Risk factors at the low end of the psychosis continuum: much the same as at the upper end?

We investigated risk factors for subclinical symptoms of psychosis, and focused on two psychosis dimensions previously identified in the Zurich Study, namely "schizophrenia nuclear symptoms" and "schizotypal signs". We examined the data from 9814 Swiss conscripts from 2003. The psychosis symptom dimensions were derived from the Symptom-Checklist-90-R (SCL-90-R), and were regressed on a broad range of known risk factors for psychosis. Risk factors typically assigned to schizophrenia and other psychotic disorders - cannabis use, childhood adversity, reading and writing difficulties, attention deficit hyperactivity disorder (ADHD), psychiatric disorders and addiction in parents and the extended family - are relevant also at subclinical levels. Our analyses suggested that specific risk factors may be assigned to distinct psychosis dimensions, as previously determined in an analysis from the Zurich Study. If there are different pathways to psychosis characterized by specific symptom dimensions and risk factors, they mostly co-exist and interact at different symptom load levels.

Risk factors for stuttering: a secondary analysis of a large data base.

The spectrum of risk and concomitant factors in stuttering is generally thought to be wide and heterogeneous. However, only a few studies have examined these factors using information from large databases. We examined the data on 11,905 Swiss conscripts from 2003. All cases with high psychiatric screening scores indicating "caseness" for a psychiatric disorder were excluded, among them potential malingerers, so that 9,814 records remained. The analyses rely on self-reported information about stuttering in childhood, problems at birth, problems in school, mental disorders of parents and relatives, childhood adversity and socio-demographic information. Statistical modelling was done using logistic regression and path analysis models. Risk factors determined in the logistic regression include premature birth, probable attention deficit hyperactive disorder, alcohol abuse of the parents, obsessive-compulsive disorder in parents and relatives, having a disabled mother and having a parent from a foreign country. There is no overwhelmingly strong risk factor; all odds ratios are about 2 or below. In conclusion, large databases are helpful in revealing less obvious and less frequent risk factors for heterogeneous disorders such as stuttering. Obviously, not only secondary analyses, but also systematical large scale studies would be required to complete the complex epidemiological puzzle in stuttering. An extensive examination of young adults who were initially assessed in childhood might provide the most promising design.

Body mass index, blood pressure, and serum cholesterol in young Swiss men: an analysis on 56784 army conscripts.

QUESTIONS UNDER STUDY: This study aimed to investigate the prevalence of excess bodyweight and high blood pressure in young Swiss men and to evaluate the associations of these disorders with serum cholesterol in this important population. METHODS: The study investigated a large cohort of 56784 Swiss army conscripts aged 18-25 years from 2004 through to 2007. RESULTS: From the investigated men, 2231 (3.9%) were underweight with a body mass index (BMI) <18.5 kg/m2, 42681 (75.2%) were normal weight (BMI 18.5-24.9 kg/m2), 9562 (16.8%) were overweight (BMI 25.0-29.9 kg/m2), and 1811 (3.2%), 402 (0.7%) and 96 (0.2%) had obesity classes I, II or III, respectively. The prevalence of blood pressure within the hypertensive range significantly increased through these categories of BMI (12.5%, 23.9%, 37.6%, 49.7%, 56.7%, and 54.2%), as did serum levels of cholesterol (3.8 +/- 0.6, 4.0 +/- 0.7, 4.4 +/- 0.8, 4.7 +/- 0.9, 4.7 +/- 0.9, and 4.8 +/- 1.1 mmol/l). Serum cholesterol also increased through categories of blood pressure (4.0 +/- 0.7 mmol/l in normotensive subjects and 4.1 +/- 0.7, 4.2 +/- 0.8, and 4.5 +/- 0.9 in those with blood pressure in the ranges of pre-hypertension, and hypertension stages 1 and 2, respectively); excess body weight and blood pressure in the hypertensive range were associated with serum cholesterol in a mutually independent manner. CONCLUSIONS: Prevalence rates of excess bodyweight and of elevated blood pressure are high in young Swiss men, and these entities are strongly interrelated. Excess body weight and high blood pressure are independently associated with high serum cholesterol in this population. Excess bodyweight and associated risk factors should receive increased attention in young Swiss men.

The pattern of psychopathology associated with malingering tendencies at basic psychiatric screening of the Swiss Armed Forces.

This study uses military recruitment data, collected in 2003 from Swiss Armed Forces conscripts, to observe the pattern of psychopathology and addictive behavior for conscripts identified as those with malingering tendencies. To that end, we first applied Derogatis' criterion for the Symptom Checklist 90 Revised to identify recruits with malingering tendencies. We then used bivariate methods (t test and chi2 tests) to compare self-reported psychopathology and addictive behavior of such recruits to that of recruits not identified as potential malingerers. We find that recruits with malingering tendencies have significantly higher mean scores in all psychopathological symptom dimensions and addictive behaviors than recruits without malingering tendencies. The results suggest that the Symptom Checklist 90 Revised is well suited as a screening for malingerers in nonpatients and conscripts.

[Growing importance of the Coordinated Medical Services]. / Steigende Bedeutung des Koordinierten Sanitätsdienstes.

Diminishing resources and growing risks call more than ever for optimum coordination of all medical assets between the different partners, so that all patients can be given the best possible medical support in all situations. The significance of the Coordinated Medical Services (CMS) has been underlined by the new ordinance which entered into force on 1 June 2005.

Respiratory symptoms and smoking behaviour in Swiss conscripts.

AIM: Smoking is a major health hazard in young adults. Reducing smoking is the only well established effective primary prevention of chronic obstructive pulmonary disease. We undertook a prospective cross sectional study to determine the prevalence of respiratory symptoms, smoking behaviour and willingness to participate in a smoking cessation program in Swiss conscripts. METHODS: Conscripts completed a standardized questionnaire on respiratory symptoms, asthma and smoking behaviour and underwent spirometry measurement. RESULTS: 2604 conscripts were included. 1252 (48%) were current smokers, 144 (6%) were former smokers, 111 (4%) were recent beginners or low intensity smokers and 1097 (42%) were never smokers. Respiratory symptoms were significantly higher in smokers compared to never smokers (wheezing 16% vs. 7%, wheezing without cold 9% vs. 4%, exercise dyspnoea 15% vs. 10%, regular cough 35% vs. 10% and regular phlegm 15% vs. 2%). The mean score of the Fagerstrom Test for Nicotine Dependency (FTND) was 2.6 (+/-2.1). According to the transtheoretical model of stage of change 50% were in the precontemplation, 34% in the contemplation, 5% in the preparation, 5% in the action and 6% in the maintenance stage. Amongst the current smokers 33% were willing to participate in a smoking cessation program. Those willing to participate in a smoking cessation program included 17% precontemplators and 53% contemplators. CONCLUSION: There is a high prevalence of respiratory symptoms in young current smokers. The Fagerstrom Test for Nicotine Dependence score in conscripts is low thus favouring a potentially successful outcome of a smoking cessation intervention. Using motivational stages to tailor smoking cessation aids might preclude adequate interventions in individuals belonging to the precontemplation stage.

Mass casualty incidents with multiple burn victims: rationale for a Swiss burn plan.

INTRODUCTION: Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland. METHODS: Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles. RESULTS: Since hospitals have limited surge capacities in the event of burn disasters, a special approach to both prehospital and hospital management of these victims is required. Specialized rescue and care can be adequately met and at all levels of needs by deploying mobile burn teams to the scene. These burn teams can bring needed skills and enhance the efficiency of the classical disaster response teams. Burn teams assist with both primary and secondary triage, contribute to initial patient management and offer advice to non-specialized designated hospitals that provide acute care for burn patients with Total Burn Surface Area (TBSA) <20-30%. The main components required for successful deployments of mobile burn teams include socio-economic feasibility, streamlined logistical implementation as well as partnership coordination with other agencies including subsidiary military resources. CONCLUSIONS: Disaster preparedness plans involving burn specialists dispatched from a referral burn center can upgrade and significantly improve prehospital rescue outcome, initial resuscitation care and help prevent an overload to hospital surge capacities in case of multiple burn victims. This is the rationale behind the ongoing development and implementation of the Swiss burn plan.

Antecedents and covariates of alcohol consumption among Swiss male conscripts.

This study aimed to investigate prevalence and correlates of alcohol consumption frequency in a sample of Swiss conscripts (n=25,611) in order to identify factors that predispose for frequent consumption. A self-report of drinking frequencies, as well as socio-demographic and psychosocial variables, was collected at psychiatric baseline screening. Based on univariate analyses, relevant variables were included in a multivariate multinomial logistic regression model. Six percent were abstainers, 15% reported rarely drinking, 53% occasional drinking, 24% regular drinking and 2% daily drinking. Except for substance use, most associations followed a "J"-shaped curve across the categories of alcohol frequency. Abstinence and frequent drinking can be perceived as deviations from the social norm. Both behaviors are associated with more psychosocial stressors and might be therefore special targets for further studies and new prevention programs.

Prevalence of long and short QT in a young population of 41,767 predominantly male Swiss conscripts.

BACKGROUND: Abnormally long and short QT intervals are recognized to be associated with an increased risk for life-threatening ventricular arrhythmias. It is therefore important to define the upper and lower border of the normal QT. OBJECTIVE: The aim of this study was to describe the normal distribution of the QT interval in a contemporary population of young conscripts and to define long and short limits of the QT interval. METHODS: In Switzerland, all young male citizens must undergo compulsory conscription for the Swiss Army at the age of 18 to 19 years. In every conscript, an electrocardiogram (ECG) is performed. Retrospectively, 41,767 consecutive ECGs of Swiss citizens who underwent conscription for the army between March 1, 2004, and July 31, 2006, were analyzed. RESULTS: The mean QTc Bazett interval was 394 +/- 22 ms. One percent of the conscripts had a Bazett QTc shorter than 347 ms, and one percent had a Bazett QTc longer than 445 ms, respectively. None of the subjects presented a QTc Bazett < 300 ms; the prevalence of a QTc Bazett < 320 ms was 0.02%. CONCLUSION: The present study shows the distribution of QT intervals in an unselected young population. Because none of the subjects presented a QTc < 300 ms, it may be concluded that the short QT syndrome is a very rare entity in the population of young male adults.