Search

Now as in the past, tobacco consumption is a major health problem in Switzerland. Efforts to reduce tobacco consumption include different preventive strategies. Although dispensary pharmacists have increased their efforts in health promotion and prevention in recent years, their role in tobacco prevention has not been documented so far. The "Tobacco Adieu!" campaign to support smoking cessation was introduced in pharmacies as a low threshold offer in Basle in 1996. This paper assesses the process and the effect of this effort. Participating pharmacies were interviewed during the evaluation and all consultations in this area were recorded in questionnaires. Customers requesting counselling from pharmacies during the campaign were also asked to fill in a questionnaire regarding their smoking behaviour and their experiences in the pharmacy. The offer was well accepted by the public: During the four week period, about 2,000 client contacts for smoking cessation took place in the 63 participating pharmacies. Compared to the pre-campaign situation, more intensive counselling took place. Clients who received counselling in the pharmacies generally attested to its good quality. In addition to counselling, further care during the smoking cessation phase was offered to clients who wanted to quit smoking. Follow-up visits were agreed in 76 percent of the cases. The project shows that smokers can be motivated to consider cessation and supported in the process by pharmacists. Therefore, pharmacies can be used as a low threshold offer in this context. Expansion of this programme in public pharmacies seems justified. However, continuing education and a motivated team are the prerequisites for successful counselling of smokers in pharmacies.

The paper examines the influence of social networks on social support and social stress and analyses the impact of social support and stress on health. 171 (t1, 1992) and 135 (t2, 1993) persons aged 75 and older in need of a little help but still living on their own were personally interviewed in three districts of the city of Zurich. The results demonstrate that social networks are important for mobilizing social support and that these mobilizing processes are characterized by sex differences: The family (i.e. the partner) is much more important for men than for women who rely both on family and non-family social networks. There are only weak relationships between social networks and social stress. Social support affects health positively by indirect mechanisms. From t1 to t2 social networks, social support and health remain rather constant while social stress changes substantially.

This paper is based on data from the first Swiss Health Survey, but deals with a more general problem; the estimation of age of onset in illegal substance consumption. First, it is shown that taking the arithmetic mean for different age-groups as estimator leads to an underestimation of age of onset in the younger groups. Consequently, an alternative method is proposed based on survival models with right censoring. The prediction of age of onset is modeled with nonlinear functions. Results show for cannabis consumption in Switzerland that age of onset did not decrease notably during the past decade.

Studies on occupational risk factors for cancer are frequently carried out without information on smoking habits. However, the proportion of smokers may vary considerably across occupational groups. Thus it is unclear, whether an observed increased cancer risk in an occupational group is at least partly the result of a higher proportion of smokers in that group. The paper demonstrates the possible extent of such confounding by using hypothetical and empirical examples of studies concerning the lung cancer and bladder cancer risk in painters. A formula for the indirect control of such confounding is applied. Relative risks greater than 1.2 for bladder cancer and 1.3 for lung cancer should thus not be considered solely the result of confounding. The degree of confounding is less than generally assumed. However, the evaluation of this degree remains questionable in case of an interaction between smoking and occupational exposure.

Cost expansion in health care has been an issue of health policy for almost 20 years. Also after the health reform act of 1988 this has not changed remarkably. On the one side this may be due to pressure groups that block effective cost constraining politics. On the other side, however, scientific approaches are insufficient in explaining this phenomenon. Models of health economics often assume a one-sided cost/benefit-rationality of the health care sector. Also sociological attempts that emphasize the "Eigen"-rationality of the health system frequently cut short the problem for instance as "Selbsthypostasierierung". This paper deals with the question to what extent can cost expansion be regarded as a product of societal context conditions. Using risk-theoretical and systems-theoretical approaches it is shown that the interaction of separated subsystems builds up a growing risk potential that comes out among other things as cost expansion. This includes the risk of crashes of the social structure which might result in the loss of generally equal access to health care.

The research project "Towards a Swiss Health Survey" (Swiss National Science Foundation grant No. 4.350.0.79.08) aims at contributing to the development, testing and critical evaluation of new ambulatory care data systems. Specifically, the research project attempts 1) to develop reliable and valid health and use indicators, 2) to present representative data on perceived morbidity of the Swiss population, and 3) to analyse the demand for health and health services using epidemiological, econometric and sociological methods. In Phase I of the study plan, representative samples of the populations within the three language groups (German, French, Italian) and one group of foreign immigrants (Italians) will be interviewed. In phase II, subgroups of special interest defined after the analysis of Phase I will be investigated in more detail. The present paper discusses the problems both of content and method inherent in such a health survey.

This paper presents a simple way of calculating the (approximate) power of a test based on the SMR. By means of an example, the use of this quantity, both for planning a study and for analysis is illustrated. Postulating an effect of a given magnitude on mortality, one can calculate the chances of success of a planned study. After data collection, one can, in the case of a nonsignificant result, at least give an upper limit to the effect: larger effects would likely have produced a significant result.

Knowledge about blood pressure and practice in terms of its measurement are two important indicators for problem areas in cardiovascular disease prevention. This paper analyses these two indicators based on a representative Health Survey (SOMIPOPS) in order to illustrate the potential of such surveys. The results demonstrate that interesting clues to preventive action can indeed be obtained. In addition, time series analyses could potentially be a basis for the continuous evaluation of health services in this area.

Intervention tricals can principally be classified into community or clinically oriented designs. The clinical approach of the randomized controlled trial (RCT) implies the individual randomization of a volunteer population into a study and a control group. In community-oriented trials, however, the study and control group are not composed of individuals, but rather of total population groups (e.g. communities, factories). The paper gives first an overview over the historial development of epidemiological methods as the basis for both study types. Shortcomings and advantages both of RCT's and of community trials are discussed, using the examples of the "diet-heart" hypothesis and of the National Research Program 1A design, respectively. The two study types uses as primary endpoints for the analysis changes in risk factor distribution, morbidity and/or mortality. A recent alternative is presented, too: advances in angiography allow direct measurements of changes in vessels with atherosclerotic disease. The different study types available complement one another in trying to understand the mechanisms involved in disease of multifactorial origin.

In this paper some initial results of a study of self-treatment in case of light illness are reported. The average number of reported measures taken is 3,5 in general infections and infections of the respiratory tract, 2,6 in digestive disorders, and 2,5 in disorders of the musculo-skeletal system. In all three groups of disorders, the most frequent single measures was bed rest, the second most frequent was measuring body temperature in the first diagnostic group, drinking tea in the second, and massage in the third. In the first diagnostic group, an average of 2,2 pharmacologic agents are taken, in the second 1,1, and in the third 1,3. Analgesic drugs play an important role in all three groups, pointing to the primordial role of pain relief in self-medication. 84,5% of the interviewed sample indicate use of folk medicines. 90% of the applied drugs come from the stock of the home pharmacy.

This paper concerns a proposal in an area of increasing importance to social psychiatry: improving personnel training. A survey in 1980 of old age and nursing homes in the psychiatric region of the Zurich Oberland showed that a quarter of the residents suffer from psychiatric disturbances. As only 12% of the personnel have completed any nursing training, the signs of overwork and the changes in personnel are many. Therefore we have developed 2 successful methods for personnel improvement: A) Patient-centered, ongoing training sessions, and B) Periodic intensive seminars. The goal of both is to increase the professional competence of those working in these homes; to give them skills and confidence to deal with sometimes difficult patients, and to increase the likelihood of their "job loyalty". The evaluation shows a trend that such an approach helps to achieve these goals, to avoid unnecessary psychiatric hospitalizations as well as reduces the turnover of personnel.

In order to participate in the production of new ideas for local health campaigns, regular sessions are held with members of the health committee and the project team. These brain-storming sessions are based on problem lists using data of the initial health examination and the experience with health education campaigns accumulated so far in the program. The ideas are operationalized into concepts for health education campaigns: for each campaign, goals have to be stated clearly (attitudinal, behavioral goals), target groups have to be identified, the arguments and the type of media have to be specified and the costs calculated. This paper presents four examples of health education campaigns within the local intervention program in Aarau. For each of the two risk factors "nutrition" and "physical activity", a mass media campaign and a group-oriented campaign is discussed (nutrition: a campaign including fifteen restaurants to promote healthy alternatives to regular menus, groups to lose weight. Physical activity: "the walk around the world", jogging groups). It is concluded that, based on a community intervention model, health education campaigns are feasible and have the potential to reach a large fraction of the population.

This paper deals with the changes in medical research due to new methodologies and technologies. The author shows that these changes generate many problems regarding data protection (DP) and right of privacy. The legal problems are mainly related to the criminal protection regarding medical secret. The DP laws extend this protection to all steps of information treatment. Since in Switzerland, the DP legislation is still to be completely developed, the author bases himself on the constitutional law to know how far the research activities have to take account of DP requirements and, inversely, how far the DP laws have to provide for less binding measures in the field of research. It is by far preferable to conduct researches with completely anonymous data. When not possible, according to the constitutional principle of interests' balance, measures have to be taken in order to make possible the formal consent of the patient, or to replace this consent by external control of the research project and by security measures.

In this paper, SMRs by socio-economic group are given for Swiss men, aged 15 to 74. One of the classifications given is similar to the English Social Classes, the other is based on distinction of self-employed and white/blue collar wage earners by economic sector (agriculture, industry or services; Table 1). The resulting differentials are similar in size to those observed between men and women, and are present with both classification schemes. Some methodological issues are discussed: SMR's have been adjusted using a random sample of 3058 death certificates from 1981 linked to their census records. Quality of occupational information does not deteriorate much up to age 74. These results are of interest as Switzerland has enjoyed an unprecedented spell of full employment and rising wages between 1950 and 1980. Implications for social security are mentioned.

One of the reasons for variations in infant mortality could be the differences in registration of vital events. In this paper the legal definitions regarding spontaneous abortion, stillbirth and live birth are studied taking into account international and time related differences. One of the often cited influencing factors on registration--the religion--has possibly influenced differences between Swiss cantons before the sixties.

The study, based on interview data of 500 school children, aimed at clarifying some pertinent issues of health and illness behavior of primary school children. Those answers are presented in this paper, which deal with experience of children with doctors.

In most European countries systematic screening programs for infants and preschool children are being introduced or are already established as a routine procedure. The contents and the possible effects of such programs are discussed critically in this paper, which also describes the present state in Switzerland as well as a pilot project initiated by the Bernese Pediatric Association.