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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]

Respiratory diseases are associated with increased cardiovascular risk in adults, but little is known on the early impact on the vasculature in youth. The SAPALDIA Youth study, the offspring study of the Swiss Study on Air Pollution and Lung and Heart Disease In Adults (SAPALDIA), investigated the association between physician-diagnosed asthma status and common carotid artery intima media thickness (CIMT). Offspring underwent standardized clinical protocols and provided information on early life factors, health, and lifestyle. The association between per subject averages of CIMT and asthma was estimated using mixed linear regression analyses adjusting for main confounders, testing for interaction with gender and age. Of 257 offspring (mean age 15 years, 53% female), 11.5% reported doctor-diagnosed asthma (male 17%, female 7%). Mean CIMT was significantly different by gender (male 0.53 mm (± 0.045), female 0.50 mm (± 0.048); p < 0.001). Interaction was highly significant by gender (p = 0.001) with significantly increased CIMT in asthmatic vs. non-asthmatics boys (difference 0.023 mm, 95% CI 0.003; 0.043), as compared to girls.Conclusion: Our study suggests an increased risk for early vascular change in adolescent asthmatic boys. Whereas the small number of girls limits the interpretation, the result necessitates further research into sex-specific atherosclerotic burden related to respiratory health in adolescence. What is Known: • Evidence points to a significant impact of adult respiratory disease on cardiovascular health indicators as well as on endpoints. • Inflammation is a key pathway in vascular change across the life course. What is New: • We observe an adverse association between physician-diagnosed asthma and carotid intima media thickness in adolescent boys. • Albeit a limited number of asthmatic girls, we hypothesize the gender typical timing of asthma or a higher male cardiovascular vulnerability as possible explanations for the gender-specific results. [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]

Purpose: Given the broad range of biopsychosocial difficulties resulting from major depressive disorder (MDD), reliable evidence for predictors of improved mental health is essential, particularly from unbiased prospective community samples. Consequently, a broad spectrum of potential clinical and non-clinical predictors of improved mental health, defined as an absence of current major depressive episode (MDE) at follow-up, were examined over a 5-year period in an adult community sample.Methods: The longitudinal population-based PsyCoLaus study from the city of Lausanne, Switzerland, was used. Subjects having a lifetime MDD with a current MDE at baseline assessment were selected, resulting in a subsample of 210 subjects. Logistic regressions were applied to the data.Results: Coping styles were the most important predictive factors in the present study. More specifically, low emotion-oriented coping and informal help-seeking behaviour at baseline were associated with the absence of an MDD diagnosis at follow-up. Surprisingly, neither formal help-seeking behaviour, nor psychopharmacological treatment, nor childhood adversities, nor depression subtypes turned out to be relevant predictors in the current study.Conclusions: The paramount role of coping styles as predictors of improvement in depression found in the present study might be a valuable target for resource-oriented therapeutic models. On the one hand, the positive impact of low emotion-oriented coping highlights the utility of clinical interventions interrupting excessive mental ruminations during MDE. On the other hand, the importance of informal social networks raises questions regarding how to enlarge the personal network of affected subjects and on how to best support informal caregivers. [ABSTRACT FROM AUTHOR]

Purpose Unintentional injuries occur frequently and many of the accident survivors suffer from temporary or permanent disabilities. Although most accident victims recover quickly, a significant fraction of them shows a complicated recovery process and accounts for the majority of disability costs. Thus, early identification of vulnerable persons may be beneficial for compensation schemes, government bodies, as well as for the worker themselves. Here we present the Work and Health Questionnaire (WHQ), a screening tool that is already implemented in the case management process of the Swiss Accident Insurance Fund (Suva). Moreover, we demonstrate its prognostic value for identifying workers at risk of a complicated recovery process. Methods A total of 1963 injured workers answered the WHQ within the first 3 months after their accident. All of them had minor to moderate accidental injuries; severely injured workers were excluded from the analyses. The anonymized individual-level data were extracted from insurance databases. We examined construct validity by factorial analyses, and prognostic validity by hierarchical multiple regression analyses on days of work disability. Further, we evaluated well-being and job satisfaction 18 months post-injury in a subsample of 192 injured workers (9.8 %) Results Factor analyses supported five underlying factors ( Job Design, Work Support, Job Strain, Somatic Condition/Pain, and Anxiety/Worries). These subscales were moderately correlated, thus indicating that different subscales measured different aspects of work and health-related risk factors of injured workers. Item analysis and reliability analysis showed accurate psychometric properties. Each subscale was predictive at least for one of the evaluated outcomes 18 months post-injury. Conclusion The WHQ shows good psychometric qualities with high clinical utility to identify injured persons with multiple psychosocial risk factors. Thus, the questionnaire appears to be suitable for exploring different rehabilitation needs among minor to moderate injured workers. [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: To characterize the dietary intake of subjects aged 40-80 years according to self-reported diabetes and presence of an anti-diabetic diet. Methods: Cross-sectional study conducted between 2009 and 2012 on 4289 participants (2274 women) living in Lausanne. Results: Of the 299 (7 %) participants with self-reported diabetes, only 151 (51 %) reported an anti-diabetic diet. Compared to participants not reporting diabetes, participants with self-reported diabetes (with or without a diet) had a higher consumption of artificial sweeteners (0.3 ± 0.7 vs. 0.4 ± 0.8 and 0.8 ± 1.0 times/day) and a lower consumption of honey/jam (mean ± standard deviation: 0.5 ± 0.5 vs. 0.4 ± 0.4 and 0.4 ± 0.4 times/day) or sugar (0.6 ± 0.9 vs. 0.4 ± 0.7 and 0.2 ± 0.5 times/day) for participants not reporting diabetes, participants with self-reported diabetes not on a diet and on a diet, respectively. Compared to participants not on a diet, participants on a diet had a higher consumption of vegetables (1.8 ± 1.3 vs. 1.4 ± 1.0 portions/day), while no differences were found regarding all other food groups and nutrients. Participants with self-reported diabetes on a diet had a higher consumption of meat (5.6 ± 3.6 vs. 4.8 ± 2.9 portions/week) and a lower consumption of simple carbohydrates (21.0 ± 7.9 vs. 23.5 ± 8.4 % total energy intake) than participants not reporting diabetes. Conclusion: People with diabetes eat less simple carbohydrates, but do not comply with current advice on fish, nuts, fruits and vegetables. Improvement of the dietary intake in persons with diabetes in Switzerland is needed. [ABSTRACT FROM AUTHOR]

The article discusses two intensive longitudinal studies on the daily variations in health behaviors (HB) and daily functioning of young adults. Topics mentioned include the association between day-to-day HB and academic performance, the effects of sleep quality and physical activity on learning goal achievement via affect, and the correlation between self-report measurements of HB and behavioral measurements.

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]

Little is known about the natural course of depressive symptoms and associated features throughout pregnancy. We examined the course of some psychological and somatic symptoms in each month of pregnancy in a normative sample. A consecutive, unselected sample of women ( N = 374) were interviewed retrospectively at 6 weeks postpartum with the Structured Clinical Interview (DSM-IV). Women were asked whether they had experienced each symptom at any time during pregnancy and the occurrence of the symptom for each month of pregnancy. Associated symptoms of depression showed complex changes across pregnancy. Depressed mood ( F(df) = 5.15(1); p = 0.02) showed a quadratic pattern with elevations at the beginning and end of pregnancy. Both linear increases () and quadratic () changes over time were observed for sensitivity to criticism ( F (df) = 20.9(1), p = 0.00; F (df) = 7.02(1), p = 0.00), lack of concentration ( F (df) = 37.0(1), p = 0.00; F (df) = 10.3(1); p = 0.00), decreased energy ( F (df) = 13.4(1); p = 0.00; F (df) = 62.6(1); p = 0.00) and feelings of heavy limbs ( F (df) = 92.9(1); p = 0.00; F (df) = 67.7(1); p = 0.00). Only guilt ( F(df) = 0.00(1); p = 0.93) showed no significant change over pregnancy. Psychological symptoms changed throughout pregnancy as much as somatic symptoms. A linear increase was found for most symptoms, but significant non-linear changes were also found. The discrepancy between the patterns of depressed mood and most somatic and psychological symptoms suggest complex interactions and potentially important implications for assessment and monitoring treatment. [ABSTRACT FROM AUTHOR]

Background: The European Randomised Study of Prostate Cancer Screening has shown a 21% relative reduction in prostate cancer mortality at 13 years. The causes of death can be misattributed, particularly in elderly men with multiple comorbidities, and therefore accurate assessment of the underlying cause of death is crucial for valid results. To address potential unreliability of end-point assessment, and its possible impact on mortality results, we analysed the study outcome adjudication data in six countries.Methods: Latent class statistical models were formulated to compare the accuracy of individual adjudicators, and to assess whether accuracy differed between the trial arms. We used the model to assess whether correcting for adjudication inaccuracies might modify the study results.Results: There was some heterogeneity in adjudication accuracy of causes of death, but no consistent differential accuracy by trial arm. Correcting the estimated screening effect for misclassification did not alter the estimated mortality effect of screening.Conclusions: Our findings were consistent with earlier reports on the European screening trial. Observer variation, while demonstrably present, is unlikely to have materially biased the main study results. A bias in assigning causes of death that might have explained the mortality reduction by screening can be effectively ruled out. [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]

This article reports on what is at work during individual supervision of medical students in the context of teaching breaking bad news (BBN). Surprisingly, there is a relative lack of research and report on the topic of supervision, even though it is regularly used in medical training. Building on our research and teaching experience on BBN at the undergraduate level, as well as interviews of supervisors, the following key elements have been identified: learning objectives (e.g., raising student awareness of structural elements of the interview, emotion (patients and students) handling), pedagogical approach (being centered on student's needs and supportive to promote already existing competences), essentials (e.g., discussing skills and examples from the clinical practice), and enhancing reflexivity while discussing specific issues (e.g., confusion between the needs of the patient and those of the student). Individual supervision has been identified as crucial and most satisfactory by students to provide guidance and to foster a reflexive stance enabling them to critically apprehend their communication style. Ultimately, the challenge is to teach medical students to not only connect with the patient but also with themselves. [ABSTRACT FROM AUTHOR]

Background: Anemia and malnutrition are highly prevalent, frequently concomitant and associated with negative outcomes and mortality in the elderly. Objectives: To evaluate the association between these two entities, and test the hypothesis that protein-energy deficit could be etiology of anemia. Design: Prospective case-control study. Setting: Geriatric and Rehabilitation Hospital, Geneva University Hospitals, Switzerland. Participants: 392 patients (mean age 84.8 years old, 68.6% female). Main outcome measures: Hematological (hemoglobin (Hb)), chemical (iron work up, cyanocobalamin, folates, renal function, C-Reactive Protein (CRP)) and nutrition (albumin, prealbumin) parameters, and mini nutritional assessment short form (MNA-SF). Results: The prevalence of anemia (defined as Hb<120 g/l) was 39.3%. Anemic patients were more frequently malnourished or at risk of malnutrition according to the MNA-SF (p=0.047), with lower serum albumin (p <0.001) and prealbumin (p <0.001) levels. Thirty-eight percent of these patients had multiple causes and 14.3% had no cause found for anemia. Among the latter 90.9% of patients with unexplained anemia had albumin levels lower than 35g/l. After exclusion of iron,vitamin B12 and folic acid deficits, anemic patients had lower albumin (p<0.001) and prealbumin (p 0.007) levels. Albumin level explained 84.5% of the variance in anemia. In multivariate analysis albumin levels remain associated with Hb only in anemic patients, explaining 6.4% of Hb variance (adj R2) and 14.7% (adj R2) after excluding inflammatory parameters (CRP>10). Conclusions: Albumin levels are strongly associated with anemia in the elderly. Screening for undernutrition should be included in anemia assessment in those patients. Further prospective studies are warranted in order to explore the effect of protein and energy supplementation on hemoglobin level. [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]

Coparenting refers to the support parents bring to each other when rearing a child. Supportive coparenting ensures cohesiveness of the family, which is linked with child outcomes. Little is known, however, about the coparental relationship in stepfamilies between the custodial parent, usually the mother, and the new partner, and how it compares to coparenting with the father. This study addressed mother-reported coparenting in stepfamilies and also compared it with that in first-marriage families. Three dimensions of coparenting were considered: family integrity, disparagement, and conflict. Mothers ( N = 300) completed questionnaires on their coparenting relationship with the father and with the partner, marital satisfaction, and attachment. Half the mothers were living in a stepfamily with a child between 5 and 13 years old from a previous marriage, and half in a first-marriage family. The main results show that (a) mothers promote family integrity in stepfamilies either with the partner, or with the father, but not with both; (b) the older the child, the less the mothers reported integrity with the father in both families, and the more they reported disparagement against the partner and conflict with the partner in stepfamilies; and (c) maternal marital satisfaction is linked with all dimensions of coparenting with the father in first-marriage families, but only with disparagement against the partner and conflict with the partner in stepfamilies. Overall, coparenting has similar characteristics in both types of families, but also presents differences that should be considered when working with parents who are committed to a new relationship. [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]

Purpose To extensively analyze the measurement properties the Spinal Function Sort (SFS) in patients with sub-acute whiplash-associated disorders (WAD). Methods Three-hundred-two patients with WAD were recruited from an outpatient work rehabilitation center. Internal consistency was assessed by Cronbach's α. Construct validity was tested based on eight a priori hypotheses. Structural validity was measured with principal component analysis (PCA). Test-retest reliability and agreement was evaluated in a sub sample (n = 32) using intraclass correlation coefficient (ICC) and limits of agreement (LoA). The predictive validity of SFS for future work status at 1, 3, 6, and 12 months follow-up was determined by area under the curve (AUC) of receiver operating characteristics. Non-return to work (N-RTW) was defined with two cut-off points: workcapacity <50 and <100 %. Results N-RTW decreased from 50 %, 1 month follow-up, to 14 %, 12 months follow-up. Cronbach's α was 0.98, PCA revealed evidence for unidimensionality. ICC was 0.86, LoA was ±33 points. Seven out of eight hypotheses for construct validity were not rejected. AUC reduced with a longer follow-up from 0.71 for 1 month to 0.61 at 12 months, for cut-off point <50 %. For cut-off point <100 % these values were 0.71 and 0.59. Conclusion In patients with sub-acute WAD test-retest reliability, internal consistency, construct- and structural validity of the SFS were adequate. LoA were substantial. Sensitivity to accurately predict N-RTW was poor. The predictive validity of the SFS for N-RTW of patients with sub-acute WAD from an outpatient work rehabilitation setting was only sufficient for the short term (1 month). [ABSTRACT FROM AUTHOR]

Phosphatidylserine (PS) and other anionic phospholipids, which become exposed on the surface of proliferating endothelial cells, tumor cells and certain leukocytes, have been used as targets for the development of clinical-stage biopharmaceuticals. One of these products (bavituximab) is currently being investigated in Phase 3 clinical trials. There are conflicting reports on the ability of bavituximab and other antibodies to recognize PS directly or through beta-2 glycoprotein 1, a serum protein that is not highly conserved across species. Here, we report on the generation and characterization of two fully human antibodies directed against phosphatidylserine. One of these antibodies (PS72) bound specifically to phosphatidylserine and to phosphatidic acid, but did not recognize other closely related phospholipids, while the other antibody (PS41) also bound to cardiolipin. Both PS72 and PS41 stained 8/9 experimental tumor models in vitro, but both antibodies failed to exhibit a preferential tumor accumulation in vivo, as revealed by quantitative biodistribution analysis. Our findings indicate that anionic phospholipids are exposed and accessible in most tumor types, but cast doubts about the possibility of efficiently targeting tumors in vivo with PS-specific reagents. [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]

Working memory (WM) and intraindividual variability (IIV) in processing speed are both hypothesized to reflect general attentional processes. In the present study, we aimed at exploring the relationship between WM capacity and IIV in reaction times (RTs) and its possible variation with development across the lifespan. Two WM tasks and six RT tasks of varying complexity were analyzed in a sample of 539 participants, consisting of five age groups: two groups of children (9-10 and 11-12 years of age), one group of young adults, and two groups of older adults (59-69 and 70-89 years of age). Two approaches were adopted. First, low-span and high-span individuals were identified, and analyses of variance were conducted comparing these two groups within each age group and for each RT task. The results consistently showed a span effect in the youngest children and oldest adults: High-span individuals were significantly faster and less variable than low-span individuals. In contrast, in young adults no difference was observed between high- and low-span individuals, whether in terms of their means or IIV. Second, multivariate analyses were conducted on the entire set of tasks, to determine whether IIV in RTs brought different information than the mean RT. The results showed that, although very strongly correlated, the mean and IIV in speed should be kept separate in terms of how they account for individual differences in WM. Overall, our results support the assumption of a link between WM capacity and IIV in RT, more strongly so in childhood and older adulthood. [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]

Study design:This is a retrospective analysis.Objectives:The objective of this study was to describe and quantify the discrepancy in the classification of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) by clinicians versus a validated computational algorithm.Settings:European Multicenter Study on Human Spinal Cord Injury (EMSCI).Methods:Fully documented ISNCSCI data sets from EMSCI's first years (2003-2005) classified by clinicians (mostly spinal cord medicine residents, who received in-house ISNCSCI training by senior SCI physicians) were computationally reclassified. Any differences in the scoring of sensory and motor levels, American Spinal Injury Association Impairment Scale (AIS) or the zone of partial preservation (ZPP) were quantified.Results:Four hundred and twenty ISNCSCI data sets were evaluated. The lowest agreement was found in motor levels (right: 62.1%, P=0.002; left: 61.8%, P=0.003), followed by motor ZPP (right: 81.6%, P=0.74; left 80.0%, P=0.27) and then AIS (83.4%, P=0.001). Sensory levels and sensory ZPP showed the best concordance (right sensory level: 90.8%, P=0.66; left sensory level: 90.0%, P=0.30; right sensory ZPP: 91.0%, P=0.18; left sensory ZPP: 92.2%, P=0.03). AIS B was most often misinterpreted as AIS C and vice versa (AIS B as C: 29.4% and AIS C as B: 38.6%).Conclusion:Most difficult classification tasks were the correct determination of motor levels and the differentiation between AIS B and AIS C/D. These issues should be addressed in upcoming ISNCSCI revisions. Training is strongly recommended to improve classification skills for clinical practice, as well as for clinical investigators conducting spinal cord studies.Sponsorship:This study is partially funded by the International Foundation for Research in Paraplegia, Zurich, Switzerland. [ABSTRACT FROM AUTHOR]

Purpose: This is a first-in-human, phase I, dose-escalation study to determine the maximum tolerated dose (MTD) of intravenous, flat-dosed ST-1968 (namitecan), a new hydrophilic camptothecan derivative. Methods: Namitecan was administered intravenously over 2 h on day 1 and day 8 every 21 days (D1-D8-Q21D), starting at a flat dose of 2.5 mg, and increased according to a 3 + 3 cohort design. Due to frequent skipping of day 8 dosing for cytopenias, the study was expanded to test namitecan dosing on day 1 every 21 days (D1-Q21) at a starting dose of 17.5 mg. Major dose-limiting toxicity (DLT) was defined as grade (G) 4 neutropenia persisting >5 days, febrile neutropenia, G3 thrombocytopenia or G2 non-hematological toxicity. Results: Thirty-four patients were included into the D1-D8-Q21D group (2.5, 5, 10, 15, 17.5, 20 mg dosing cohorts), 29 patients into the D1-21D group (17.5, 20, 23, 27, 30 mg dosing cohorts). Neutropenia was the DLT in both groups, with 15 mg being defined as the recommended dose (RD) for the D1-D8-Q21D group, and 23 mg for the D1-Q21D group. Non-hematological toxicity was negligible. One patient with endometrial cancer in the D1-D8-Q21D group and one patient with cholangiocellular carcinoma in the D1-Q21D group experienced a partial remission. Namitecan exhibited fully dose-proportional pharmacokinetics. Conclusions: This study demonstrates clinical safety, favourable pharmacokinetics and preliminary antitumor activity of the novel hydrophilic camptothecin analogue namitecan in patients with heavily pretreated solid malignancies, when given either on a 2 out of 3 weeks or 3-weekly regimen. [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]

Aim of the study The tumor metastases targeting ruthenium complex NAMI-A synergistically improves the activity of gemcitabine in combination therapies. High-throughput screening was used to identify other potential drug combinations from a library of FDA approved drugs. Doxorubicin was identified as a hit compound and was therefore evaluated in combination with NAMI-A in vitro and in a preclinical in vivo model. Results High-throughput screening identified eight structurally diverse compounds that synergize with NAMI-A including doxorubicin. The combination index on MCF-7 cells showed synergism as the concentration of NAMI-A increases independent of the doxorubicin concentration. In MCa mammary carcinoma of CBA mice, NAMI-A (35 mg/kg/day i.p. on days 7-12) followed by doxorubicin (10 mg/kg i.p. on day 16), significantly increased the effects of the individual drugs on metastases with 70 % animals resulting free of macroscopically detectable tumor nodules in the lungs at sacrifice. NAMI-A, unlike doxorubicin, cured 60 % of the treated mice but the combination therapy was toxic to the animals. Conclusions The combined therapy of NAMI-A with doxorubicin synergizes on lung metastasis in a preclinical mouse model. The combination therapy at the maximum tolerated doses of the two drugs is toxic. Hence, this combination is not suitable for clinical studies using maximum tolerated doses. [ABSTRACT FROM AUTHOR]

Objectives: To describe associations and co-occurrence of nutrition and substance use in Swiss residents with spinal cord injury (SCI) and to compare prevalence with a matched general population sample. Methods: Analysis of cross-sectional data ( n = 511) from the Swiss SCI community survey (SwiSCI) including Swiss residents with SCI aged over 16. Regression models were computed to assess associations of age, sex, socioeconomic position, social support, and self-efficacy with nutrition (liquid, fruit, vegetable, and meat intake), smoking, alcohol and cannabis consumption. Co-occurrence was evaluated by residual correlations of multivariable models. Results: Age differences in smoking, alcohol and cannabis consumption, and sex differences in nutrition and alcohol consumptionwere identified. Socioeconomic position, social support and self-efficacy were not associated with nutrition and substance use. Poor nutrition was related to higher alcohol consumption and most substance use behaviors co-occurred. Compared to the general population, persons with SCI reported higher liquid and cannabis intake but lower alcohol and meat consumption. Conclusion: In this population with severe disability, age and sex differences in nutrition and substance use should be considered in health intervention planning. [ABSTRACT FROM AUTHOR]

Summary: In this double-blind RCT, 4-month treatment with calcifediol compared with vitamin D improved gait speed by 18 % among young postmenopausal women. Consistently, change in 25(OH)D blood levels over time were significantly correlated with improvement in gait speed in these women. No effect could be demonstrated for trunk sway. Introduction: The aim of this study is to test the effect of calcifediol compared with vitamin D on gait speed and trunk sway. Methods: Twenty healthy postmenopausal women with an average 25(OH)D level of 13.2 ng/ml (SD = ±3.9) and a mean age of 61.5 years (SD = ±7.2) were randomized to either 20 μg of calcifediol or 20 μg (800 IU) of vitamin D per day in a double-blind manner. At baseline and at 4 months of follow-up, the same physiotherapist blinded to treatment allocation tested 8-m gait speed and a body sway test battery (Sway star pitch and roll angle plus velocity while walking 8 m, and standing on both legs on a hard and soft surface). All analyses adjusted for baseline measurement, age, and body mass index. Results: Mean 25(OH)D levels increased to 69.3 ng/ml (SD = ±9.5) in the calcifediol group and to 30.5 ng/ml (SD = ±5.0) in the vitamin D group ( p < 0.0001). Women receiving calcifediol compared with vitamin D had an 18 % greater improvement in gait speed at 4-month follow-up ( p = 0.046) adjusting for baseline gait speed, age, and body mass index. Also, change in gait speed was significantly correlated with change in serum 25(OH)D concentrations ( r = 0.5; p = 0.04). Across three tests of trunk sway, there were no consistent differences between groups and no significant correlation between change in 25(OH)D serum concentrations and change in trunk sway. Conclusions: Calcifediol improved gait speed in early postmenopausal women compared with vitamin D and change in 25(OH)D level was moderately correlated with improvement in gait speed. A benefit on trunk sway could not be demonstrated. [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]

This study explored, in a community sample of mothers of toddlers, parenting beliefs and values, to gain insight into the parent-child relationship. Acceptance of specific discipline techniques (DTs), and their actual use in daily life were examined. A mixed-methods approach comprising three different methods was used: (1) parenting beliefs and values were explored with Q-methodology; (2) acceptance of the DTs was assessed with the questionnaire Dimensions of Discipline Inventory; and (3) actual use of those DTs in daily-life incidents of discipline was documented using ecological momentary assessment for ten consecutive days. The results showed the mothers' parenting beliefs and values reflected a warm parent-child relationship. The mothers rated explaining rules, timeout, removal of privileges, and social reinforcement as moderately to highly acceptable. However, planned ignoring received a low acceptance rating. Mothers' high acceptability ratings of the DTs contrasted with moderate use when they were faced with their misbehaving child, with the exception of explaining rules, which was always manifested. Yelling and spanking received the lowest acceptance ratings. Nonetheless, in daily life, yelling was employed as often as timeout. These findings suggest the need for more attention to be paid to both acceptance and daily use of specific DTs in order to highlight DTs which parents may have difficulty implementing. [ABSTRACT FROM AUTHOR]

Ensuring confidentiality is the cornerstone of trust within the doctor-patient relationship. However, health care providers have an obligation to serve not only their patient's interests but also those of potential victims and society, resulting in circumstances where confidentiality must be breached. This article describes the attitudes of mental health professionals (MHPs) when patients disclose past crimes unknown to the justice system. Twenty-four MHPs working in Swiss prisons were interviewed. They shared their experiences concerning confidentiality practices and attitudes towards breaching confidentiality in prison. Qualitative analysis revealed that MHPs study different factors before deciding whether a past crime should be disclosed, including: (1) the type of therapy the prisoner-patient was seeking (i.e., whether it was court-ordered or voluntary), (2) the type of crime that is revealed (e.g., a serious crime, a crime of a similar nature to the original crime, or a minor crime), and (3) the danger posed by the prisoner-patient. Based on this study's findings, risk assessment of dangerousness was one of the most important factors determining disclosures of past crimes, taking into consideration both the type of therapy and the crime involved. Attitudes of MHPs varied with regard to confidentiality rules and when to breach confidentiality, and there was thus a lack of consensus as to when and whether past crimes should be reported. Hence, legal and ethical requirements concerning confidentiality breaches must be made clear and known to physicians in order to guide them with difficult cases. [ABSTRACT FROM AUTHOR]

Prisoners sometimes die in prison, either due to natural illness, violence, suicide, or a result of imprisonment. The purpose of this study is to understand deaths in custody using qualitative methodology and to argue for a comprehensive definition of death in custody that acknowledges deaths related to the prison environment. Interviews were conducted with 33 experts, who primarily work as lawyers or forensic doctors with national and/or international organisations. Responses were coded and analysed qualitatively. Defining deaths in custody according to the place of death was deemed problematic. Experts favoured a dynamic approach emphasising the link between the detention environment and occurrence of death rather than the actual place of death. Causes of deaths and different patterns of deaths were discussed, indicating that many of these deaths are preventable. Lack of an internationally recognised standard definition of death in custody is a major concern. Key aspects such as place, time, and causes of death as well as relation to the prison environment should be debated and incorporated into the definition. Systematic identification of violence within prison institutions is critical and efforts are needed to prevent unnecessary deaths in prison and to protect vulnerable prisoners. [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]

The article discusses research being done on acute myocardial infarction (AMI). It references the study "Utility of Absolute and Relative Changes in Cardiac Troponin Concentrations in the Early Diagnosis of Acute Myocardial Infarction," by T. Rachlin et al. in the 2011 issue of "Circulation." The variables used include the use of ultrasensitive assays in the detection of cardiac troponin (cTn), the measurement of the area under the curve (AUC), and acute coronary syndrome (ACS).

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]

This study employs the concept of structured ambivalence to analyse the effect of grandchild care on quality of life (QoL) in different cultural contexts. We define structured ambivalence as the contradiction between behaviour and cultural norms. The analysis is based on the Survey of Health, Ageing and Retirement in Europe with 14 countries in the sample. We focus on grandparents aged 50 and over with at least one grandchild 12 years old or younger ( n = 12,740). In countries with high grandparent obligations, grandparents who did not look after their grandchildren reported a lower quality of life. Compliance with such grandparental obligations (e.g. providing grandchild care in a country with high grandparent obligations) was found to increase the QoL of grandparents. Family policy should consider family practices that better match the realities of current grandparents' lives in order to reduce structured ambivalence and increase the QoL of grandparents. [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]