Patient Satisfaction and Quality of Life in People with Schizophrenia-Spectrum Disorders in a Rural Area.

People suffering from schizophrenia-spectrum disorders often endorse a reduced quality of life (QoL) as compared to the general population. There appears to be a lack of studies for rural catchment areas for this patient population. We conducted a cross-sectional study with 94 people with schizophrenia-spectrum disorders in a mainly rural alpine area. We used multilevel models controlled for covariates to analyze the data. Total service satisfaction was associated with psychological aspects of subjective QoL and physical well-being in our model. Variables characterizing autonomy and empowerment of the person seem crucial concerning the QoL in this population.

Sports injuries and illnesses during the 2015 Winter European Youth Olympic Festival.

BACKGROUND: The prevention of injury and illness remains an important issue among young elite athletes. Systematic surveillance of injuries and illnesses during multi-sport events might provide a valuable basis to develop preventive measures, focusing especially on adequate information for youth athletes. AIM: To analyse the frequencies and characteristics of injuries and illnesses during the 2015 Winter European Youth Olympic Festival (W-EYOF). METHODS: All National Olympic Committees were asked to report daily the occurrence or non-occurrence of newly sustained injuries and illnesses on a standardised reporting form. RESULTS: Among the 899 registered athletes (37% female) with a mean age of 17.1±0.8 years, a total of 38 injuries and 34 illnesses during the 5 competition days of the W-EYOF were reported, resulting in an incidence of 42.3 injuries and 37.8 illnesses per 1000 athletes, respectively. Injury frequency was highest in snowboard cross (11%), Nordic combined (9%), alpine skiing (6%), and ice hockey (6%), taking into account the respective number of registered athletes. In snowboard cross, females showed a significant higher injury frequency compared to males (22% vs 4%, p=0.033). The lower back (16%), the pelvis (13%), the knee (11%), and the face (11%) were the most common injury locations. About 58% of injuries occurred in competition and about 42% in training. In total, 42% of injuries resulted in an absence of training or competition. The prevalence of illness was highest in figure skating (10%) and Nordic combined (9%), and the respiratory system was affected most often (53%). CONCLUSIONS: Four per cent of the athletes suffered from an injury and 4% from illnesses during the 2015 W-EYOF, which is about twofold lower compared to the first Winter Youth Olympic Games in 2012.

Prevalence of vitamin B(12) depletion and deficiency in Liechtenstein.

OBJECTIVE: Data about vitamin B(12) (B(12)) deficiency in the general population are scarce. The present study was performed to determine the prevalence of B(12) deficiency in the general population of the Principality of Liechtenstein, as well as to identify sub-populations potentially at high risk. DESIGN: Retrospective study. SETTING: Ambulatory setting, population of the Principality of Liechtenstein. SUBJECTS: Seven thousand four hundred and twenty-four patients seeking medical attention whose serum samples were referred for routine work-up in an ambulatory setting were consecutively enrolled. Serum total B(12) was determined in all patients in this cohort. In addition, for a subgroup of 1328 patients, serum holotranscobalamin was also measured. Prevalence of B(12) deficiency was calculated. Further, multivariate logistical regression models were applied to identify covariates independently associated with B(12) deficiency and depletion. RESULTS: Nearly 8% of the general population was suffering from either B(12) depletion or deficiency. The ratio between B(12) depletion and deficiency was 2:1 for all age ranges. Pathological changes were detected predominantly in older people. Female gender was a significant predictor of B(12) depletion. In the cohort, nearly 40% exhibited either depletion or deficiency of B(12). CONCLUSIONS: B(12) depletion and deficiency are common in Liechtenstein, a Central European country. The measurement of biochemical markers represents a cost-efficient and valid assessment of the B(12) state. When a deficiency of B(12) is diagnosed at an early stage, many cases can be treated or prevented, with beneficial effects on individual outcomes and subsequent potential reductions in health-care costs.

Schoolchildren in the Principality of Liechtenstein are mildly iodine deficient.

OBJECTIVE: To investigate the iodine status of schoolchildren in the Principality of Liechtenstein. DESIGN: A representative, cross-sectional principality-wide screening of iodine level in household salt and urinary iodine concentrations (UIC) in primary-school children. Data were compared with the WHO criteria and with 2009 iodine survey data from Switzerland, a neighbouring country that supplies most of the salt used in Liechtenstein. SETTINGS: Principality of Liechtenstein. SUBJECTS: Schoolchildren (n 228) aged 6-12 years from five different primary schools representing 11·4 % of the children at this age. RESULTS: The median UIC was 96 (range: 10-446) µg/l; 11 %, 56 % and 1 % of children had a UIC <50, <100 and >300 µg/l, respectively. In all, 79 % of households were using adequately iodised salt (≥15 ppm). The median UIC was 20 % lower than that in children at comparable age in Switzerland (120 µg/l; P < 0·05). CONCLUSIONS: According to the WHO criteria, schoolchildren in Liechtenstein are mildly iodine deficient and household iodised salt coverage is inadequate. Public health measures to increase iodine intakes in the Principality should be considered.

COVID-19 in Switzerland and Liechtenstein: A Cross-Sectional Survey among Dentists' Awareness, Protective Measures and Economic Effects.

The aim of this observational cross-sectional study was to gain information on the awareness; protective measures and economic effects of dentists in Switzerland during the global COVID-19 pandemic. All dentist were members of the Swiss Dental Association SSO from all over Switzerland-including all Swiss cantons and Liechtenstein-and received a previously calibrated questionnaire as an ad hoc online version. The questionnaire was divided into four parts: personal data; precautionary measures; awareness; perception. In total, 1324 questionnaires were analyzed; the response rate was 30.59% (ntotal = 4328). Participants stated in less than 2% common symptoms/signs of COVID-19; of which only fatigue was statistically significant (p < 0.01). A small number of dentists reported a positive test (0.91%; n = 12) or having one or more symptoms (2.65%; n = 35) of COVID-19 during the pandemic; whereas only 6.71% (n = 87) of the participants reported having treated SARS-CoV-2 infected patients. High prevalence areas were only medium-large and large Swiss cantons (p < 0.01). Face filter (FFP2/FFP3) masks were used by about half of the dentists, while disposable visor was rarely used. The majority of dentists had to reduce the dental practice activity to a minimum of 0-10% (n = 923; 69.98%) due to the lockdown. This economic impact forced 1.4% (n = 18) to close their practice permanently or by the end of 2020 due to the economic situation. These results can be helpful to better prepare dental practices for future outbreaks of infection (e.g., prophylactic storage of additional protective measures), define the best strategy and organize the dental workforce. Political decision-makers should consider drastic economic effects when deciding on drastic measures such as "lockdown", which can lead to practice closures and unemployment of dental staff after only a few weeks. This should be taken into account, especially with regard to possible financial assistance to severely impaired dental practices to maintain a high level of dental care.

Flattening the curve in 52 days: characterisation of the COVID-19 pandemic in the Principality of Liechtenstein - an observational study.

BACKGROUND: The principality of Liechtenstein had its first COVID-19 case at the beginning of March 2020. After exponential growth, the pandemic’s first wave was contained, with the last case being diagnosed 52 days after the initial occurrence. AIM: To characterise the COVID-19 pandemic in Liechtenstein. METHODS: All patients diagnosed in Liechtenstein were followed up until recovery and again 6–8 weeks after symptom onset. They were contacted every 2 days to record their clinical status until the resolution of their symptoms. The diagnosis of COVID-19 was based on clinical symptoms and molecular testing. Household and close workplace contacts were included in the follow-up, which also comprised antibody testing. In addition, public health measures installed during the pandemic in Liechtenstein are summarised. RESULTS: During the first wave, 5% of the population obtained a reverse transcriptase polymerase chain reaction test. A total of 95 patients (median age 39 years) were diagnosed with COVID-19 (82 who resided in Liechtenstein), resulting in an incidence in Liechtenstein of 0.211%. One patient, aged 94, died (mortality rate 1%). Only 62% of patients could retrospectively identify a potential source of infection. Testing the patients’ household and close workplace contacts (n = 170) with antibody tests revealed that 25% of those tested were additional COVID-19 cases, a quarter of whom were asymptomatic. Those households which adhered to strict isolation measures had a significantly lower rate of affected household members than those who didn’t follow such measures. The national public health measures never restricted free movement of residents. Masks were only mandatory in healthcare settings. The use of home working for the general workforce was promoted. Gatherings were prohibited. Schools, universities, certain public spaces (like sports facilities and playgrounds), childcare facilities, nonessential shops, restaurants and bars were closed. Social distancing, hygienic measures, solidarity and supporting individuals who were at risk were the main pillars of the public health campaigns. CONCLUSION: The close collaboration of all relevant stakeholders allowed for the complete workup of all COVID-19 patients nationwide. A multitude of factors (e.g., young age of the patients, low-threshold access to testing, close monitoring of cases, high alertness and adherence to public health measures by the population) led to the early containment of the first wave of the pandemic, with a very low rate of serious outcomes. Antibody testing for SARS-CoV-2 revealed a substantial proportion of undiagnosed COVID-19 cases among close contacts of the patients.

Tuberculosis in the EU and EEA/EFTA countries: what is the latest data telling us?

Since 1 January 2008, the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization Regional Office for Europe (WHO/Europe) jointly coordinate the tuberculosis (TB) surveillance activities in Europe. The data collected provides an opportunity for a comprehensive analysis of the TB situation. We aimed at analysing the EU and EEA/EFTA data to identify general TB trends and to provoke some discussion regarding the challenges and needs for monitoring the epidemic.

Malaria cases in Switzerland from 2005 to 2015 and recent rise of imported Plasmodium vivax malaria.

Reporting cases of malaria to the Federal Office of Public Health has been mandatory in Switzerland since 1974. We analysed notifications of imported confirmed malaria cases between 2005 and 2015 in Switzerland or Liechtenstein. Data for previously visited countries, nationality and reason for travelling were analysed. In contrast with the impressive drop of malaria cases reported worldwide since 2000, we found that the number of malaria cases imported yearly in Switzerland doubled in 2014 and 2015 compared to the average for the preceding decade. Since 2014, Plasmodium vivax infection represented 36% of all diagnosed malaria cases in Switzerland, compared to 11% in the decade leading to 2013. Most of the vivax malaria patients originated from the Horn of Africa, especially from Eritrea. This rise in cases was a consequence not only of an increase in the number of Eritrean refugees, but also their vivax malaria incidence rate, which jumped from 1-3‰ previously to 12‰ in 2014. This is a trend that is not matched by national statistics in Eritrea. An unreported increased incidence in the country of origin (Eritrea) might be the cause of the rise of Pv cases imported into Switzerland, but infections are also likely to occur along the harsh and long migration journey. This epidemiology highlights the need to register and use primaquine for the treatment of latent-phase P. vivax malaria in Switzerland, a medicine currently neither marketed nor systematically reimbursed. Moreover, general practitioners should be aware of this specific epidemiological situation in order to avoid misdiagnosis of febrile Eritreans even months after they reach Switzerland.

Risk factors for premature ventricular contractions in young and healthy adults.

BACKGROUND: Premature ventricular contractions (PVCs) are associated with an increased risk of morbidity and mortality. Therefore, it was aimed to assess risk factors for the frequency of PVCs in young and healthy adults. METHODS: Our population-based study included 2048 healthy adults from the general population aged 25-41 years. PVC frequency was determined by 24-hour Holter ECG. We performed multivariable regression analysis using stepwise backward selection to identify factors independently associated with PVC frequency. RESULTS: Median age was 37 years, 953 (46.5%) were male. At least one PVC during the 24-hour monitoring period was observed in 69% of participants. Median number of detected PVCs was 2, the 95th percentile was 193. In multivariable regression analyses, we found 17 significant risk factors for PVC frequency. Low educational status (risk ratio (RR) 3.33; 95% CI 1.98 to 5.60), body height>median (1.58, 95% CI 1.11 to 2.24) and increasing levels of waist:hip ratio (2.15, 95% CI 1.77 to 2.61), N-terminal pro brain natriuretic peptide (1.52, 95% CI 1.30 to 1.76) and Sokolow-Lyon Index (1.38, 95% CI 1.15 to 1.66) (all p≤0.01) were associated with a higher PVC frequency. Physical activity (RR fourth vs first quartile 0.51, 95% CI 0.34 to 0.76) and increasing levels of haemoglobin (0.58, 95% CI 0.47 to 0.70) and glucagon-like peptide-1 (0.72, 95% CI 0.64 to 0.82) (all p<0.001) were related to a lower PVC frequency. CONCLUSIONS: PVC occurrence is common even in healthy low-risk individuals, and its frequency is associated with several covariates mainly related to cardiovascular risk factors, markers of cardiac structure and function and socioeconomic status.

Molecular characterization and virus neutralization patterns of severe, non-epizootic forms of feline calicivirus infections resembling virulent systemic disease in cats in Switzerland and in Liechtenstein.

Feline calicivirus (FCV) infections are associated with oral ulceration, chronic stomatitis and a limping syndrome. Epizootic outbreaks of virulent systemic disease (VSD) have been reported in the USA and Europe. Here, the molecular characterization and neutralization patterns of FCV isolates from cases of severe, non-epizootic infection associated with skin ulceration and edema are presented. Samples from eleven symptomatic cats, four in-contact cats and 27 cats with no contact with symptomatic cats were collected and tested for FCV, feline herpesvirus-1 (FHV-1), feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV). Phylogenetic analyses based on the capsid (VP1) gene of FCV and virus neutralization with antisera raised against four FCV vaccine strains were performed. Nine kittens and two adult cats in two shelters and two veterinary clinics in four geographically distinct locations in Switzerland and Liechtenstein were affected. The cats showed fever, tongue and skin ulceration, head and paw edema, and occasionally jaundice, generalized edema and dyspnea. All symptomatic cats tested FCV-positive but were negative for FHV-1, FeLV and FIV, with the exception of one FIV-positive kitten. All kittens of one litter and both adult cats died. The disease did not spread to cats in the environment. Cats in the environment displayed phylogenetically distinct, but related, FCV strains. Virus neutralization patterns suggested that some cases might have been potentially prevented by vaccination with the optimal vaccine strain. In conclusion, clinicians should be aware of severe, non-epizootic forms of FCV infections with initial clinical presentations similar to VSD.

[Borna disease in Switzerland and in the principality of Liechtenstein]. / Die "Bornasche Krankheit" in der Schweiz und im Fürstentum Liechtenstein.

Borna disease (BD) is a rare immunopathological disorder of the central nervous system (CNS) caused by infection with Borna disease virus (BDV) and histologically characterized by mononuclear encephalomyelitis. BD primarily affects equines and sheep in well defined endemic areas of central Europe, but BDV infections have also been reported in other host species including humans, as well as in non endemic regions. In this paper recent data on the pathogenesis of BD are reviewed and the current situation in Switzerland and the Principality of Liechtenstein is summarized.

Association of smoking and nicotine dependence with pre-diabetes in young and healthy adults.

INTRODUCTION: Several studies have shown an increased risk of type 2 diabetes among smokers. Therefore, the aim of this analysis was to assess the relationship between smoking, cumulative smoking exposure and nicotine dependence with pre-diabetes. METHODS: We performed a cross-sectional analysis of healthy adults aged 25-41 in the Principality of Liechtenstein. Individuals with known diabetes, Body Mass Index (BMI) >35 kg/m² and prevalent cardiovascular disease were excluded. Smoking behaviour was assessed by self-report. Pre-diabetes was defined as glycosylated haemoglobin between 5.7% and 6.4%. Multivariable logistic regression models were done. RESULTS: Of the 2142 participants (median age 37 years), 499 (23.3%) had pre-diabetes. There were 1,168 (55%) never smokers, 503 (23%) past smokers and 471 (22%) current smokers, with a prevalence of pre-diabetes of 21.2%, 20.9% and 31.2%, respectively (p <0.0001). In multivariable regression models, current smokers had an odds ratio (OR) of pre-diabetes of 1.82 (95% confidential interval (CI) 1.39; 2.38, p <0.0001). Individuals with a smoking exposure of <5, 5-10 and >10 pack-years had an OR (95% CI) for pre-diabetes of 1.34 (0.90; 2.00), 1.80 (1.07; 3.01) and 2.51 (1.80; 3.59) (p linear trend <0.0001) compared with never smokers. A Fagerström score of 2, 3-5 and >5 among current smokers was associated with an OR (95% CI) for pre-diabetes of 1.27 (0.89; 1.82), 2.15 (1.48; 3.13) and 3.35 (1.73; 6.48) (p linear trend <0.0001). DISCUSSION: Smoking is strongly associated with pre-diabetes in young adults with a low burden of smoking exposure. Nicotine dependence could be a potential mechanism of this relationship.

[Endangering of the Liechtenstein population by the early-summer meningoencephalitis virus]. / Gefährdung der Bevölkerung in Liechtenstein durch das Virus der Frühsommer-Meningoenzephalitis (FSME).

There have been a few severe cases of tick-borne encephalitis in Liechtenstein during the last 20 years. To form a better idea of the risk of infection and the potential benefit of vaccination, a total of 311 sera from different cohorts were investigated for antibodies to tick-borne encephalitis. The mean seroprevalence found was 3.6% and was not higher even in persons who were active in professional forestry. The antibodies measured derived in all groups mainly from previous vaccination and in only 2 cases (0.6%) from natural infection. It is concluded that the risk of TbE infection in Liechtenstein is very low. Therefore, a reduction in cases would probably be achieved only by mass vaccination.

Detection of tick-borne encephalitis (TBE) virus in Liechtenstein.

In this study, we present the first detection of a focus of tick-borne encephalitis (TBE) virus-infected ticks in Liechtenstein. The focus is located on a much-used forest path near Vaduz, the capital of the principality. The virus isolated is a representative of the Western subtype of the TBE virus. It is thus closely related to or identical with the other strains isolated in western Europe.