False positive dengue NS1 antigen test in a traveller with an acute Zika virus infection imported into Switzerland.

We report the first case of an acute Zika virus infection imported into Switzerland by a traveller returning from Canoa Quebrada, Ceará state, in the north-eastern part of Brazil. Due to a false positive dengue virus NS1 antigen test, IgG antibody seroconversion and a suggestive clinical picture,an acute dengue fever was initially considered. However, because of lack of specific IgM-antibodies, stationary IgG antibody titre and a negative dengue virus PCR test result, a dengue virus infection was excluded and a cross-reaction with other, causative flaviviruses was postulated. Based on recent reports of Zika fever cases in the north-eastern parts of Brazil, an acute Zika virus infection was suspected. Because of a lack of commercially available Zika virus diagnostic tests, the case was confirmed in the WHO reference laboratory. As the clinical presentation of Zika virus infection can be confused with dengue fever and chikungunya fever, and because of possible public health implications, all patients returning from affected areas should be additionally tested for Zika virus. This case illustrates the urgent medical need for a broadly available assay capable of differentiating Zika from Dengue infections.

Health technology assessment in Switzerland.

OBJECTIVES AND METHODS: To review Switzerland's mixed public and private healthcare system with regard to health technology assessment (HTA). RESULTS: In the past, remarkable work in HTA was done. Accomplishments include the following: (i) Switzerland became an early member of the International Network of Agencies for Health Technology Assessment. (ii) HTA has its legal bases in terms of effectiveness, appropriateness, and efficiency. (iii) The federal law allows the introduction of new technologies for a limited time for evaluation. (iv) A Swiss Network for Health Technology Assessment was established. In 2004, federal HTA activities moved from the Swiss Federal Office "of Social Security" to the one for "Public Health." The Office mainly mandates, manages, and coordinates evaluations attached to its prevention and intervention sections in the fields of AIDS, illegal drugs, and legal drugs. CONCLUSIONS: Because of the absence of a governmental institution assessing and reporting on new health technologies, private and for profit organizations became more important for the decision-making processes. In a regulated market, the implications may be crucial for the public health.

The Check Bus Project and its effectiveness on health promotion at work.

Employees of two large companies in Switzerland took part in a nationwide health information and promotion campaign at work, which included various physical examinations. A total of 5,849 consecutive participants were sent a questionnaire to determine whether changes had been made in their lifestyles and if they had benefited from participation; 2,361 (40.4%) responded. The campaign was rated highly at 8.3 on a scale from 1 to 10. Respondents reported benefiting most from the personal examination results, in particular the measurement of bone density, examination of the carotid arteries and discussions with the staff. Of the respondents, 921 stated they changed their lifestyle in the area of physical activity (64.4%) and nutrition (63.6%). Multiple logistic regression analysis showed the variables predictive of responding were age, hierarchy, diet and smoking. Health promotion at work and the choice of offered examinations may influence the effects of health care promotion at the workplace and the readiness of participants to improve their attitudes to health. Health promotion at work is highly regarded by employees who pay more attention to diet, smoke less and in particular those over 50 yr of age. High-tech equipment in a mobile unit may attract employers and employees may profit most from the individual examination results; 39% of the respondents stated they changed their lifestyle as a consequence of the Check Bus campaign.

Cross-sectional view of factors associated with back pain.

OBJECTIVE: To examine the factors associated with back pain within a working population. METHODS: A cross-sectional survey of employees using a self-administered questionnaire and physical fitness tests. This study assessed 10,321 participants (6,251 male and 4,070 female) of two nationwide companies throughout Switzerland between 1996 and 1998. The participation rate was 41%. RESULTS: Of the participants, 4,945 (48%) suffered mild back pain and 696 (7%) suffered severe back pain. Reported "stress" was associated with back pain of any intensity. Abdominal muscle strength was inversely associated with severe back pain, while physical activity was non-linearly associated with severe back pain. Smoking was directly associated with any intensity of back pain. The variables gender, obesity, strength of the abdominal musculature and frequency of physical activity were insignificant for back pain of any intensity in multivariate analyses. CONCLUSION: Our results confirm the association of back pain with physical and behavioural factors. The non-linear relationship between physical activity and back pain may need further examination. Performing any kind of sport three to four times a week appears optimal.

Assessment of indications in interventional cardiology: appropriateness and necessity of coronary angiography and revascularization.

In this study we present appropriateness and necessity assessments of coronary angiographies and revascularizations to determine adherence to Swiss guidelines by using the computerized second-opinion system (SOS) as a reference. We prospectively compared SOS ratings with ratings of treating cardiologists and surgeons for 203 coronary angiographies and 100 percutaneous transluminal coronary angioplasties. We also retrospectively assessed indications of 103 coronary artery bypass grafts. SOS ratings of appropriate, uncertain, and inappropriate indications for coronary angiography were 85.5%, 10%, and 4.5%, respectively, and 99.5%, 0.5%, and 0%, respectively, for revascularization. Corresponding clinicians' ratings were 95%, 4%, and 1% and 100%, 0%, and 0%, respectively. SOS ratings of necessary, uncertain, and unnecessary indications for angiography were 82.4%, 17.6%, and 0%, respectively, and 97%, 3%, and 0%, respectively, for revascularization. Corresponding clinicians' values were 88.2%, 10.6%, and 1.2% and 98%, 2%, and 0%, respectively. Significant statistical differences for coronary angiography were found for patients with acute myocardial infarction and for patients within 12 weeks of myocardial infarction. A high accordance between estimated SOS and clinically estimated appropriateness of procedures was found, which might suggest that the guidelines are valid. Regular validation and updating of the guidelines is highlighted. Possible overuse of angiography in patients within 12 weeks of myocardial infarction may need further investigation.

Awareness of vaccination status and its predictors among working people in Switzerland.

BACKGROUND: Adult vaccination status may be difficult to obtain, often requiring providers to rely on individual patient recall. To determine vaccination status awareness and the sociodemographic predictors of awareness for tetanus, hepatitis A and B, tick born encephalitis (TBE) and influenza vaccination. METHODS: Multivariate analyses were used to evaluate a questionnaire survey of 10,321 employees (4070 women and 6251 men aged 15-72 years) of two companies in Switzerland. RESULTS: Among 10,321 respondents, 75.5% reported knowing their tetanus vaccination status, 64.1% hepatitis A, 61.1% hepatitis B, 64.3% TBE and 71.9% influenza. Between 1 in 4 and 1 in 3 employees were not aware of their vaccination status. Differences in awareness for the five vaccinations considered correlated with gender and language. These differences persisted in multivariate analyses. CONCLUSION: Women employees, German-speaking employees and employees who paid more attention to their diet were more often aware of their vaccination status. A more reliable and readily accessible data source for vaccination status is needed in order to capitalize on opportunities to update vaccinations among Swiss employees.