Effect of ibandronate on spontaneous osteonecrosis of the knee: a randomized, double-blind, placebo-controlled trial.

UNLABELLED: Based on this double-blind, placebo-controlled study, ibandronate has no beneficial effect on clinical and radiological outcome in patients with spontaneous osteonecrosis of the knee over and above anti-inflammatory medication. INTRODUCTION: Observational studies suggest beneficial effects of bisphosphonates in spontaneous osteonecrosis (ON) of the knee. We investigated whether ibandronate would improve clinical and radiological outcome in newly diagnosed ON. METHODS: In this randomized, double-blind, placebo-controlled trial, 30 patients (mean age, 57.3 ± 10.7 years) with ON of the knee were assigned to receive either ibandronate (cumulative dose, 13.5 mg) or placebo intravenously (divided into five doses 12 weeks). All subjects received additional treatment with oral diclofenac (70 mg) and supplementation with calcium carbonate (500 mg) and vitamin D (400 IU) to be taken daily for 12 weeks. Patients were followed for 48 weeks. The primary outcome was the change in pain score after 12 weeks. Secondary endpoints included changes in pain score, mobility, and radiological outcome (MRI) after 48 weeks. RESULTS: At baseline, both treatment groups (IBN, n = 14; placebo, n = 16) were comparable in relation to pain score and radiological grading (bone marrow edema, ON). After 12 weeks, mean pain score was reduced in both ibandronate- (mean change, -2.98; 95% CI, -4.34 to -1.62) and placebo- (-3.59; 95% CI, -5.07 to -2.12) treated subjects (between-group comparison adjusted for age, sex, and osteonecrosis type, p = ns). Except for significant decrease in bone resorption marker (CTX) in ibandronate-treated subjects (p < 0.01), adjusted mean changes in all functional and radiological outcome measures were comparable between treatment groups after 24 and 48 weeks. CONCLUSIONS: In patients with spontaneous osteonecrosis of the knee, bisphosphonate treatment (i.e., IV ibandronate) has no beneficial effect over and above anti-inflammatory medication.

Nonirritant intradermal skin test concentrations of ciprofloxacin, clarithromycin, and rifampicin.

BACKGROUND: Intradermal skin testing of the clinically important antibiotics ciprofloxacin, clarithromycin, and rifampicin in the case of suspected allergies to antibiotics is poorly standardized. For clinical practice, standardized procedures and protocols are desired. METHODS: Fifteen healthy volunteers were tested with different concentrations of the antibiotics as well as with appropriate controls. Test readings included wheal area measured by digital image analysis and blood flow increase measured by laser Doppler flowmetry (LDF). To reduce interpersonal variability, test results were normalized with the individual controls using a novel protocol. RESULTS: Nonirritating concentrations of the three antibiotics (ciprofloxacin ~0.0067 mg/ml, clarithromycin ~0.05 mg/ml, rifampicin ~0.002 mg/ml) could be defined for healthy volunteers. Laser Doppler flowmetry generates comparable results to wheal area measurement. Normalization of the test results is necessary and can be applied in a practical algorithm. CONCLUSIONS: Standardized skin testing to detect sensitization to broadly used nonbetalactam antibiotics was presented and should be applied in truly sensitized patients. This approach should help to minimize the inter- and intraindividual differences in reactivity.

Prediction of long-term disability in multiple sclerosis.

BACKGROUND: Little is known about the predictive value of neurophysiological measures for the long-term course of multiple sclerosis (MS). OBJECTIVE: To prospectively investigate whether combined visual (VEP) and motor evoked potentials (MEP) allow prediction of disability over 14 years. METHODS: A total of 30 patients with relapsing-remitting and secondary progressive MS were prospectively investigated with VEPs, MEPs and the Expanded Disability Status Scale (EDSS) at entry (T0) and after 6, 12 and 24 months, and with cranial MRI scans at entry (T2-weighted and gadolinium-enhanced T1-weighted images). EDSS was again assessed at year 14 (T4). The association between evoked potential (EP), magnetic resonance (MR) data and EDSS was measured using Spearman's rank correlation. Multivariable linear regression was performed to predict EDSS(T4) as a function of z-transformed EP-latencies(T0). The model was validated using a jack-knife procedure and the potential for improving it by inclusion of additional baseline variables was examined. RESULTS: EDSS values(T4) correlated with the sum of z-transformed EP-latencies(T0) (rho = 0.68, p < 0.0001), but not with MR-parameters(T0). EDSS(T4) as predicted by the formula EDSS(T4) = 4.194 + 0.088 * z-score P100(T0) + 0.071 * z-score CMCT(UE, T0) correlated with the observed values (rho = 0.69, p < 0.0001). CONCLUSION: Combined EPs allow prediction of long-term disability in small groups of patients with MS. This may have implications for the choice of monitoring methods in clinical trials and for daily practice decisions.

Evaluation of a physical activity promotion program in primary care.

BACKGROUND: Physical inactivity increases the risk of many chronic disorders. It is not clear which strategies are the most appropriate to enable people to adopt a more active lifestyle. Randomized controlled trials have found that brief advice from GPs supported by written material had a significant positive effect on patient's physical activity. The pilot project 'Move for Health and the Environment' translated this evidence into a program suitable for the real-life situation of busy practices. The aim of this study was to evaluate the change in physical activity level of the participating patients 1 year after the intervention. METHODS: Patients aged 16-65 years completed a screening questionnaire before consultation with their physician. Insufficiently active patients were offered an information leaflet and a voucher for a physical activity counselling session. One year later, all inactive patients and a random selection of the active were re-contacted and invited to answer identical questions. RESULTS: A total of 1239 (73.9%) returned the follow-up questionnaire. In all, 37.3% of the formerly inactive patients met the threshold of sufficient activity at follow-up, whereas 20.3% of the previously active no longer did. Formerly inactive patients reported an increase of 58.8 minutes/week of moderate and 34.6 minutes/week of vigorous activity and spending more time walking and cycling. Formerly active patients reported less time spent in moderate activities. CONCLUSIONS: Systematic counselling in primary care encouraged insufficiently active patients to adopt a more active lifestyle. Yet it became evident that active patients also need counselling to maintain their activity levels.

Marginal bone loss one year after implantation: a systematic review of different loading protocols.

The aim of this study was to analyse the influence of different loading protocols on marginal bone loss (MBL). The outcomes of different implant loading protocols were assessed at 1year after implantation, with focus on MBL; protocols included immediate, immediate non-occlusal, early, and conventional loading. The search strategy resulted in 889 studies. Twenty-two of these studies fulfilled the inclusion criteria. Among the included studies, the lowest MBL was for immediately loaded implants (0.05±0.67mm) and the highest for immediate non-occlusally loaded implants (1.37±0.5mm). The results of the meta-analysis showed an estimated mean MBL of 0.457mm (95% confidence interval (CI) 0.133-0.781) for immediate loading, 0.390mm (95% CI 0.240-0.540) for immediate non-occlusal loading, 0.488mm (95% CI 0.289-0.687) for early loading (>2 days to <3 months), and 0.852mm (95% CI 0.429-1.275) for conventional loading (>3 months) implant protocols. The lowest decrease in 1-year implant survival per millimetre increase in MBL was observed for immediate loading and the highest for conventional loading. Conventional loading showed a significantly higher MBL than the other three loading protocols. This systematic review and meta-analysis indicates that the immediate loading protocol is a reasonable alternative to the conventional loading protocol.

Patient and physician acceptance of a campaign approach to promoting physical activity: the "Move for Health" project.

QUESTIONS UNDER STUDY: Physical inactivity increases the risk of many chronic disorders. There is clear evidence that primary care-based interventions to promote physical activity may be effective under controlled research conditions. Yet little is known how this evidence translates into routine primary care practice. The pilot project "Move for Health" tested recruitment of family physicians for a primary prevention project and evaluated the feasibility of systematic assessment and discussion of patients' physical activity taking daily practice routine into account. METHOD: Patients aged 16-65 years completed a screening questionnaire during 8 two-week campaigns in 2004-5. Physicians evaluated and discussed questionnaire responses and offered a physical activity information leaflet and/or a voucher for a special physical activity counselling session to all inactive patients. Participating practices were interviewed to assess their experience of the project. RESULTS: 40 primary care physicians were motivated to participate. Recruitment was most effective through personal contacts of the project team's colleagues. 67% of the patients completed the screening questionnaire and 92% of these questionnaires were discussed during consultation. 83% of patients accepted the leaflet or the voucher, but only a minority of patients attended the special counselling session. With increasing age and readiness for behavioural change patients were more likely to attend the counselling session. CONCLUSIONS: A campaign approach consisting of systematic screening and brief counselling of insufficiently active patients in general practice is feasible. Participating practices considered the amount of work associated with the project to be manageable and 1-3 counselling campaigns per year to be feasible if the project runs for several years.

Selection bias of elderly patients with chronic angina referred for catheterization.

BACKGROUND: Registry patients are generally older and more sick than patients enrolled in trials questioning the generalizability of trial results. We assessed whether such a selection bias also exists in elderly patients with chronic angina referred for catheterization. METHODS AND RESULTS: All 119 patients age>or=75 years with Trial of Invasive versus Medical Therapy in the Elderly (TIME) inclusion but no major exclusion criteria referred for catheterization during the TIME trial inclusion period in four TIME centers were registered and followed-up for one year. Registry patients differed from the 188 trial patients in the same hospitals in that they were younger, somewhat more frequently male, with less antianginal drugs and studied more often after acute chest pain at rest but with more comorbidities than study patients. Left ventricular ejection fraction and vessel disease were similar. One year mortality was 11.4% in registry and 9.6% in invasive TIME patients but differences disappeared after adjustment for baseline differences. Symptomatic status after one year was similar too. CONCLUSIONS: In elderly patients with chronic angina, a bias in the selection for invasive management exists which seems different from that reported in younger patient settings. After adjustment for these selection factors, however, one-year outcome was remarkably similar in registry and trial patients.

Seroprevalence of varicella-zoster virus immunoglobulin G antibodies in Swiss adolescents and risk factor analysis for seronegativity.

BACKGROUND: Little is known about the seroprevalence of anti-varicella-zoster virus (VZV) serum antibodies in adolescents in Switzerland as in most other European countries. METHODS: Serum specimens from 13- to 15-year-old students from eight urban and rural areas in Switzerland, obtained as part of an allergy risk assessment study project (SCARPOL), were available for analysis of IgG antibodies against VZV by enzyme-linked immunosorbent assay (ELISA) and confirmation by fluorescent antibody staining of membrane antigen in a subcohort. Serum specimens and comprehensive sociodemographic data had been collected during two study periods between 1992 and 1995. RESULTS: Data and serum specimens were available from 1709 and 1788 subjects, respectively. Seroprevalence of anti-VZV antibodies as measured by ELISA was 95.5% (95% confidence interval, 94.5 to 96.4). When serum specimens that were indeterminate by ELISA were tested by FAMA, seroprevalence was 96.5% (95% confidence interval, 95.7 to 97.4). After logistic regression analysis, the number of siblings was the only factor that significantly influenced the presence of VZV antibodies (90.1% in those with no siblings, >96% with 1 or more siblings), whereas residence (urban vs. rural), parental education, nationality and gender did not. CONCLUSIONS: Seroprevalence of anti-VZV serum antibodies is comparatively high among Swiss adolescents. Individuals who grow up without siblings have a significant risk of evading natural VZV infection in childhood, and they therefore form a potential target group for varicella immunization in Switzerland.

Perceived environmental housing quality and wellbeing of movers.

STUDY OBJECTIVE: To examine whether changes in environmental housing quality influence the wellbeing of movers taking into account other dimensions of housing quality and sociodemographic factors. DESIGN: Cross sectional telephone survey. Associations between changes in satisfaction with 40 housing quality indicators (including environmental quality) and an improvement in self rated health (based on a standardised question) were analysed by multiple logistic regression adjusting for sociodemographic variables. Objective measures of wellbeing or environmental quality were not available. SETTING: North western region of Switzerland including the city of Basel. PARTICIPANTS: Random sample of 3870 subjects aged 18-70 who had moved in 1997, participation rate 55.7%. RESULTS: A gain in self rated health was most strongly predicted by an improved satisfaction with indicators related to the environmental housing quality measured as "location of building" (adjusted odds ratio (OR) =1.58, 95% confidence intervals (CI) =1.28, 1.96) and "perceived air quality" (OR=1.58, 95% CI=1.24, 2.01) and to the apartment itself, namely "suitability" (OR=1.77, 95% CI=1.41, 2.23), "relationship with neighbours" (OR=1.46, 95% CI=1.19, 1.80) and "noise from neighbours" (OR=1.32, 95% CI=1.07, 1.64). The destination of moving and the main reason to move modified some of the associations with environmental indicators. CONCLUSION: An improvement in perceived environmental housing quality was conducive to an increase in wellbeing of movers when other dimensions of housing quality and potential confounders were taken into account.

Comparison of responses to an asthma symptom questionnaire (ISAAC core questions) completed by adolescents and their parents. SCARPOL-Team. Swiss Study on Childhood Allergy and Respiratory Symptoms with respect to Air Pollution.

The primary objective of the study was to determine the impact of the identity of the respondent (parents versus adolescents) on prevalence estimates of asthma symptoms in Swiss adolescents. In addition, factors influencing agreement between parents' and adolescents' responses to the same questions were analysed. One thousand three hundred and seventy-four (78.4%) adolescents, aged 14 years, self-completed a questionnaire at school based on the International Study of Asthma and Allergy in Childhood (ISAAC) core questions on wheezing and asthma. The same questions were incorporated into a questionnaire to be completed by the parents at home. The adolescents' self-reported prevalence rates of current asthma symptoms and "asthma ever" were significantly higher than those obtained from the parental questionnaires. 856 (62.6%) parental questionnaires were filled in by parents without the help of the adolescents, 460 (37.4%) were completed by parents and adolescents and 51 (3.7%) were completed by the adolescents without the parents. Prevalence rates were higher when parents and adolescents completed the questionnaire jointly than when questionnaires were completed by parents alone. The level of agreement between parental and self-completed questionnaires was moderate to low (kappa coefficients 0.22-0.68). Agreement between parental and adolescents reports of asthma symptoms was best when questionnaires were completed jointly by parents and adolescents, when the adolescent was a girl, when a family history of asthma was recorded, when the adolescent was a non-smoker, and when the parental education was high. We conclude that the higher reporting of prevalence rates of current asthma symptoms by adolescents compared to reporting by their parents demonstrates the need to take the respondent to a questionnaire into account when comparisons are made between prevalence studies. The results also suggest that factors related to the family milieu influence symptom reporting.

Occupational exposure to inhalative irritants and methacholine responsiveness.

OBJECTIVES: Occupational exposures to inhalative irritants have been associated with an increased reporting of respiratory symptoms in previous studies. Methacholine responsiveness represents a continuous measure of airway responsiveness. As such, it may be less subject to recall bias and more sensitive to detecting effects of occupational exposure on airways. Such effects may be stronger among atopic persons. The objective of the study was to examine the relationship between self-reports of occupational exposure to dusts, gases, vapors, aerosols, and fumes and methacholine responsiveness. METHODS: A sample was studied of never smokers (N=3044) chosen randomly from 8 areas in Switzerland. Atopy was defined as any positive skin test to 8 inhalative allergens. Nonspecific bronchial reactivity was tested using methacholine chloride and quantified by calculating the slope of the dose-response. RESULTS: The methacholine slopes were 19% [95% confidence interval (95% CI) 6-32] higher for never smokers with exposure to dusts, fumes, vapors, gases, or aerosols than for the unexposed group. When only atopic never smokers were examined. the increase was larger (37%, 95% CI 7-75), and for persons with >2 positive skin prick tests the effect was still higher (42%, 95% CI -1.5-104). Exposure to vapors and aerosols was strongly associated with increased methacholine slopes among the atopic subjects. CONCLUSIONS: Occupational exposure, particularly to dusts and fumes, was associated with increased bronchial reactivity in never smokers in this study. The magnitude of the effect was larger among atopic subjects.

[Bias due to non-responders in an epidemiological study (SAPALDIA)]. / Etude du biais dû aux non-répondants dans une étude épidemiologique (SAPALDIA).

Within the Swiss Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) 16267 adults aged 18 to 60 years from 8 different locations in Switzerland were randomly selected for answering a questionnaire about respiratory health and have a lung function examination with allergy test. 9561 subjects agreed with the examination (59%) (= responders, R). In order to study the possible influence of the bias introduced by non-responders (NR), 221 subjects who refused to participate among the 966 first subjects selected in Payerne were contacted by phone. 142 accepted a home visit and answered a shortened questionnaire about the main respiratory symptoms and diseases and indicated furthermore the reasons for their refusal. Non-responders have a lower mean educational level and belong to lower social classes than responders. The frequency of respiratory symptoms and diseases, allergies and smoking is similar in R and NR except a higher frequency of wheezing during the last 12 month (R: 12.5%, NR: 5.6%, p = 0.03). The level of carbon monoxide in expired air is higher in NR (17.6 ppm) that in R (11.9 ppm) (p = 0.01). A similar difference exists between NR (30.7 pp) and R (24.8 ppm) among current smokers (p < 0.01). The main reasons for refusal are lack of time (27.5%), lack of interest for medical study (22.6%), fear of health professionals (18.3%) or the existence of a another disease (9.9%). Furthermore, 2.8% of the subjects consider a medical study as useless and refuse principally any participation. The role of local press and media in the decision to participate seems to be important. Globally, the differences between R and NR are minimal and should not influence the validity of the results of the SAPALDIA study.

SAPALDIA: methods and participation in the cross-sectional part of the Swiss Study on Air Pollution and Lung Diseases in Adults.

SAPALDIA--the Swiss Study on Air Pollution and Lung Diseases in Adults--focuses on the long term health effects of low to moderate levels of air pollutants as typically seen in different parts of Switzerland. The aim of the SAPALDIA cross-sectional study carried out in 1991 was to determine the prevalence of bronchial asthma, chronic bronchitis and allergic conditions in the adult population of Switzerland and to identify and to determine the respective importance of potentially influencing factors. These could be both personal (smoking habits, allergy status, family history, occupation) and environmental (outdoor and indoor pollution, aeroallergens, climate). A further aim of the cross-sectional study consisted in the identification of individuals susceptible to present symptoms during a two year observation period and to be included in the SAPALDIA follow-up study. This technical report represents the methodological documentation for the cross-sectional study of SAPALDIA. The instruments and the methods of standardisation are presented and discussed. The medical examination consisted of a computerised interview using a standardised questionnaire, the taking of a blood sample for serological tests, allergy skin testing, the measurement of end expiratory CO and body height, and pulmonary function testing followed by methacholine challenge testing or bronchodilatation testing. The pattern of participation and the 9651 participants of the study, representing 59.3% of the sample, are described. Based on information on non-participants gained by telephone interviews and mailed short questionnaires, possible selection biases are quantified and discussed.

Prediction of MS disability by multimodal evoked potentials: investigation during relapse or in the relapse-free interval?

OBJECTIVE: Little is known about optimal timing of multimodal evoked potential (EP)-investigations regarding prediction of MS disability. The aim of this study was to investigate whether timing of EP-investigations during a relapse or in the relapse-free interval influences prediction of MS disability. METHODS: Two groups of MS patients with similar age and gender distributions received visual, motor and somatosensory EPs either during a relapse (Group 1) or in the relapse-free interval (Group 2). Expanded Disability Status Score (EDSS) was obtained at baseline (T0) and year 3 (T2). Linear regression analysis was performed to examine the association between EDSS(T2) and a baseline EP compound measure (s-EP-Q(T0)) for each group. RESULTS: Median EDSS(T0) was 3.0 for Group 1 and 1.5 for Group 2. Mean disease durations were 2.0 and 2.8 years, respectively. Median EDSS(T2) was 2.0 for both groups. The s-EP-Q(T0) significantly predicted EDSS(T2) (R(2)=0.47) for patients in Group 2, but not for patients in Group 1 (R(2)=0.07). CONCLUSION: In early MS the functional remnants of relapses are a better predictor for development of medium-term disability than is the extent of impulse propagation impairment measured during relapse. SIGNIFICANCE: This suggests a role of multimodal EPs in prediction of MS disability if performed in the relapse-free interval.

[Treatment recommendations in psychiatric disability insurance expertises: are they helpful]. / Nützen Behandlungsempfehlungen in psychiatrischen versicherungsrechtlichen Gutachten?

BACKGROUND: In recent years the total number of people drawing a pension - especially for psychiatric reasons - from Switzerland's Federal Disability Insurance ("IV") has been steadily climbing. As we have revealed in earlier studies of persons applying for a disability pension for psychiatric reasons only 64 % had received psychiatric treatment and only 20 % adequate drug treatment . HYPOTHESIS: In this study we examined whether, treatment recommendations given by medical experts were followed and if so, how successfully. METHODS: In 40 patients who had got a psychiatric expertise in 2004 at the Psychiatric Outpatient Department, University of Basel, on behalf of the Swiss Disability Insurance, a 1-year follow-up was done and the results were compared. RESULTS: At reassessment significantly more patients (58 %) were in psychiatric-psychotherapeutic treatment than at first assessment (32 %). The recommended drug treatments were fully complied with in only 43 % of the cases; the recommended psychotherapy in only 9 % of the cases; and recommended in-patient treatment at a psychiatric hospital in only 14 % of the cases. During the time between evaluations, the seriousness of the condition had altered in a number of cases: in 33 % the condition had noticeably improved (e. g. from severe to mild depression) or was no longer present, and in 9 % the condition had worsened (e. g. from mild to severe depression). No significant relationship was found between compliance (full, partial or no implementation of recommended treatments) and change in illness severity. Partnership has been identified as the factor with the strongest influence on illness severity: in subjects who were married or living with a partner illness course was much better than in subjects without a stable partnership.

Improvements in physical and mental domains of quality of life by anti-ischaemic drug and revascularisation treatment in elderly men and women with chronic angina.

BACKGROUND: The severity of angina is related to a reduction in global quality of life (QoL), which may be improved by anti-ischaemic treatment. It is not known, however, whether improvements relate only to physical or also to mental and social domains of QoL and whether women benefit in a similar way to men. OBJECTIVES: To relate improvements in angina severity through anti-ischaemic treatment to physical and mental domains of QoL in elderly men and women and to assess differences in this relation between the sexes. METHODS: Angina severity and full assessment of QoL by structured, self-administered and validated questionnaires were measured prospectively at baseline and after 6 months' optimal drug or revascularisation treatment in all 301 patients of the Trial of Invasive versus Medical therapy in Elderly (TIME) patients with chronic angina. RESULTS: At baseline, angina severity correlated significantly with physical domains of QoL (trend test at least p<0.02) and daily activities (p = 0.05). At similar angina levels, women had significantly lower QoL scores than men. With anti-ischaemic treatment, physical as well as mental and social QoL domains and daily activities improved, together with a relief in angina (trend tests at least p<0.02). This was true for women and men and was more pronounced after revascularisation than with medical treatment. CONCLUSIONS: These findings confirm the relation between angina severity and physical limitation. In addition, they show that anti-ischaemic treatment not only relieves angina and improves physical components of QoL but also improves mental and social domains. This is true for women as well as for men despite the lower overall scores for women.

Exposure to indoor mould and children's respiratory health in the PATY study.

BACKGROUND: Living in a damp or mouldy home reportedly damages children's respiratory health, yet mould appears not to be a prominent risk factor in the public's perception. Analyses of data on over 58,000 children from the Pollution and the Young (PATY) study are presented. In this collaboration, researchers from 12 cross-sectional studies pooled their data to assess the effects of air quality on a spectrum of children's respiratory disorders. METHOD: Original studies were conducted in Russia, North America and 10 countries in Eastern and Western Europe. Pooled analyses were restricted to children aged 6-12 years. Associations between visible mould reported in the household and a spectrum of eight respiratory and allergic symptoms were estimated within each study. Logistic regressions were used, controlling for individual risk factors and for study area. Heterogeneity between study-specific results and mean effects (allowing for heterogeneity) were estimated using meta-analysis. RESULTS: Visible mould was reported by 13.9% of respondents in Russia, increasing to 39.1% in North America. Positive associations between exposure to mould and children's respiratory health were seen with considerable consistency across studies and across outcomes. Confounder-adjusted combined ORs ranged from 1.30 (95% CI 1.22 to 1.39) for "nocturnal cough" to 1.50 (1.31 to 1.73) for "morning cough". Evidence of stronger effects in more crowded households was statistically significant for only asthma and sensitivity to inhaled allergens. No consistent interactions between mould and age, sex or parental smoking were found. CONCLUSION: Indoor mould exposure was consistently associated with adverse respiratory health outcomes in children living in these diverse countries.

Reaction pattern to histamine and codeine in a human intradermal skin test model.

BACKGROUND: Skin prick and intradermal skin tests (IDT) are useful tools in evaluating IgE-mediated allergic disorders. In the literature, many variations of the techniques used are described. No general agreement exists on test procedures and reading of test results. OBJECTIVE: To analyse test conditions for IDT to facilitate comparability between different study protocols. METHODS: We tested 24 healthy volunteers with three concentrations of histamine and codeine each on the upper back, lateral upper arm and volar forearm, with/without addition of ethylene diamine tetra-acetic acid. Reading of the resulting weal was performed by taking a digital image of the weal, later outlining the weal perimeter in triplicate and calculating the weal area using the NIH Image J software version 1.3. RESULTS: Weal size was dose dependent for both substances, generally larger on the upper back than on the forearm and upper arm, and larger after codeine than after histamine. Addition of the Ca2+ -chelator ethylene diamine tetra-acetic acid did not significantly affect weal size. Weal size induced by histamine showed better consistency than that induced by codeine. CONCLUSIONS: The results and our technique provide valuable tools for the daily routine as well as for the ability to compare information of intradermal tests from different studies or clinical reports. When assessing skin reactivity, we recommend the use of 1 mg/mL codeine as well as 0.1 mg/mL histamine to reflect aspects of mast-cell releasability and of vascular reactivity. The involvement of local factors influencing the vascular reactivity or differences in opiate receptor density on mast cells surfaces needs to be addressed in future studies.

Trends in prevalence of asthma, allergic rhinitis and atopic dermatitis in 5-7-year old Swiss children from 1992 to 2001.

BACKGROUND: Changing occurrence rates of asthma, allergic rhinitis and atopic dermatitis are of public health concern and require surveillance. Changes in prevalence rates of these atopic diseases were monitored during 10 years and their trend with time was determined taking into account the influence of personal and environmental risk factors. METHODS: Four cross-sectional surveys in 5-7-year old children were performed in seven different communities in Switzerland between 1992 and 2001. Prevalence of respiratory and allergic symptoms and of affecting risk factors including parental environmental concern were assessed using a standardized parental questionnaire. RESULTS: A total of 988 (74.1%), 1778 (79.0%), 1406 (82.6%) and 1274 (78.9%) children participated, respectively, in the 1992, 1995, 1998 and 2001 surveys. Prevalence rates of asthma and hay fever symptoms remained quite stable over time (wheeze/past year: 8.8%, 7.8%, 6.4% and 7.4%, sneezing attack during pollen season: 5.0%, 5.6%, 5.4% and 4.6%). Rates of reported atopic dermatitis symptoms (specific skin rash/past year: 4.6%, 6.5%,7.4% and 7.6%) showed an increase over time, but those of diagnosis of eczema did not show a clear pattern (18.4%, 15.7%, 14.0% and 15.2%). Stratified analysis by parental environmental concern and by parental atopy showed similar trends. Rates of atopic dermatitis symptoms showed significant increase in girls but stayed stable in boys. CONCLUSION: Results of these four consecutive surveys suggest that the increase in prevalence of asthma and hay fever in 5-7-year old children living in Switzerland may have ceased. However, symptoms of atopic dermatitis may still be on the rise, especially among girls.

[Measles, mumps and rubella: vaccination rate and seroprevalence in 8th grade students of 8 different sites in Switzerland 1995/96]. / Masern, Mumps und Röteln: Durchimpfungsrate und Seroprävalenz bei 8.-Klässlern in acht verschiedenen Orten der Schweiz 1995/96.

In 1987, the Swiss Federal Health Office (BAG) and the Swiss cantons launched the MMR-vaccination campaign. Within the frame of the SCARPOL Study, the vaccination status of 649, 8th class students was registered and serum samples were collected. The measles, mumps and rubella specific antibody levels were determined. The vaccination rate was 84% for measles, 74% for mumps, and 62% for rubella, 55% of these children had been vaccinated with the combined vaccine MMR. The vaccination rate for the different study areas varied from 70% to 95% for measles, 42% to 94% for mumps and 18% to 89% for rubella, 92% of the children tested seropositive for measles specific antibodies, 87% for mumps and 84% for rubella. The seroprevalence for measles, mumps and rubella was significantly higher for vaccinated than for unvaccinated children. Non-Swiss children had, without exception, a higher seroprevalence rate than Swiss children. Undergoing the disease did not influence the seroprevalence for measles, but it did so for mumps and rubella, for vaccinated and unvaccinated children alike. By analysis according to study site, we observed that sites with higher vaccination rates (e.g. Grabs in Rheintal) sometimes showed a lower seroprevalence than sites with lower vaccination rates (e.g. Langnau). This was the case for all three vaccines. This, together with other observations, shows that a booster is necessary for an adequate immunisation--as a wild virus infection or as a second vaccination.