Health of singleton neonates in Switzerland through time and crises: a cross-sectional study at the population level, 2007-2022.

BACKGROUND: Being exposed to crises during pregnancy can affect maternal health through stress exposure, which can in return impact neonatal health. We investigated temporal trends in neonatal outcomes in Switzerland between 2007 and 2022 and their variations depending on exposure to the economic crisis of 2008, the flu pandemic of 2009, heatwaves (2015 and 2018) and the COVID-19 pandemic. METHODS: Using individual cross-sectional data encompassing all births occurring in Switzerland at the monthly level (2007-2022), we analysed changes in birth weight and in the rates of preterm birth (PTB) and stillbirth through time with generalized additive models. We assessed whether the intensity or length of crisis exposure was associated with variations in these outcomes. Furthermore, we explored effects of exposure depending on trimesters of pregnancy. RESULTS: Over 1.2 million singleton births were included in our analyses. While birth weight and the rate of stillbirth have remained stable since 2007, the rate of PTB has declined by one percentage point. Exposure to the crises led to different results, but effect sizes were overall small. Exposure to COVID-19, irrespective of the pregnancy trimester, was associated with a higher birth weight (+12 grams [95% confidence interval (CI) 5.5 to 17.9 grams]). Being exposed to COVID-19 during the last trimester was associated with an increased risk of stillbirth (odds ratio 1.24 [95%CI 1.02 to 1.50]). Exposure to the 2008 economic crisis during pregnancy was not associated with any changes in neonatal health outcomes, while heatwave effect was difficult to interpret. CONCLUSION: Overall, maternal and neonatal health demonstrated resilience to the economic crisis and to the COVID-19 pandemic in a high-income country like Switzerland. However, the effect of exposure to the COVID-19 pandemic is dual, and the negative impact of maternal infection on pregnancy is well-documented. Stress exposure and economic constraint may also have had adverse effects among the most vulnerable subgroups of Switzerland. To investigate better the impact of heatwave exposure on neonatal health, weekly or daily-level data is needed, instead of monthly-level data.

Health of neonates born in the maternity hospital in Bern, Switzerland, 1880-1900 and 1914-1922.

The identification of factors impeding normal fetal development and growth is crucial for improving neonatal health. Historical studies are relevant because they show which parameters have influenced neonatal health in the past in order to better understand the present. We studied temporal changes of neonatal health outcomes (birth weight, gestational age, stillbirth rate) and the influence of different cofactors in two time periods. Moreover, we investigated particularly neonatal health in the wake of the 1918/19 influenza pandemic. Data were transcribed from the Bern Maternity Hospital and consists of two time periods: A) The years 1880, 1885, 1890, 1895 and 1900 (N = 1530, births' coverage 20%); B) The years 1914-1922 (N = 6924, births' coverage 40-50%). Linear regression models were used to estimate the effect of birth year on birth weight, and logistic regression models to estimate the effect of birth year and of the exposure to the pandemic on premature birth, stillborn and low birth weight (LBW). Mean birth weight increased only minimally between the two datasets; whereas, in the years 1914-1922, the preterm birth and stillbirth rates were markedly reduced compared with the years 1880-1900. Sex, parity, gestational age and maternal age were significantly associated with birth weight in both time periods. The probability of LBW was significantly increased in 1918 (OR 1.49 (95% CI 1.00-2.23)) and in 1919 (OR 1.55 (95% CI 1.02-2.36)) compared to 1914. Mothers who were heavily exposed to the influenza pandemic during pregnancy had a higher risk of stillbirth (OR 2.27 (95% CI 1.32-3.9)). This study demonstrated that factors influencing neonatal health are multifactorial but similar in both time periods. Moreover, the exposure to the 1918/19 pandemic was less associated with LBW and more associated with an increased risk of stillbirth. If this trend is confirmed by further studies, it could indicate some consistency across pandemics, as similar patterns have recently been shown for COVID-19.

Associations between 3D surface scanner derived anthropometric measurements and body composition in a cross-sectional study.

BACKGROUND: 3D laser-based photonic scanners are increasingly used in health studies to estimate body composition. However, too little is known about whether various 3D body scan measures estimate body composition better than single standard anthropometric measures, and which body scans best estimate it. Furthermore, little is known about differences by sex and age. METHODS: 105 men and 96 women aged between 18 and 90 years were analysed. Bioelectrical Impedance Analysis was used to estimate whole relative fat mass (RFM), visceral adipose tissue (VAT) and skeletal muscle mass index (SMI). An Anthroscan VITUSbodyscan was used to obtain 3D body scans (e.g. volumes, circumferences, lengths). To reduce the number of possible predictors that could predict RFM, VAT and SMI backward elimination was performed. With these selected predictors linear regression on the respective body compositions was performed and the explained variations were compared with models using standard anthropometric measurements (Body Mass Index (BMI), waist circumference (WC) and waist-to-height-ratio (WHtR)). RESULTS: Among the models based on standard anthropometric measures, WC performed better than BMI and WHtR in estimating body composition in men and women. The explained variations in models including body scan variables are consistently higher than those from standard anthropometrics models, with an increase in explained variations between 5% (RFM for men) and 10% (SMI for men). Furthermore, the explained variation of body composition was additionally increased when age and lifestyle variables were added. For each of the body composition variables, the number of predictors differed between men and women, but included mostly volumes and circumferences in the central waist/chest/hip area and the thighs. CONCLUSIONS: 3D scan models performed better than standard anthropometric measures models to predict body composition. Therefore, it is an advantage for larger health studies to look at body composition more holistically using 3D full body surface scans.

From pandemic to endemic: Spatial-temporal patterns of influenza-like illness incidence in a Swiss canton, 1918-1924.

In pandemics, past and present, there is no textbook definition of when a pandemic is over, and how and when exactly a respiratory virus transitions from pandemic to endemic spread. In this paper we have compared the 1918/19 influenza pandemic and the subsequent spread of seasonal flu until 1924. We analysed 14,125 reports of newly stated 32,198 influenza-like illnesses from the Swiss canton of Bern. We analysed the temporal and spatial spread at the level of 497 municipalities, 9 regions, and the entire canton. We calculated incidence rates per 1000 inhabitants of newly registered cases per calendar week. Further, we illustrated the incidences of each municipality for each wave (first wave in summer 1918, second wave in fall/winter 1918/19, the strong later wave in early 1920, as well as the two seasonal waves in 1922 and 1924) on a choropleth map. We performed a spatial hotspot analysis to identify spatial clusters in each wave, using the Gi* statistic. Furthermore, we applied a robust negative binomial regression to estimate the association between selected explanatory variables and incidence on the ecological level. We show that the pandemic transitioned to endemic spread in several waves (including another strong wave in February 1920) with lower incidence and rather local spread until 1924 at least. At the municipality and regional levels, there were different patterns of spread both between pandemic and seasonal waves. In the first pandemic wave in summer 1918 the probability of higher incidence was increased in municipalities with a higher proportion of factories (OR 2.60, 95%CI 1.42-4.96), as well as in municipalities that had access to a railway station (OR 1.50, 95%CI 1.16-1.96). In contrast, the strong fall/winter wave 1918 was very widespread throughout the canton. In general, municipalities at higher altitude showed lower incidence. Our study adds to the sparse literature on incidence in the 1918/19 pandemic and subsequent years. Before Covid-19, the last pandemic that occurred in several waves and then became endemic was the 1918-19 pandemic. Such scenarios from the past can inform pandemic planning and preparedness in future outbreaks.

Intergenerational transmission of height in a historical population: From taller mothers to larger offspring at birth (and as adults).

Changes in growth and height reflect changes in nutritional status and health. The systematic surveillance of growth can suggest areas for interventions. Moreover, phenotypic variation has a strong intergenerational component. There is a lack of historical family data that can be used to track the transmission of height over subsequent generations. Maternal height is a proxy for conditions experienced by one generation that relates to the health/growth of future generations. Cross-sectional/cohort studies have shown that shorter maternal height is closely associated with lower birth weight of offspring. We analyzed the maternal height and offspring weight at birth in the maternity hospital in Basel, Switzerland, from 1896 to 1939 (N = ∼12,000) using generalized additive models (GAMs). We observed that average height of the mothers increased by ∼4 cm across 60 birth years and that average birth weight of their children shows a similarly shaped and upward trend 28 years later. Our final model (adjusted for year, parity, sex of the child, gestational age, and maternal birth year) revealed a significant and almost linear association between maternal height and birth weight. Maternal height was the second most important variable modeling birth weight, after gestational age. In addition, we found a significant association between maternal height and aggregated average height of males from the same birth years at time of conscription, 19 years later. Our results have implications for public health: When (female/maternal) height increases due to improved nutritional status, size at birth-and subsequently also the height in adulthood of the next generation-increases as well. However, the directions of development in this regard may currently differ depending on the world region.

Reinfections and Cross-Protection in the 1918/19 Influenza Pandemic: Revisiting a Survey Among Male and Female Factory Workers.

Objectives: The COVID-19 pandemic highlights questions regarding reinfections and immunity resulting from vaccination and/or previous illness. Studies addressing related questions for historical pandemics are limited. Methods: We revisit an unnoticed archival source on the 1918/19 influenza pandemic. We analysed individual responses to a medical survey completed by an entire factory workforce in Western Switzerland in 1919. Results: Among the total of n = 820 factory workers, 50.2% reported influenza-related illness during the pandemic, the majority of whom reported severe illness. Among male workers 47.4% reported an illness vs. 58.5% of female workers, although this might be explained by varied age distribution for each sex (median age was 31 years old for men, vs. 22 years old for females). Among those who reported illness, 15.3% reported reinfections. Reinfection rates increased across the three pandemic waves. The majority of subsequent infections were reported to be as severe as the first infection, if not more. Illness during the first wave, in the summer of 1918, was associated with a 35.9% (95%CI, 15.7-51.1) protective effect against reinfections during later waves. Conclusion: Our study draws attention to a forgotten constant between multi-wave pandemics triggered by respiratory viruses: Reinfection and cross-protection have been and continue to be a key topic for health authorities and physicians in pandemics, becoming increasingly important as the number of waves increases.

Body height among adult male and female Swiss Health Survey participants in 2017: Trends by birth years and associations with self-reported health status and life satisfaction.

The increase in adult height for 150 years is linked to overall improvements in nutrition, hygiene, and living standards. Height is positively associated with general health and success on various levels (e.g. quality of life, earnings or happiness). The aim of this study was to investigate whether different subgroups show different trends across birth cohorts. We wanted to know whether taller individuals considered themselves as healthier and their quality of life as better than shorter individuals. We included 19,435 participants from the Swiss population-based Health Survey 2017. GAM were used to assess nonlinear associations between height and birth year. Multinomial logistic regression was used to predict probabilities of self-rated health in relation to height. The increase in average height slows down from the 1970s birth cohorts. Participants with parents from Central/Northern/Western Europe (men 177.9 cm, women: 165.1 cm) or Eastern Europe (men 178.7 cm, women: 165.7 cm) were taller than participants with parents from South America (men 174.3 cm, women: 161. cm) and Asia (men 173.2 cm, women: 160.1 cm). Participants with tertiary education were taller than participants from education levels (mean difference men: 4.5 cm, women: 5.0 cm). Height was positively associated with self-declared aspects of health and life satisfaction. These results support the conclusion that body height as a co-factor of health aspects should be considered in public health research. Although adult body height can no longer be influenced, nutritional status and thus also healthy growth can be influenced in childhood by public health programs, by eliminating social inequalities, and by strengthen healthy living conditions.

A quantitative synthesis study on body mass index and associated factors among adult men and women in Switzerland.

Excess weight is caused by multiple factors and has increased sharply in Switzerland since the 1990s. Its consequences represent a major challenge for Switzerland, both in terms of health and the economy. Until now, there has been no cross-dataset overview study on excess weight in adults in Switzerland. Therefore, our aim was to conduct the first synthesis on excess weight in Switzerland. We included all existing nationwide Swiss studies (eight total), which included information on body mass index (BMI). Mixed multinomial logistic regression analyses were performed to assess the associations between different socio-demographic, lifestyle cofactors and the World Health Organization (WHO) categories for BMI. Along with lifestyle factors, socio-demographic factors were among the strongest determinants of BMI. In addition, self-rated health status was significantly lower for underweight, pre-obese and obese men and women than for normal weight persons. The present study is the first to synthesise all nationwide evidence on the importance of several socio-demographic and lifestyle factors as risk factors for excess weight. In particular, the highlighted importance of lifestyle factors for excess weight opens up the opportunity for further public health interventions.

Body height in adult women and men in a cross-sectional population-based survey in Geneva: temporal trends, association with general health status and height loss after age 50.

OBJECTIVE: On the one hand, trends in average height in adulthood mirror changes in living standard and health status of a population and its subgroups; on the other hand, height in general, as well as the loss of height in older age in particular, are associated in different ways with outcomes for health. For these aspects, there is hardly any information for Switzerland based on representative and measured body height data. DESIGN: Repeated cross-sectional survey study. SETTING: Fully anonymised data from the representative population-based Geneva Bus Santé Study between 2005 and 2017 were analysed. METHODS: Data from N=8686 study participants were used in the trend analysis. Height was measured and sociodemographic information and self-rated health was collected via questionnaires. Follow-up (mean: 7.1 years) measurements from N=2112 participants were available to assess height loss after age 50. RESULTS: Women were, on average, 166.2 cm (SD 6.5) tall and men 179.2 cm (SD 6.5). Among men and women, higher socioeconomic status was associated with taller average height. The flattening of the increase in height from the 1970s birth years appears to begin earlier in the subgroup with the highest education level. The tallest average height was measured for men and women from Central and Northern Europe, the shortest for South America and Asia. The likelihood that participants rated their health as 'very good' increased with greater body height. The follow-up data show that men lost -0.11 cm per follow-up year (95% CI -0.12 to -0.10), women -0.17 cm (95% CI -0.18 to 0.15). CONCLUSIONS: The association of height and health status is currently understudied. Monitoring changes in average body height may indicate disparities in different subgroups of populations. Based on our study and a growing literature, we think that the multifaceted role of body height should be better considered in clinical practice.

Associations between hydration status, body composition, sociodemographic and lifestyle factors in the general population: a cross-sectional study.

BACKGROUND: Whole-body hydration status is associated with several health outcomes, such as dehydration, edema and hypertension, but little is known about the nonclinical determinants. Therefore, we studied the associations of sex, age, body composition, nutrition, and physical activity on several body hydration measures. METHODS: We assessed sociodemographic variables, dietary habits, and physical activity by questionnaire and body composition by bioelectric impedance analysis (BIA). We compared determinants between the sexes and calculated associations between determinants and BIVA hydration measures by multivariable linear regressions. RESULTS: A total of 242 adults from the general population (age 18-94, 47% women) were included. Women were younger, smaller, lighter, and had a smaller BMI (kg/m2) than men (p < 0.05). Women had less muscle mass, less visceral fat mass and less extracellular and intracellular water than men (p < 0.001). Women showed less intracellular water per extracellular water than men, while men showed higher phase angle values than women (both p < 0.001). Men had a stronger association of hydration measures with physical activity than women. Both sexes showed a decrease in hydration measures with age. CONCLUSIONS: Sex, age, body composition, and physical activity influence body hydration. There seem to be differences in body water regulation between the sexes. Especially interesting are factors susceptible to preventive measures such as physical activity.

The role of body height as a co-factor of excess weight in Switzerland.

OBJECT: Excess weight (Body Mass Index [BMI] ≥25.0 kg/m2 ) is a major health issue worldwide, including in Switzerland. For high-income countries, little attention has been paid to body height in context of excess weight. The aim of this study is to assess the importance of body height as a co-factor for excess weight in multiple large nationwide data sets. DATA AND METHODS: In this comparative study, we included the largest nationwide and population-based studies in the fields of public health, nutrition and economics for Switzerland, as well as data of the medical examination during conscription for the Swiss Armed Forces, which contained information on BMI and, if possible, waist-to-height-ratio (WHtR) and waist-to-hip-ratio (WHR). RESULTS: The multinomial logistic regressions show that the probability of belonging to the excess weight category (BMI ≥25.0 kg/m2 ) decreased with increasing height in both sexes inall contemporary data sets. This negative association was shown to be constant, only among conscripts measured in the 1870s the association was positive, when increasing height was associated with a higher BMI. The negative association not only emerge in BMI, but also in WHtR and WHR. CONCLUSION: Our results emphasize the importance of body height as a co-factor of excess weight, suggesting a clear negative association between height and BMI, WHtR and WHR. Evidence indicates that both early-life environmental exposures and alleles associated with height may contribute to these associations. This knowledge could serve as further starting points for prevention programs in the field of public health.

Historically High Excess Mortality During the COVID-19 Pandemic in Switzerland, Sweden, and Spain.

BACKGROUND: Excess mortality quantifies the overall mortality impact of a pandemic. Mortality data have been accessible for many countries in recent decades, but few continuous data have been available for longer periods. OBJECTIVE: To assess the historical dimension of the COVID-19 pandemic in 2020 for 3 countries with reliable death count data over an uninterrupted span of more than 100 years. DESIGN: Observational study. SETTING: Switzerland, Sweden, and Spain, which were militarily neutral and not involved in combat during either world war and have not been affected by significant changes in their territory since the end of the 19th century. PARTICIPANTS: Complete populations of these 3 countries. MEASUREMENTS: Continuous series of recorded deaths (from all causes) by month from the earliest available year (1877 for Switzerland, 1851 for Sweden, and 1908 for Spain) were jointly modeled with annual age group-specific death and total population counts using negative binomial and multinomial models, which accounted for temporal trends and seasonal variability of prepandemic years. The aim was to estimate the expected number of deaths in a pandemic year for a nonpandemic scenario and the difference in observed and expected deaths aggregated over the year. RESULTS: In 2020, the number of excess deaths recorded per 100 000 persons was 100 (95% credible interval [CrI], 60 to 135) for Switzerland, 75 (CrI, 40 to 105) for Sweden, and 155 (CrI, 110 to 195) for Spain. In 1918, excess mortality was 6 to 7 times higher. In all 3 countries, the peaks of monthly excess mortality in 2020 were greater than most monthly excess mortality since 1918, including many peaks due to seasonal influenza and heat waves during that period. LIMITATION: Historical vital statistics might be affected by minor completeness issues before the beginning of the 20th century. CONCLUSION: In 2020, the COVID-19 pandemic led to the second-largest infection-related mortality disaster in Switzerland, Sweden, and Spain since the beginning of the 20th century. PRIMARY FUNDING SOURCE: Foundation for Research in Science and the Humanities at the University of Zurich, Swiss National Science Foundation, and National Institute of Allergy and Infectious Diseases.

Risk for Invasive Cancers in Women With Breast Cancer In Situ: Results From a Population Not Covered by Organized Mammographic Screening.

BACKGROUND: Even though breast cancer in situ (BCIS) incidence has been increasing, the prognosis of BCIS patients has not been extensively investigated. According to the literature, women with BCIS have a higher risk of developing subsequent invasive breast cancer; conflicting information has been reported regarding their potential risk for a subsequent invasive non-breast cancer. METHODS: Data from 1,082 women, whose first-ever cancer diagnosis was primary BCIS between 2003 and 2015 and were living in the canton of Zurich, were used. Standardized incidence ratios (SIRs) were calculated to compare the risk of an invasive breast or non-breast cancer among women with a primary BCIS with the corresponding risk of the adult female population. SIRs were calculated overall and by patient and tumor characteristics. To investigate potential risk factors (e.g., age at diagnosis, treatment) for a subsequent invasive breast or non-breast cancer we used Cox proportional hazards regression models. RESULTS: BCIS patients had 6.85 times [95% confidence interval (CI): 5.52-8.41] higher risk of being diagnosed with invasive breast cancer compared to the general population. They additionally faced 1.57 times (95% CI: 1.12-2.12) higher risk of an invasive non-breast cancer. The SIRs were higher for women < 50-years old for both invasive breast and non-breast cancer at BCIS diagnosis. Age ≥ 70-years old at BCIS diagnosis was statistically significantly associated with a subsequent invasive non-breast cancer diagnosis. CONCLUSIONS: BCIS patients had a higher risk of being diagnosed with invasive breast and non-breast cancer compared to the general population. Age 70 years or older at BCIS diagnosis was the only risk factor statistically significantly associated with a subsequent invasive non-breast cancer. Our results support the increased risk for subsequent cancers in BCIS patients reported in the literature. Future studies should establish the risk factors for subsequent cancers, highlight the need for intensive monitoring in this population, and help distinguish BCIS patients who could benefit from systemic therapy to prevent distant cancers.

Public Health Interventions, Epidemic Growth, and Regional Variation of the 1918 Influenza Pandemic Outbreak in a Swiss Canton and Its Greater Regions.

Public health interventions implemented during the coronavirus disease 2019 (COVID-19) pandemic are based on experience gained from past pandemics. The 1918 influenza pandemic is the most extensively researched historical influenza outbreak. All 9335 reports available in the State Archives on 121 152 cases of influenza-like illness from the canton of Bern from 473 of 497 municipalities (95.2%) were collected; the cases were registered between 30 June 1918 and 30 June 1919. The overall incidence rates of newly registered cases per week for the 9 greater regions of Bern for both the first and second waves of the pandemic were calculated. Relative incidence rate ratios (RIRRs) were calculated to estimate the change in the slope of incidence curves associated with public health interventions. During the first wave, school closures (RIRR, 0.16 [95% CI, 0.15 to 0.17]) and restrictions of mass gatherings (RIRR, 0.57 [CI, 0.54 to 0.61]) were associated with a deceleration of epidemic growth. During the second wave, in autumn 1918, cantonal authorities initially reacted hesitantly and delegated the responsibility to enact interventions to municipal authorities, which was associated with a lack of containment of the second wave. A premature relaxation of restrictions on mass gatherings was associated with a resurgence of the epidemic (RIRR, 1.18 [CI, 1.12 to 1.25]). Strikingly similar patterns were found in the management of the COVID-19 outbreak in Switzerland, with a considerably higher amplitude and prolonged duration of the second wave and much higher associated rates of hospitalization and mortality.

Residential Altitude Associates With Endurance but Not Muscle Power in Young Swiss Men.

INTRODUCTION: Physical fitness benefits health. However, there is a research gap on how physical fitness, particularly aerobic endurance capacity and muscle power, is influenced by residential altitude, blood parameters, weight, and other cofactors in a population living at low to moderate altitudes (300-2100 masl). MATERIALS AND METHODS: We explored how endurance and muscle power performance changes with residential altitude, Body Mass Index (BMI), hemoglobin and creatinine levels among 108,677 Swiss men aged 18-22 years (covering >90% of Swiss birth cohorts) conscripted to the Swiss Armed Forces between 2007 and 2012. The test battery included a blood test of about 65%, a physical evaluation of about 85%, and the BMI of all conscripts. RESULTS: Residential altitude was significantly associated with endurance (p < 0.001) but not with muscle power performance (p = 0.858) after adjusting for all available cofactors. Higher BMI showed the greatest negative association with both endurance and muscle power performance. For muscle power performance, the association with creatinine levels was significant. Elevated C-reactive protein (CRP) and hemoglobin levels were stronger contributors in explaining endurance than muscle power performance. CONCLUSION: We found a significant association between low to moderate residential altitude and aerobic endurance capacity even after adjustment for hemoglobin, creatinine, BMI and sociodemographic factors. Non-assessed factors such as vitamin D levels, air pollution, and lifestyle aspects may explain the presented remaining association partially and could also be associated with residential altitude. Monitoring the health and fitness of young people and their determinants is important and of practical concern for disease prevention and public health implications.

Impact of World War 1 on placenta weight, birth weight and other anthropometric parameters of neonatal health.

BACKGROUND: Wars do not only affect combatant countries, populations in neutral zones can be afflicted by circumjacent conflicts as well, posing a great health burden on mothers and newborns. As neonatal health remains an ongoing cause for concern, identifying determinants that impede fetal growth is crucial. Under this pretext, the study aimed to analyze the impact of World War 1 in the neutral city of Basel on neonatal health by assessing changes in anthropometric parameters. METHODS: A retrospective analysis of yearly cross sections of term births in the maternity hospital of Basel from 1912 to 1923 was conducted (n = 3718). We tested adjusted anthropometry for time trends in comparison to a pre-war baseline, including birth weight, placenta weight, birth length, ponderal index and gestational age. Interrelations of placenta weights and birth weights were examined separately through birth weight to placenta weight (BW/PW) ratios and residuals of placenta weight to birth weight regressions. RESULTS: Birth weights, placenta weights and residuals were at their lowest in 1918/19, a trend not reflected in BW/PW ratios. Birth lengths remained low while ponderal indexes declined during the entire period of war, gestational age remained rather stable. DISCUSSION: 1918/19 were the pinnacle years for the population of Basel, who were suffering from general detrimental economic conditions, a food supply crisis and an outbreak of the Spanish Flu. These adverse circumstances coincided with low birth and placenta weights, residuals depicting the correlation of birth weights to placental weights more closely than bw/pw ratios.

Correction to: The relative risk of second primary cancers in Switzerland: a population-based retrospective cohort study.

Following publication of the original article [1], an error was reported in the author group. The correct author group should read as follows.

The relative risk of second primary cancers in Switzerland: a population-based retrospective cohort study.

BACKGROUND: More people than ever before are currently living with a diagnosis of cancer and the number of people concerned is likely to continue to rise. Cancer survivors are at risk of developing a second primary cancer (SPC). This study aims to investigate the risk of SPC in Switzerland. METHODS: The study cohort included all patients with a first primary cancer recorded in 9 Swiss population-based cancer registries 1981-2009 who had a minimum survival of 6 months, and a potential follow-up until the end of 2014. We calculated standardized incidence ratios (SIR) to estimate relative risks (RR) of SPC in cancer survivors compared with the cancer risk of the general population. SIR were stratified by type of first cancer, sex, age and period of first diagnosis, survival period and site of SPC. RESULTS: A total of 33,793 SPC were observed in 310,113 cancer patients. Both male (SIR 1.18, 95%CI 1.16-1.19) and female (SIR 1.20, 95%CI 1.18-1.22) cancer survivors had an elevated risk of developing a SPC. Risk estimates varied substantially according to type of first cancer and were highest in patients initially diagnosed with cancer of the oral cavity and pharynx, Hodgkin lymphoma, laryngeal, oesophageal, or lung cancer. Age-stratified analyses revealed a tendency towards higher RR in patients first diagnosed at younger ages. Stratified by survival period, risk estimates showed a rising trend with increasing time from the initial diagnosis. We observed strong associations between particular types of first and SPC, i.e. cancer types sharing common risk factors such as smoking or alcohol consumption (e.g. repeated cancer of the oral cavity and pharynx (SIRmales 20.12, 95%CI 17.91-22.33; SIRfemales 37.87, 95%CI 30.27-45.48). CONCLUSION: Swiss cancer survivors have an increased risk of developing a SPC compared to the general population, particularly patients first diagnosed before age 50 and those surviving more than 10 years. Cancer patients should remain under continued surveillance not only for recurrent cancers but also for new cancers. Some first and SPCs share lifestyle associated risk factors making it important to promote healthier lifestyles in both the general population and cancer survivors.

Clash of the pandemics - At least 150'000 adults in Switzerland suffer from obesity grades 2 or 3 and are thus at elevated risk for severe COVID-19.

Background: Grade 2 and 3 obesity, alongside with other relevant risk factors, are substantially and independently associated with adverse outcomes of coronavirus disease 2019 (COVID-19). However, for Switzerland, due to the lack of synthesis studies, it is currently unknown how many people are affected by obesity at all. This knowledge may help to better estimate the relevance and size of this group at elevated risk, which could be incorporated into strategies to protect risk groups during the still unfolding COVID-19 pandemic. This study aimed to provide a first overall estimation of how many people in Switzerland are currently affected by grade 2 or 3 obesity. Methods: Five representative national population-based studies were accessed which were conducted between 2012 and 2017 and which include data on height and weight of adult men and women in Switzerland. Results: In Switzerland in 2012-2017, among the 11.20% adults who were obese (body mass index (BMI) ≥30.0kg/m2), 1.76% (95% CI 1.50-2.02) suffered from grade 2 obesity (BMI 35.0-39.9 kg/m2), and 0.58% (95% CI 0.50-0.66) from grade severe 3 obesity (BMI ≥40.0 kg/m2). Converted into estimated absolute population numbers, this corresponds to a total of approximately n=154,515 people who suffer from grade 2 or 3 obesity (n=116,216 and n=38,298, respectively). Conclusions: This risk group includes many younger people in Switzerland. The number of people with obesity-related risk becomes 3.8 to 13.6 times higher if grade 1 obesity and overweight people are also included in this risk group, for which there are arguments arising in the latest literature. In general, this large group at risk for severe COVID-19 should be given more attention and support. If it is confirmed that obesity plays a major role in severe COVID-19 courses, then every kilo of body weight that is not gained or that is lost in lockdown counts.