma carnitine stores and slightly increases the skeletal muscle carnitine content in vegetarians, but without affecting muscle function and energy metabolism. [ABSTRACT FROM AUTHOR]

Purpose The construct validity of functional capacity evaluations (FCE) in whiplash-associated disorders (WAD) is unknown. The aim of this study was to analyse the validity of FCE in patients with WAD with cultural differences within a workers' compensation setting. Methods 314 participants (42 % females, mean age 36.7 years) with WAD (grade I and II) were referred for an interdisciplinary assessment that included FCE tests. Four FCE tests (hand grip strength, lifting waist to overhead, overhead working, and repetitive reaching) and a number of concurrent variables such as self-reported pain, capacity, disability, and psychological distress were measured. To test construct validity, 29 a priori formulated hypotheses were tested, 4 related to gender differences, 20 related associations with other constructs, 5 related to cultural differences. Results Men had significantly more hand grip strength (+17.5 kg) and lifted more weight (+3.7 kg): two out of four gender-related hypotheses were confirmed. Correlation between FCE and pain ranged from −0.39 to 0.31; FCE and self-reported capacity from −0.42 to 0.61; FCE and disability from −0.45 to 0.34; FCE and anxiety from −0.36 to 0.27; and FCE and depression from −0.41 to 0.34: 16 of 20 hypotheses regarding FCE and other constructs were confirmed. FCE test results between the cultural groups differed significantly (4 hypotheses confirmed) and effect size (ES) between correlations were small (1 hypothesis confirmed). In total 23 out of 29 hypotheses were confirmed (79 %). Conclusions The construct validity for testing functional capacity was confirmed for the majority of FCE tests in patients with WAD with cultural differences and in a workers' compensation setting. Additional validation studies in other settings are needed for verification. [ABSTRACT FROM AUTHOR]

This study sought to determine the distribution of early-onset restrictive eating disturbances characteristic of the new DSM-5 diagnosis, avoidant/restrictive food intake disorder (ARFID) in middle childhood, as well as to evaluate the screening instrument, Eating Disturbances in Youth-Questionnaire (EDY-Q). A total of 1,444 8- to 13-year-old children were screened in regular schools (3rd to 6th grade) in Switzerland using the self-report measure EDY-Q, consisting of 12 items based on the DSM-5 criteria for ARFID. 46 children (3.2 %) reported features of ARFID in the self-rating. Group differences were found for body mass index, with underweight children reporting features of ARFID more often than normal and overweight children. The EDY-Q revealed good psychometric properties, including adequate discriminant and convergent validity. Early-onset restrictive eating disturbances are commonly reported in middle childhood. Because of possible negative short- and long-term impact, early detection is essential. Further studies with structured interviews and parent reports are needed to confirm this study's findings. [ABSTRACT FROM AUTHOR]

The Health Action Process Approach (HAPA) assumes that volitional processes are important for effective behavioral change. However, intraindividual associations have not yet been tested in the context of smoking cessation. This study examined the inter- and intraindividual associations between volitional HAPA variables and daily smoking before and after a quit attempt. Overall, 100 smokers completed daily surveys on mobile phones from 10 days before until 21 days after a self-set quit date, including self-efficacy, action planning, action control, and numbers of cigarettes smoked. Negative associations between volitional variables and daily numbers of cigarettes smoked emerged at the inter- and intraindividual level. Except for interindividual action planning, associations were stronger after the quit date than before the quit date. Self-efficacy, planning and action control were identified as critical inter- and intraindividual processes in smoking cessation, particularly after a self-set quit attempt when actual behavior change is performed. [ABSTRACT FROM AUTHOR]

Purpose: Reports on the protective effect of a Mediterranean diet on mortality usually refer to populations from Mediterranean countries, leaving uncertain whether really diet is the fundamental cause. Our aim was to examine the effect of a Mediterranean diet on mortality in Switzerland, a country combining cultural influences from Mediterranean and Central European countries within a common national health and statistical registry. Methods: In this prospective investigation, we included 17,861 men and women aged ≥16 years who participated 1977-1993 in health studies and were followed up for survival until 2008 by anonymous record linkage with the Swiss National Cohort. A 9-point score Mediterranean Diet Score (MDS) was used to assess adherence to a Mediterranean diet. Mortality hazard ratios (HR) and 95 % confidence intervals (CIs) were calculated by using Cox regression models adjusted for age, sex, survey wave, marital status, smoking, body mass index, language region and nationality. Results: In all language regions, MDS was inversely associated with mortality. Consumption of dairy products was also consistently associated with lower mortality. When categorizing dairy food consumption as beneficial instead of harmful, this association between MDS and mortality increased in strength and was partly statistically significant. For all causes of death combined (HR for a one-point increase in MDS 0.96, 95 % CI 0.94-0.98), in men (0.94, 0.92-0.97), in women (0.98, 0.95-1.02) for cardiovascular diseases (CVD, 0.96, 0.92-0.99; 0.95, 0.90-1.00; 0.98, 0.92-1.04) and for cancer (0.95, 0.92-0.99; 0.92, 0.88-0.97; 0.98, 0.93-1.04). Conclusions: Stronger adherence to a Mediterranean diet was associated with lower all-cause, CVD and cancer mortality, largely independently of cultural background. These associations were primary due to the effect in men. Our finding of a beneficial rather than a deleterious impact of dairy products consumption prompts at considering culturally adapted Mediterranean diet recommendations. However, results should be interpreted with caution since only a crude 1-day dietary estimate was available to assess individuals' habitual dietary intake. [ABSTRACT FROM AUTHOR]

Purpose: Since the 1970s, the use of metamizole is controversial due to the risk of agranulocytosis. The aim of this study was to analyze individual case safety reports (ICSRs) of metamizole-associated hematological adverse drug reactions (ADRs). Methods: International and Swiss metamizole-associated ICSR concerning selected hematological ADR were retrieved from VigiBase™, the World Health Organization Global Database of ICSR, and the Swiss Pharmacovigilance Database. We evaluated demographic data, co-medication, drug administration information, dose and duration of metamizole treatment, as well as the latency time of ADR, their course, and severity. The subgroup analysis of Swiss reports allowed us to analyze cases with fatal outcome more in depth and to estimate a rough minimal incidence rate. Results: A total of 1417 international and 77 Swiss reports were analyzed. Around 52 % of the international and 33 % of the Swiss metamizole-associated hematological ADR occurred within a latency time of ≤7 days. More women were affected. The annual number of hematological reports and those with fatal outcome increased over the last years parallel to metamizole sales figures. In Switzerland, the minimal incidence rate of agranulocytosis was 0.46-1.63 cases per million person-days of use (2006-2012). Female sex, old age, pancytopenia, and co-medication with methotrexate were striking characteristics of the seven Swiss fatal cases. Conclusions: Metamizole-associated hematological ADR remain frequently reported. This is underscored by increasing annual reporting rates, which mainly reflect growing metamizole use. Early detection of myelotoxicity and avoidance of other myelotoxic substances such as methotrexate are important measures for preventing fatalities. [ABSTRACT FROM AUTHOR]

Pregnant women with preterm labour (PTL) in pregnancy often experience increased distress and anxieties regarding both the pregnancy and the child's health. The pathogenesis of PTL is, among other causes, related to the stress-associated activation of the maternal-foetal stress system. In spite of these psychobiological associations, only a few research studies have investigated the potential of psychological stress-reducing interventions. The following paper will present an online anxiety and stress management self-help program for pregnant women with PTL. Structure and content of the program will be illustrated by a case-based experience report. L.B., 32 years (G3, P1), was recruited at gestational week 27 while hospitalized for PTL for 3 weeks. She worked independently through the program for 6 weeks and had regular written contact with a therapist. Processing the program had a positive impact on L.B.'s anxiety and stress levels, as well as on her experienced depressive symptoms and bonding to the foetus. As PTL and the risk of PTB are associated with distress, psychological stress-reducing interventions might be beneficial. This study examines the applicability of an online intervention for pregnant women with PTL. The case report illustrates how adequate low-threshold psychological support could be provided to these women. [ABSTRACT FROM AUTHOR]

Rising numbers of ageing prisoners and goals on implementing equivalent health care in prison raise issues surrounding end-of-life care for prisoners. The paucity of research on this topic in Europe means that the needs of older prisoners contemplating death in prison have not been established. To investigate elderly prisoners' attitudes towards death and dying, 35 qualitative interviews with inmates aged 51 to 71 years were conducted in 12 Swiss prisons. About half of the prisoners reported having thought about dying in prison, with some mentioning it in relation with suicidal thoughts and others to disease and old age. Themes identified during data analysis included general thoughts about death and dying, accounts of other prisoners' deaths, availability of end-of-life services, contact with social relations, and wishes to die outside of prison. Study findings are discussed using Allmark's concept of 'death without indignities,' bringing forth two ethical issues: fostering autonomy and removing barriers. Attributing the identified themes to these two ethical actions clarifies the current needs of ageing prisoners in Switzerland and could be a first step towards the implementation of end-of-life services in correctional systems. [ABSTRACT FROM AUTHOR]

Purpose: Obesity represents a growing public health concern worldwide. The latest data in Switzerland rely on self-reported body mass index (BMI), leading to underestimation of prevalence. We reassessed the prevalence of obesity and overweight in a sample of the Swiss population using measured BMI and waist circumference (WC) and explored the association with nutritional factors and living in different linguistic-cultural regions. Methods: Data of 1,505 participants of a cross-sectional population-based survey in the three linguistic regions of Switzerland were analyzed. BMI and WC were measured, and a 24-h urine collection was performed to evaluate dietary sodium, potassium and protein intake. Results: The prevalence of overweight, obesity and abdominal obesity was 32.2, 14.2 and 33.6 %, respectively. Significant differences were observed in the regional distribution, with a lower prevalence in the Italian-speaking population. Low educational level, current smoking, scarce physical activity and being migrant were associated with an higher prevalence of obesity. Sodium, potassium and protein intake increased significantly across BMI categories. Conclusions: Obesity and overweight affect almost half of the Swiss adolescents and adults, and the prevalence appears to increase. Using BMI and WC to define obesity led to different prevalences. Differences were furthermore observed across Swiss linguistic-cultural regions, despite a common socio-economic and governmental framework. We found a positive association between obesity and salt intake, with a potential deleterious synergistic effect on cardiovascular risk. [ABSTRACT FROM AUTHOR]

22q11.2 deletion syndrome (22q11DS) is associated with increased risk for schizophrenia. Better identifying risk factors for the emergence of psychotic symptoms in this population is needed to improve clinical assessment and early interventions. Schizophrenia spectrum disorders, hallucinations and delusions were characterized in an original sample of 104 individuals with 22q11DS. Further analysis of positive and negative symptoms was performed in a subsample of 59 individuals. Finally, longitudinal data available in 56 patients were used to explore the developmental trajectories of psychotic symptoms as well as the associations between psychotic symptoms and cognitive functioning. Schizophrenia spectrum disorders and psychotic symptoms were frequent in adolescent and adults with 22q11DS. The severity of hallucinations and non-persecutory delusional ideas discriminated patients at ultra-high risk for conversion to psychosis. Whereas approximately one-third of patients experienced an emergence of psychotic symptoms during a 4-year interval, 20 % displayed transient symptoms. Individuals with psychotic symptoms were characterized by a lower cognitive functioning in the context of the 22q11DS. The present study adds important data on the characteristics and developmental trajectory of psychotic symptoms in this population. This information may ultimately help clinicians dealing with these patients to reduce the duration of untreated psychosis and improve outcome. [ABSTRACT FROM AUTHOR]

Purpose: Prevalence data on the off-label use (OLU) of anticancer drugs are limited despite OLU being controversial for medical, pharmaco-economic, and ethical reasons. We therefore quantified and characterized the OLU of anticancer drugs and compared OLU based on the national drug label with international treatment recommendations. Methods: We prospectively collected data on patients receiving systemic anticancer therapy between October and December 2012 at hospitals affiliated with the Eastern Switzerland Oncology Network. Individual data on patient characteristics, tumor disease, and systemic treatment were collected, and each individual treatment was compared with the national drug label and international treatment guidelines. Results: A total of 985 consecutive patients receiving 1,737 anticancer drug treatments were included in the study. Overall, 32.4 % of all patients received at least one off-label drug, corresponding to 27.2 % of all anticancer drugs administered. Major reasons for OLU were the lack of approval for the specific disease entity (15.7 %) and modified application of the anticancer drug (10 %). OLU that was unsupported by the current European Society for Medical Oncology (ESMO) treatment recommendations was rare (6.6 %) but higher for bevacizumab (29.6 %) due to its use in treating advanced ovarian cancer beyond the second-line setting and advanced breast cancer beyond the first-line setting and for lenalidomide (22.6 %) due to its use in treating Non-Hodgkin lymphoma. Conclusions: Based on data collected on our patient cohort, OLU of anticancer drugs in a European clinical setting applies to one-third of all cancer patients. ESMO-unsupported use of chemotherapies or molecularly-targeted drugs is rare, opposing concerns that the off-label use of newer anticancer drugs is a substantial clinical problem. [ABSTRACT FROM AUTHOR]

The purpose of this study was to test child and adolescent psychosocial and psychopathological risk factors as predictors of adult criminal outcomes in a Swiss community sample. In particular, the role of active and avoidant problem coping in youths was analysed. Prevalence rates of young adult crime convictions based on register data were calculated. Univariate and multivariate logistic regressions were used to analyse the prediction of adult criminal convictions 15 years after assessment in a large Swiss community sample of children and adolescents ( n = 1,086). Risk factors assessed in childhood and adolescence included socio-economic status (SES), migration background, perceived parental behaviour, familial and other social stressors, coping styles, externalizing and internalizing problems and drug abuse including problematic alcohol consumption. The rate of any young adult conviction was 10.1 %. Besides externalizing problems and problematic alcohol consumption, the presence of any criminal conviction in young adulthood was predicted by low SES and avoidant coping even after controlling for the effects of externalizing problems and problematic alcohol use. The other predictors were significant only when externalizing behaviours and problematic alcohol use were not controlled. In addition to child and adolescent externalizing behaviour problems and substance use, low SES and inadequate problem-solving skills, in terms of avoidant coping, are major risk factors of young adult criminal outcomes and need to be considered in forensic research and criminal prevention programs. [ABSTRACT FROM AUTHOR]

Purpose: Several countries have recently reported stabilization and/or a decrease in the prevalence of pediatric obesity. However, systematic, repeated national monitoring studies are scarce, and it is unclear whether this trend would be sustained. The objective was to present the latest overweight and obesity prevalence in Swiss children and to investigate trends in prevalence from 1999 to 2012. Methods: Using probability-proportionate-to-size cluster sampling, nationally representative samples of children aged 6-12 years were recruited in 1999 ( n = 594), 2002 ( n = 2,493), 2004 ( n = 328), 2007 ( n = 2,218), 2009 ( n = 907), and 2012 ( n = 2,963). Height and weight were measured to calculate BMI (kg/m). BMI cutoffs proposed by the Centers for Disease Control and Prevention (CDC) and by the International Obesity Task Force were used to determine the prevalence of overweight (excluding obesity) and obesity. Waist circumference was measured in 2007 and 2012, and multiple skinfold thicknesses assessed in 2002 and 2012. Results: Using the CDC criteria, prevalences of overweight and obesity in 2012 were 11.9 % (95 % CI 10.7-13.1) and 7.1 % (95 % CI 6.2-8.0), respectively, and did not change between 1999 and 2012 ( β = −0.144, p = 0.293 and β = −0.063, p = 0.552, respectively). Boys had significantly higher obesity prevalence than girls in 2007 (5.6 vs. 3.4 %) and 2012 (8.1 vs. 5.9 %). Percentage of children with excess waist circumference and body fat percentage did not differ between 2007 and 2012, and 2002 and 2012, respectively. Conclusion: Our data indicate the prevalence of childhood adiposity in Switzerland stabilized between 1999 and 2012, but ≈1 in 5 children remain overweight or obese and further efforts are needed to control the epidemic. [ABSTRACT FROM AUTHOR]

Summary: In the present study, we evaluated the potential for aminobisphosphonates to enhance the development of bone-forming osteoblasts from progenitor cells isolated from aged female osteoporotic patients. The aminobisphosphonates tested significantly enhanced osteoblast formation and thus lend further insights into their possible mode of action in the treatment of osteoporosis. Introduction: The primary aim of this study was to evaluate the influence of aminobisphosphonates on the osteogenesis of human bone marrow stromal cells (hBMSCs) and mineralization of differentiating bone-forming cells isolated from osteoporotic patients. Methods: The influence of aminobisphosphonate treatment on hBMSC osteogenesis was assessed by the quantitative measurement of alkaline phosphatase (ALP) activity, in addition to quantitative reverse transcription polymerase chain reaction and Western blot analysis of known osteogenic markers. Mineralized matrix formation by hBMSC-derived osteoblasts was visualized and quantified using Alizarin red staining. Results: hBMSC cultures treated with osteogenic medium supplemented with zoledronate demonstrated a significant increase in Alizarin red staining after 3 weeks as compared to cells cultured in osteogenic medium alone. Similarly, cultures of differentiating hBMSCs isolated from patients receiving alendronate treatment also demonstrated an increased propensity for mineralization, even in the absence of further in vitro stimulation by zoledronate. The stimulatory effects of aminobisphosphonate treatment on hBMSC-derived osteoblast-mediated mineralization were independent of any alterations in ALP activity, although significant decreases in the expression levels of osteopontin ( SPP1) were evident in hBMSCs following exposure to aminobisphosphonates. Further analysis including Western blotting and loss-of-function studies revealed osteopontin as having a negative influence on the mineralization of differentiating osteoporotic bone-forming cells. Conclusions: The results presented here demonstrate for the first time that aminobisphosphonate treatment of osteoporotic hBMSCs enhances their capacity for osteoblast formation and subsequent mineral deposition, thus supporting the concept of aminobisphosphonates as having an osteoanabolic effect in osteoporosis. [ABSTRACT FROM AUTHOR]

Study design:Randomized, within-in participant cross-over study.Objective:The purpose of this study was to determine the effect on comfort and pressure of lying with the shoulders and bed in different positions for people with tetraplegia.Setting:Rehabilitation hospital.Methods:Twenty people with tetraplegia were tested lying supine with the shoulders and bed in seven different positions. The positions used a combination of three arm and two bed positions. Six of the positions reflected what is commonly recommended in acute spinal cord injury units including a crucifix-type position. The seventh position was selected by participants and reflected their preferred sleeping position. There were five outcomes: general comfort, shoulder comfort, participant choice of preferred position, peak pressure under the shoulders and areal pressure under the shoulders. Pressure was measured using a pressure mapping system and comfort using a visual analogue scale (VAS).Results:The participants reported significantly higher (P<0.01) general comfort and shoulder comfort in their self-selected position compared with all other positions. There was no statistical difference in peak pressure (P=0.15) or areal pressure (P=0.08) under the shoulders between the seven positions. Most participants indicated that they preferred to lie with their shoulders adducted and internally rotated and the hands either by their sides or on their stomachs.Conclusion:The position of the shoulders has little effect on pressure but a notable effect on comfort. Participants preferred to sleep with their arms beside their bodies, not with their arms in a crucifix position as commonly advocated. [ABSTRACT FROM AUTHOR]

Background: Although physical exercise is recommended for asthmatics, evidence on the effects of exercise on clinical key factors is still missing. Objectives: We performed a systematic review and meta-analysis to determine the effect of exercise training (EXT) on quality of life (QoL), bronchial hyperresponsiveness (BHR), exercise-induced bronchoconstriction (EIB), lung function and exercise capacity, plus the factors affecting changes in QoL and exercise capacity in asthmatics after a period of EXT. Data Sources: A computerized search was conducted in MEDLINE, EMBASE, and CINAHL (last search on 15 November 2012), without language restriction, and references of original studies and reviews were searched for further relevant studies. Study Selection: Two independent investigators screened full-text studies with asthmatic subjects undertaking EXT (defined as training for ≥7 days, ≥2 times per week, ≥5 training sessions in total) that assessed at least one of the following outcomes: QoL, airway hyperreactivity, forced expiratory volume in one second (FEV), peak expiratory flow (PEF), inflammatory parameters, exercise capacity, or exercise endurance. Potentially relevant studies were excluded if only respiratory muscle training, breathing exercises or yoga was performed, if asthmatic subjects with co-morbidities were investigated, if only data of mixed patient groups without separate results for asthmatics were presented, if training regimens were not sufficiently specified, if no numerical outcome data were presented, and if new long-term medication was introduced in addition to physical training. Of 500 potentially relevant articles, 13.4 % (67 studies including 2,059 subjects) met the eligibility criteria and were included for further analyses. Study Appraisal and Synthesis Methods: Data extraction and risk of bias assessment was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis of all randomized controlled trials (RCTs) was performed to determine the effect of EXT on asthma symptoms, BHR, EIB, FEV, exercise capacity and exercise endurance compared with control training. In addition, relative pre/post changes were analysed in all RCTs and controlled trials. Finally, multiple linear regression models were used to identify effects of relative changes in airway hyperreactivity (BHR or EIB), lung function (FEV or PEF) and training hours on QoL and exercise performance. Results: In a total of 17 studies including 599 subjects, meta-analyses showed a significant improvement in days without asthma symptoms, FEV and exercise capacity while BHR only tended to improve. The analysis of relative within-group changes after EXT showed, however, significant improvements in QoL (17 %), BHR (53 %), EIB (9 %), and FEV (3 %) compared with control conditions. Multiple linear regression models revealed that changes in airway hyperreactivity and lung function significantly contributed to the change in QoL, while mainly the changes in airway hyperreactivity contributed to the change in exercise capacity. Conclusion: EXT was shown to improve asthma symptoms, QoL, exercise capacity, BHR, EIB, and FEV in asthmatics and improvements in BHR explained part of the improvement in QoL and exercise capacity. Thus, physical activity should be recommended as a supplementary therapy to medication. However, more well controlled studies should be performed assessing the relationship of physical activity, QoL, airway hyperreactivity, lung function and especially airway inflammation as well as medication intake. [ABSTRACT FROM AUTHOR]

Introduction Whiplash-associated disorders (WAD) are a burden for both individuals and society. It is recommended to evaluate patients with WAD at risk of chronification to enhance rehabilitation and promote an early return to work. In patients with low back pain (LBP), functional capacity evaluation (FCE) contributes to clinical decisions regarding fitness-for-work. FCE should have demonstrated sufficient clinimetric properties. Reliability and safety of FCE for patients with WAD is unknown. Methods Thirty-two participants (11 females and 21 males; mean age 39.6 years) with WAD (Grade I or II) were included. The FCE consisted of 12 tests, including material handling, hand grip strength, repetitive arm movements, static arm activities, walking speed, and a 3 min step test. Overall the FCE duration was 60 min. The test-retest interval was 7 days. Interclass correlations (model 1) (ICCs) and limits of agreement (LoA) were calculated. Safety was assessed by a Pain Response Questionnaire, observation criteria and heart rate monitoring. Results ICCs ranged between 0.57 (3 min step test) and 0.96 (short two-handed carry). LoA relative to mean performance ranged between 15 % (50 m walking test) and 57 % (lifting waist to overhead). Pain reactions after WAD FCE decreased within days. Observations and heart rate measurements fell within the safety criteria. Conclusions The reliability of the WAD FCE was moderate in two tests, good in five tests and excellent in five tests. Safety-criteria were fulfilled. Interpretation at the patient level should be performed with care because LoA were substantial. [ABSTRACT FROM AUTHOR]

Summary: We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients. Introduction: Bone fragility is an emerging issue in HIV-infected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations. Methods: We studied the influence of long-term HIV infection on bone microstructure as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 22 HIV-positive (+ve) premenopausal eumenorrheic women and 44 age- and body mass index (BMI)-matched HIV-negative (−ve) controls. All subjects completed questionnaires regarding calcium/protein intakes and physical activity, and underwent DXA and HR-pQCT examinations for BMD and peripheral skeleton microstructure, respectively. A risk factor analysis of tibia trabecular density using linear mixed models was conducted. Results: In HIV+ve women on successful antiretroviral therapy (undetectable HIV-RNA, median CD4 cell count, 626), infection duration was 16.5 ± 3.5 (mean ± SD) years; median BMI was 22 (IQR, 21-26) kg/m. More HIV+ve women were smokers (82 versus 50 %, p = 0.013). Compared to controls, HIV+ve women had lower lumbar spine (spine T-score −0.70 vs −0.03, p = 0.014), but similar proximal femur BMD. At distal tibia, HIV+ve women had a 14.1 % lower trabecular density and a 13.2 % reduction in trabecular number compared to HIV−ve women ( p = 0.013 and 0.029, respectively). HR-pQCT differences in distal radius were significant for cortical density (−3.0 %; p = 0.029). Conclusions: Compared with HIV−ve subjects, premenopausal HIV+ve treated women had trabecular and cortical bone alterations. Adjusted analysis revealed that HIV status was the only determinant of between group tibia trabecular density differences. The latter could contribute to increased bone fragility in HIV+ve patients. [ABSTRACT FROM AUTHOR]

Background: Although at least 20 different functional somatic syndromes (FSS) have been described, and overlaps between individual FSS and a high comorbidity with depressive and anxiety disorders have been suggested, barely any studies have examined a broad array of FSS within one study. Moreover, information on psychosocial risk factors gained from prospective studies is scarce. Purpose: This study aimed to determine prevalence rates, overlap, and comorbidity in 17 FSS and to estimate the influence of psychosocial risk factors on the development of FSS. Methods: In total, 3,054 students (73.4 % women) completed a Web survey containing questions on FSS, comorbidity, and psychosocial risk factors at baseline. Of these, 429 completed the survey again 6 months later. Results: The prevalence of any FSS was 9.5 %, with 227 (78.6 %) subjects fulfilling criteria for only one FSS, 49 (17.0 %) reporting two, and 12 (4.2 %) reporting three syndromes simultaneously. Only one person suffered from four FSS at the same time. 'Major depressive syndrome' (15.6 %), 'panic syndrome' (4.8 %), and 'other anxiety syndromes' (19.7 %) frequently occurred among persons with FSS. Significant predictors of FSS were number of somatic symptoms (OR = 1.15), impairment in daily activities (OR = 3.17), depression (OR = 1.13), and somatization (OR = 1.15). Conclusions: Our findings indicate that FSS are common in nonclinical samples. The frequency of overlap and comorbidity in FSS was lower compared with previous research. A consideration of psychosocial risk factors is warranted in the prevention and management of FSS. [ABSTRACT FROM AUTHOR]

Cyberbullying, a modern form of bullying performed using electronic forms of contact (e.g., SMS, MMS, Facebook, YouTube), has been considered as being worse than traditional bullying in its consequences for the victim. This difference was mainly attributed to some specific aspect that are believed to distinguish cyberbullying from traditional bullying: an increased potential for a large audience, an increased potential for anonymous bullying, lower levels of direct feedback, decreased time and space limits, and lower levels of supervision. The present studies investigated the relative importance of medium (traditional vs. cyber), publicity (public vs. private), and bully's anonymity (anonymous vs. not anonymous) for the perceived severity of hypothetical bullying scenarios among a sample of Swiss seventh- and eight-graders (study 1: 49 % female, mean age = 13.7; study 2: 49 % female, mean age = 14.2). Participants ranked a set of hypothetical bullying scenarios from the most severe one to the least severe one. The scenarios were experimentally manipulated based on the aspect of medium and publicity (study 1), and medium and anonymity (study 2). Results showed that public scenarios were perceived as worse than private ones, and that anonymous scenarios were perceived as worse than not anonymous ones. Cyber scenarios generally were perceived as worse than traditional ones, although effect sizes were found to be small. These results suggest that the role of medium is secondary to the role of publicity and anonymity when it comes to evaluating bullying severity. Therefore, cyberbullying is not a priori perceived as worse than traditional bullying. Implications of the results for cyberbullying prevention and intervention are discussed. [ABSTRACT FROM AUTHOR]

Summary: End-stage renal disease (ESRD) patients have a high risk of fractures. We evaluated bone microstructure and finite-element analysis-estimated strength and stiffness in patients with ESRD by high-resolution peripheral computed tomography. We observed an alteration of cortical and trabecular bone microstructure and of bone strength and stiffness in ESRD patients. Introduction: Fragility fractures are common in ESRD patients on dialysis. Alterations of bone microstructure contribute to skeletal fragility, independently of areal bone mineral density. Methods: We compared microstructure and finite-element analysis estimates of strength and stiffness by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 33 ESRD patients on dialysis (17 females and 16 males; mean age, 47.0 ± 12.6 years) and 33 age-matched healthy controls. Results: Dialyzed women had lower radius and tibia cortical density with higher radius cortical porosity and lower tibia cortical thickness, compared to controls. Radius trabecular number was lower with higher heterogeneity of the trabecular network. Male patients displayed only a lower radius cortical density. Radius and tibia cortical thickness correlated negatively with bone-specific alkaline phosphatase (BALP). Microstructure did not correlate with parathyroid hormone (PTH) levels. Cortical porosity correlated positively with 'Kidney Disease: Improving Global Outcomes' working group PTH level categories ( r = 0.36, p < 0.04). BMI correlated positively with trabecular number ( r = 0.4, p < 0.02) and negatively with trabecular spacing ( r = −0.37, p < 0.03) and trabecular network heterogeneity ( r = −0.4, p < 0.02). Biomechanics positively correlated with BMI and negatively with BALP. Conclusion: Cortical and trabecular bone microstructure and calculated bone strength are altered in ESRD patients, predominantly in women. Bone microstructure and biomechanical assessment by HR-pQCT may be of major clinical relevance in the evaluation of bone fragility in ESRD patients. [ABSTRACT FROM AUTHOR]

Purpose: Hypoxia has been shown to reduce energy intake and lead to weight loss, but the underlying mechanisms are unclear. The aim was therefore to assess changes in eating after rapid ascent to 4,559 m and to investigate to what extent hypoxia, acute mountain sickness (AMS), food preferences and satiation hormones influence eating behavior. Methods: Participants ( n = 23) were studied at near sea level (Zurich (ZH), 446 m) and on two days after rapid ascent to Capanna Margherita (MG) at 4,559 m (MG2 and MG4). Changes in appetite, food preferences and energy intake in an ad libitum meal were assessed. Plasma concentrations of cholecystokinin, peptide tyrosine-tyrosine, gastrin, glucagon and amylin were measured. Peripheral oxygen saturation (SpO) was monitored, and AMS assessed using the Lake Louis score. Results: Energy intake from the ad libitum meal was reduced on MG2 compared to ZH (643 ± 308 vs. 952 ± 458 kcal, p = 0.001), but was similar to ZH on MG4 (890 ± 298 kcal). Energy intake on all test days was correlated with hunger/satiety scores prior to the meal and AMS scores on MG2 but not with SpO on any of the 3 days. Liking for high-fat foods before a meal predicted subsequent energy intake on all days. None of the satiation hormones showed significant differences between the 3 days. Conclusion: Reduced energy intake after rapid ascent to high altitude is associated with AMS severity. This effect was not directly associated with hypoxia or changes in gastrointestinal hormones. Other peripheral and central factors appear to reduce food intake at high altitude. [ABSTRACT FROM AUTHOR]

Identifying patients' expectations of and need for healthcare chaplaincy is important in terms of appropriate intervention. Therefore, a sample of 612 patients from 32 general hospitals and psychiatric clinics in the German part of Switzerland was surveyed about their expectations of chaplaincy service. A principal component factor analysis of participants' ratings found that the survey items fell into three distinct categories. These were the need for (1) emotional support, (2) help to cope with illness/disease, and (3) religious/spiritual assistance. Among the expectations, the need for emotional support was rated most important, followed by help to cope and, lastly, religious/spiritual assistance. Gender, religious denomination, general religiosity, and subjective health status significantly influenced these expectations. The results showed that fulfilling patients' expectations increases their overall satisfaction with, and the importance they accord to the chaplain's visit, as well as their confidence in the chaplain. [ABSTRACT FROM AUTHOR]

Purpose: Body mass index (BMI) and waist circumference (WC) are widely used to predict % body fat (BF) and classify degrees of pediatric adiposity. However, both measures have limitations. The aim of this study was to evaluate whether a combination of WC and BMI would more accurately predict %BF than either alone. Methods: In a nationally representative sample of 2,303 6- to 13-year-old Swiss children, weight, height, and WC were measured, and %BF was determined from multiple skinfold thicknesses. Regression and receiver operating characteristic (ROC) curves were used to evaluate the combination of WC and BMI in predicting %BF against WC or BMI alone. An optimized composite score (CS) was generated. Results: A quadratic polynomial combination of WC and BMI led to a better prediction of %BF ( r = 0.68) compared with the two measures alone ( r = 0.58-0.62). The areas under the ROC curve for the CS [0.6 * WC-SDS + 0.4 * BMI-SDS] ranged from 0.962 ± 0.0053 (overweight girls) to 0.982 ± 0.0046 (obese boys) and were somewhat greater than the AUCs for either BMI or WC alone. At a given specificity, the sensitivity of the prediction of overweight and obesity based on the CS was higher than that based on either WC or BMI alone, although the improvement was small. Conclusion: Both BMI and WC are good predictors of %BF in primary school children. However, a composite score incorporating both measures increased sensitivity at a constant specificity as compared to the individual measures. It may therefore be a useful tool for clinical and epidemiological studies of pediatric adiposity. [ABSTRACT FROM AUTHOR]

Objectives: Two distinct types of specific respiratory muscle training (RMT), i.e. respiratory muscle strength (resistive/threshold) and endurance (hyperpnoea) training, have been established to improve the endurance performance of healthy individuals. We performed a systematic review and meta-analysis in order to determine the factors that affect the change in endurance performance after RMT in healthy subjects. Data sources: A computerized search was performed without language restriction in MEDLINE, EMBASE and CINAHL and references of original studies and reviews were searched for further relevant studies. Review methods: RMT studies with healthy individuals assessing changes in endurance exercise performance by maximal tests (constant load, time trial, intermittent incremental, conventional [non-intermittent] incremental) were screened and abstracted by two independent investigators. A multiple linear regression model was used to identify effects of subjects' fitness, type of RMT (inspiratory or combined inspiratory/expiratory muscle strength training, respiratory muscle endurance training), type of exercise test, test duration and type of sport (rowing, running, swimming, cycling) on changes in performance after RMT. In addition, a meta-analysis was performed to determine the effect of RMT on endurance performance in those studies providing the necessary data. Results: The multiple linear regression analysis including 46 original studies revealed that less fit subjects benefit more from RMT than highly trained athletes (6.0% per 10 mL • kg-1 • min-1 decrease in maximal oxygen uptake, 95% confidence interval [CI] 1.8, 10.2%; p=0.005) and that improvements do not differ significantly between inspiratory muscle strength and respiratory muscle endurance training (p=0.208), while combined inspiratory and expiratory muscle strength training seems to be superior in improving performance, although based on only 6 studies (+ 12.8% compared with inspiratory muscle strength training, 95% CI 3.6, 22.0%; p=0.006). Furthermore, constant load tests (+16%, 95% CI 10.2, 22.9%) and intermittent incremental tests (+18.5%, 95% CI 10.8, 26.3%) detect changes in endurance performance better than conventional incremental tests (both p<0.001) with no difference between time trials and conventional incremental tests (p=0.286). With increasing test duration, improvements in performance are greater (+0.4% per minute test duration, 95% CI 0.1, 0.6%; p=0.011) and the type of sport does not influence the magnitude of improvements (all p>0.05). The metaanalysis, performed on eight controlled trials revealed a significant improvement in performance after RMT, which was detected by constant load tests, time trials and intermittent incremental tests, but not by conventional incremental tests. Conclusion: RMT improves endurance exercise performance in healthy individuals with greater improvements in less fit individuals and in sports of longer durations. The two most common types of RMT (inspiratory muscle strength and respiratory muscle endurance training) do not differ significantly in their effect, while combined inspiratory/expiratory strength training might be superior. Improvements are similar between different types of sports. Changes in performance can be detected by constant load tests, time trials and intermittent incremental tests only. Thus, all types of RMT can be used to improve exercise performance in healthy subjects but care must be taken regarding the test used to investigate the improvements. [ABSTRACT FROM AUTHOR]

Velo-cardio-facial syndrome (VCFS) is characterized by a high prevalence of depression and anxiety disorders in childhood and adolescence. These disorders are a source of great impairment in everyday functioning, as well as important risk factors for the emergence of later psychotic disorders. Impairment in daily and social functioning as well as loss of IQ throughout growth are also are well-established correlates of the VCFS. This study aimed to confirm the high prevalence of depression and anxiety disorders. The second objective was to ascertain the correlation between anxious and depressive symptoms and the decline in adaptive and cognitive functioning. A total of 73 children and adolescents with VCFS (mean age 11.9 years) underwent psychiatric evaluation. Subjects were further divided into four age groups: ages 6-9, 9-12, 12-15 and 15-18 years. Assessments measuring intelligence, anxious and depressive symptoms, and adaptation skills reported by parents were submitted to a subsample of 62 children (mean age 12.2 years); 62.2 % of the sample showed an anxiety disorder, specific phobia being the most represented at all ages. Lifetime depression concerned 27 % of the sample, peaking at age 12-15 years. Anxious and depressive symptoms and low IQ were significantly associated with low adaptive functioning. Anxiety and depression are common disorders in children and adolescents with VCFS and have a great impact on adaptive functioning. Clinicians should pay great attention to diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Patients with unknown stroke onset are generally excluded from acute recanalisation treatments. We designed a pilot study to assess feasibility of a trial of perfusion computed tomography (PCT)-guided thrombolysis in patients with ischemic tissue at risk of infarction and unknown stroke onset. Methods: Patients with a supratentorial stroke of unknown onset in the middle cerebral artery territory and significant volume of at-risk tissue on PCT were randomized to intravenous thrombolysis with alteplase (0.9 mg/kg) or placebo. Feasibility endpoints were randomization and blinded treatment of patients within 2 h after hospital arrival, and the correct application (estimation) of the perfusion imaging criteria. Results: At baseline, there was a trend towards older age [69.5 (57-78) vs. 49 (44-78) years] in the thrombolysis group ( n = 6) compared to placebo ( n = 6). Regarding feasibility, hospital arrival to treatment delay was above the allowed 2 h in three patients (25%). There were two protocol violations (17%) regarding PCT, both underestimating the predicted infarct in patients randomized in the placebo group. No symptomatic hemorrhage or death occurred during the first 7 days. Three of the four (75%) and one of the five (20%) patients were recanalized in the thrombolysis and placebo group respectively. The volume of non-infarcted at-risk tissue was 84 (44-206) cm in the treatment arm and 29 (8-105) cm in the placebo arm. Conclusions: This pilot study shows that a randomized PCT-guided thrombolysis trial in patients with stroke of unknown onset may be feasible if issues such as treatment delays and reliable identification of tissue at risk of infarction tissue are resolved. Safety and efficiency of such an approach need to be established. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the association of welfare state policies and the gendered organisation of intergenerational support (instrumental help and personal care) to older parents. The study distinguishes between support to older parents provided at least weekly, i.e. time-intensive and often burdening support, and supplemental sporadic support. Three policy instruments were expected to be associated with daughters' and sons' support or gender inequality in intergenerational support respectively: (1) professional social services, (2) cash-for-care payments and (3) legal obligations to provide or co-finance care for parents. The analyses based on the Survey of Health, Ageing and Retirement in Europe showed that daughters provided somewhat more sporadic and much more intensive support than sons throughout Europe. While about half of all children who sporadically supported a parent were men, this applied to only one out of four children who provided intensive support. Logistic multilevel models revealed that legal obligations were positively associated with daughters' likelihood of giving intensive support to parents but did not affect the likelihood of sons doing so. Legal obligations thus stimulate support in a gender-specific way. Both legal obligations and cash-for-care schemes were also accompanied by a more unequal distribution of involvement in intensive support at the expense of women. Social services, in contrast, were linked to a lower involvement of daughters in intensive support. In sum, the results suggest that welfare states can both preserve or reduce gender inequality in intergenerational support depending on specific arrangements. [ABSTRACT FROM AUTHOR]

Background: Telomere length has been considered in many cross-sectional studies as a biomarker of aging. However the association between shorter telomeres with lower survival at advanced ages remains a controversial issue. This association could reflect the impact of other health conditions than a direct biological effect. Objective: To test whether leukocyte telomere length is associated with 5-year survival beyond the impact of other risk factors of mortality like comorbidity, functional, nutritional and cognitive status. Design: Prospective study. Setting and participants: A population representative sample of 444 patients (mean age 85 years; 74% female) discharged from the acute geriatric hospital of Geneva University Hospitals (January-December 2004), since then 263 (59.2%) had died (December 2009). Measurements: Telomere length in leukocytes by flow cytometry. Results: In univariate model, telomere length at baseline and cognitive status were not significantly associated with mortality even when adjusting for age (R=9.5%) and gender (R=1.9%). The best prognostic predictor was the geriatric index of comorbidity (GIC) (R=8.8%; HR=3.85) followed by more dependence in instrumental (R=5.9%; HR=3.85) and based (R2=2.3%; HR=0.84) activities of daily living and lower albumin levels (R=1.5%; HR=0.97). Obesity (BMI>30: R=1.6%; HR=0.55) was significantly associated with a two-fold decrease in the risk of mortality compared to BMI between 20-25. When all independent variables were entered in a full multiple Cox regression model (R=21.4%), the GIC was the strongest risk predictor followed by the nutritional and functional variables. Conclusion: Neither telomeres length nor the presence of dementia are predictors of survival whereas the weight of multiple comorbidity conditions, nutritional and functional impairment are significantly associated with 5-year mortality in the oldest old. [ABSTRACT FROM AUTHOR]

Purpose: The hypothesis of this clinical study was to determine whether glucocorticoid use and immobility were associated with in-hospital nutritional risk. Methods: One hundred and one patients consecutively admitted to the medical wards were enrolled. Current medical conditions, symptoms, medical history, eating and drinking habits, diagnosis, laboratory findings, medications, and anthropometrics were recorded. The Nutrition Risk Score 2002 (NRS-2002) was used as a screening instrument to identify nutritional risk. Results: The results confirmed that glucocorticoid use and immobility are independently associated with nutritional risk determined by the NRS-2002. Constipation could be determined as an additional cofactor independently associated with nutritional risk. Conclusions: Glucocorticoid treatment, immobility, and constipation are associated with nutritional risk in a mixed hospitalized population. The presence of long-time glucocorticoid use, immobility, or constipation should alert the clinician to check for nutritional status, which is an important factor in mortality and morbidity. [ABSTRACT FROM AUTHOR]