Children In Switzerland Research Articles

Isolated extraordinary daytime urinary frequency of childhood: a case series of 26 children in Switzerland

The term 'isolated extraordinary daytime urinary frequency' designates an abnormally increased diurnal frequency of painless urination in a completely toilet-trained child with normal urinalysis. We report the history of 26 children (16 boys and 10 girls; aged between 4.1 and 10 years) who were referred to us between 2002 and 2006 and subsequently diagnosed with this condition. Possible psychosocial problems, or recent emotional stressors, were disclosed in the majority of the children: recent (36 months or less) asylum seekers (n = 9), school-related problems (n = 4), parental divorce (n = 2) or death of the mother (n = 1). Possible dietary causes were observed in 9 patients: oxalate-rich beverages (n = 5) and liberal ingestion of 'acidic' juices (n = 4). A diet low in oxalates was recommended when children were consuming large quantities of oxalate-rich beverages; and a diet low in acidic juice was recommended in those liberally ingesting acidic juices. Reassurance and observation were the approach in the remaining cases. The median duration of the symptoms was 5 months. A longer (p < 0.05) duration was noted in children of asylum seekers. This functional condition is easily identifiable, but often under- or misdiagnosed. Confounding the condition might result in redundant investigation.

Advertising to children in Switzerland

Describes the legal environment of advertising regulation in Switzerland as it affects children; there is a patchwork of federal and self‐regulatory codes, but although the constitution protects children’s physical, mental and moral development, there is no law specifically relating to advertising to children. Outlines restrictions on advertising in specific media and products: television and radio, where tobacco and alcohol advertising are banned; cinema, where tobacco is not advertised before pm; tobacco and alcohol, which can be advertised if this is socially responsible and not aimed at children under 18; medicine, where advertising is restricted to over‐the‐counter products; books and magazines, where alcohol and tobacco advertising are banned, as are pornography and violence; and toys. Concludes that advertising to children is very liberal in Switzerland, and the system of self‐regulation works well.

Overweight and obesity in 6-12 year old children in Switzerland.

Our aim was to estimate the national prevalence of overweight and obesity in Swiss primary schoolchildren and to determine if adiposity is increasing in this age group. We used a cross-sectional, 3-stage, probability-proportionate-to-size cluster sampling of primary schools throughout Switzerland to obtain a representative national sample of 6-12 year old children (n = 2431). Height and weight were measured and used to calculate body mass index (BMI). BMI references from the U.S. Centers for Disease Control and Prevention (CDC) and the International Obesity Task Force (IOTF) were used to define adiposity. The triceps, biceps, subscapular and suprailiac skinfold thickness (SFT) was measured and used to calculate body fat percentage (BF%). BMI and BF% were compared to data from 6-12 year old Swiss children in the 1960's and 1980's. BMI and BF% were well correlated in both boys and girls (r2 = 0.74). Using the IOTF references, the prevalence of overweight and obesity was 16.6% and 3.8% in boys and 19.1% and 3.7% in girls. Using the CDC references, the prevalence of overweight and obesity was 19.9% and 7.4% in boys and 18.9% and 5.7% in girls. There was no significant age or gender difference in the prevalence of overweight or obesity. At all ages, boys and girls had 50-100% higher mean BF% than Swiss children from the 1960's and 1980's. Using the current CDC BMI references, the prevalence of overweight has increased more than 5-fold in Swiss children since the mid-1980's. These findings suggest there has been a striking increase in BF% and the prevalence of overweight and obesity in Swiss children in the last two decades.

Overweight and obesity in 6-12 year old children in Switzerland.

Our aim was to estimate the national prevalence of overweight and obesity in Swiss primary schoolchildren and to determine if adiposity is increasing in this age group. We used a cross-sectional, 3-stage, probability-proportionate-to-size cluster sampling of primary schools throughout Switzerland to obtain a representative national sample of 6-12 year old children (n = 2431). Height and weight were measured and used to calculate body mass index (BMI). BMI references from the U.S. Centers for Disease Control and Prevention (CDC) and the International Obesity Task Force (IOTF) were used to define adiposity. The triceps, biceps, subscapular and suprailiac skinfold thickness (SFT) was measured and used to calculate body fat percentage (BF%). BMI and BF% were compared to data from 6-12 year old Swiss children in the 1960's and 1980's. BMI and BF% were well correlated in both boys and girls (r2 = 0.74). Using the IOTF references, the prevalence of overweight and obesity was 16.6% and 3.8% in boys and 19.1% and 3.7% in girls. Using the CDC references, the prevalence of overweight and obesity was 19.9% and 7.4% in boys and 18.9% and 5.7% in girls. There was no significant age or gender difference in the prevalence of overweight or obesity. At all ages, boys and girls had 50-100% higher mean BF% than Swiss children from the 1960's and 1980's. Using the current CDC BMI references, the prevalence of overweight has increased more than 5-fold in Swiss children since the mid-1980's. These findings suggest there has been a striking increase in BF% and the prevalence of overweight and obesity in Swiss children in the last two decades.

Cost-effectiveness of a pneumococcal conjugate immunisation program for infants in Switzerland

Objective: To compare projected economic costs and health benefits associated with using pneumococcal conjugate heptavalent vaccine as routine immunisation in healthy children in Switzerland. Design: A cost-utility analysis was performed from both the societal as well as the sickness funds’ perspective. Setting: Simulated birth cohorts of 80,000 children (the approximate size of a birth cohort in Switzerland) were followed from birth up to age of 5. Main outcome measures: Reduction in disease burden, costs of vaccination, cost-utility ratio (cost per quality-adjusted life year (QALY)). Results: With a vaccine coverage of 70% vaccination of newborns only would avert 4 deaths, 8 cases of meningitis, 37 cases of other invasive pneumococcal disease, 150 cases of pneumococcal pneumonia and about 2700 cases of otitis media (OM) per year. The net cost of the vaccination program would be 22 Mio. CHF per year for society and about 19 Mio. CHF for the sickness funds. This results in a cost-utility ratio of 35,700 CHF (approximately 26,300 USD 1 Exchange rate: 1 USD=1.36 CHF (24.01.03). 1 ) per QALY from the societal perspective and 39,300 CHF (28,900 USD) per QALY from the sickness funds’ perspective. Additional catch-up vaccination of all infants <24 months in the years after vaccine introduction would result in additional benefits at a cost of 33,600 CHF per additional QALY gained. However, if the catch-up vaccination should include all children <60 months, each additional QALY would be gained at a very high cost (162,000 CHF per additional QALY). Conclusions: Routine vaccination of healthy infants <2 years in Switzerland can reduce mortality and long term neurologic impairment resulting from invasive pneumococcal disease at a reasonable cost-utility ratio.

Survey of children supported by long-term mechanical ventilation in Switzerland.

The aim of the present study was to identify the number of children, from birth to 16 years of age, on long-term mechanical ventilation in Switzerland, and to establish their current location, underlying diagnoses and ventilatory needs. Postal questionnaires were sent to all chest physicians (pulmonologists), intensive care specialists, neurologists, national health care organisations, rehabilitation services and ventilator suppliers known or thought to be involved in paediatric long-term ventilation in Switzerland. Detailed information was obtained on 32 children from 7 centers. Underlying disorders included congenital central hypoventilation syndrome (CCHS, 41%), neuromuscular disorders (41%), spinal cord injury (6%), craniofacial anomalies (6%) and others (6%). 10 children received positive pressure ventilation by tracheostomy and 19 children by nasal mask. Two children were ventilated by phrenic nerve pacing and one child with the help of a pneumatic belt. Children with CCHS were almost equally divided into nasal mask and tracheostomy users. Ventilation for 16-24 hours a day was necessary in 5 children, exclusively during sleep in 24 children and only episodically in 3 children. All but 2 children were cared for at home. The majority of families received home care support. The most common reasons for readmission into hospital were regular follow-up examinations and respiratory tract infections. The children were mainly admitted to paediatric intensive care units. There are few ventilator-supported children in Switzerland and most of them are cared for at home. Nevertheless, there is a need to establish a system for continuing data collection in this particular patient population to assess outcome and quality of home care support and to follow incidence trends.

Survey of children supported by long-term mechanical ventilation in Switzerland.

The aim of the present study was to identify the number of children, from birth to 16 years of age, on long-term mechanical ventilation in Switzerland, and to establish their current location, underlying diagnoses and ventilatory needs. Postal questionnaires were sent to all chest physicians (pulmonologists), intensive care specialists, neurologists, national health care organisations, rehabilitation services and ventilator suppliers known or thought to be involved in paediatric long-term ventilation in Switzerland. Detailed information was obtained on 32 children from 7 centers. Underlying disorders included congenital central hypoventilation syndrome (CCHS, 41%), neuromuscular disorders (41%), spinal cord injury (6%), craniofacial anomalies (6%) and others (6%). 10 children received positive pressure ventilation by tracheostomy and 19 children by nasal mask. Two children were ventilated by phrenic nerve pacing and one child with the help of a pneumatic belt. Children with CCHS were almost equally divided into nasal mask and tracheostomy users. Ventilation for 16-24 hours a day was necessary in 5 children, exclusively during sleep in 24 children and only episodically in 3 children. All but 2 children were cared for at home. The majority of families received home care support. The most common reasons for readmission into hospital were regular follow-up examinations and respiratory tract infections. The children were mainly admitted to paediatric intensive care units. There are few ventilator-supported children in Switzerland and most of them are cared for at home. Nevertheless, there is a need to establish a system for continuing data collection in this particular patient population to assess outcome and quality of home care support and to follow incidence trends.

Epidemiology of type I diabetes mellitus in Switzerland: steep rise in incidence in under 5 year old children in the past decade.

In this nationwide prospective study we wanted to verify the trend of increasing diabetes incidence data from our earlier retrospective analysis of the military registry of Swiss men. The data collection of newly diagnosed children in Switzerland at an age younger than 15 years started in 1991. The countrywide survey used a small questionnaire which was sent back to the study centre. The questionnaire was anonymous and contained: hospital of diagnosis, initials, sex, birth date, date of diagnosis, residence, country of citizenship, and responsible physician. General data on the population were taken from publications of the Swiss Federal Statistical Office. A total of 941 children below the age of 15 years with newly diagnosed Type I (insulin-dependent) diabetes mellitus were collected (434 girls, 507 boys). The incidence in children aged 0 to 14 years rose significantly between 1991 and 1999 with a yearly average increase of 5.1%. In the age group 0 to 4 years a more than four-fold increase in incidence from 2.4/100,000 per year to 10.5/100,000 per year (p = 0.0002) was recorded, whereas the age-specific incidence in the 5 to 9-year-old and 10 to 14-year-old children did not change during the data collection period. The incidence was significantly higher in boys than in girls, whereas no difference was found between rural and urban populations. The incidence of Type I diabetes is rising in children living in Switzerland but only the youngest age group of under 5 years of age is affected showing a large annual average increase of 23.8%.

The paediatrician’s role in ambulatory health care of the older child in Switzerland

ABSTRACT Objective Data selected from a larger study, ‘Schoolchildren in the Paediatric Practice’, were analysed to examine the role of the practising paediatrician in providing care to the older child/adolescent. Design For the base study, paediatricians in private practice collected data on schoolchildren during two year‐long research segments. At the end of the study, each paediatrician was interviewed. To assist the focused analysis of this paper, statistics on physician utilization patterns and diagnoses were obtained from two external sources. Setting and Sample Thirty‐four paediatricians practising in the canton of Bern, Switzerland received a sample of 5971 schoolchildren, aged 6–16. Results The paediatricians saw a decreasing number of children with increasing ages. Other medical specialities showed no comparable decline. The length of time a paediatrician had been practising was related to having more older patients. The paediatricians expressed mixed opinions about the decline in older patients, with 59% stating this to be normal or not a problem. A minority felt the situation was a serious threat to the profession. Issues concerning the paediatricians included the image of the profession, the medical and administrative management of adolescent visits, and inadequate reimbursement. Implications for practice To take the lead in assuring adequate care for the country’s older children, Swiss paediatricians need to clarify their desired role and address the questions of competence, training needs, personal barriers to offering services, and manpower coverage.

A Study of Growth in the Height of Children by the International Comparative Method

The growth in the height of children in Japan was compared with that in Switzerland. After World War II, Japanese improved physically.The growth in the height of Japanese children who were born between 1954 and 1956 shows a similar tendency to that of children in Switzerland during the same time, but the change in the height of Japanese children was comparatively less: 5.9cm to 8.9cm in boys and 5.3cm to 8.5cm in girls than that of Swiss children.During the next 20 years, Japanese children became taller and close to the height of Swiss children. For example, the height of the 12 to 14 year old boys and the 11 to 12 year old girls in Japan became nearly equal to those of Swiss children.It is said that the primary factors promoting the growth of children are changes in food, clothing and house. After World War II, nutrition and the living environment improved as the Japanese economy developed. The diet changed from rice and pickles to a more balanced diet. The 11 year old boys and 13 year old girls, grew remarkably. It is probably because primary school meals were planned nutritionally. When the students entered high school, their diet returned to unbalanced one and they were subjected to a stress for preparing examination. As a result, the rate of growth in height decreased rapidly.

Impact of polymerase chain reaction on clinical pertussis research: Finnish and Swiss experiences.

Since April 1993 in Finland and March 1994 in Switzerland, polymerase chain reaction (PCR) has been used routinely nationwide for the diagnosis of pertussis. Nasopharyngeal specimens from 3794 patients suspected of having pertussis and 1125 controls were tested. Finnish and Swiss assays found 23% and 36% of clinical specimens positive, respectively. PCR showed a higher incidence of pertussis infection among 1- to 6-year-old children in Switzerland than in Finland (P < .001). This difference may be due to the booster dose of vaccine given at 2 years of age in Finland but not in Switzerland. In Finland, PCR-confirmed asymptomatic cases were more common among children <7 years old than in older children (P < .001), whereas older children tended to have symptomatic infection. The use of PCR markedly improves the diagnosis of pertussis and opens new perspectives for epidemiologic and vaccine efficacy studies.

Cholesterol screening in childhood: results of a 9-year follow-up study in Swiss and Italian children in Switzerland.

Mass screening for blood cholesterol as part of routine preventive health care of children continues to be discussed in several countries. Results of longitudinal studies underline the importance of the predictive value of cholesterol levels assessed during childhood. Some countries have changed their recommendations during the past years to blood cholesterol screening for obese children only or for children of high risk families. In the Kindergarten-study Basel, a follow-up study on somatic, psychic and social development of Swiss and immigrant schoolchildren, cardiovascular risk factors were assessed at the ages of 5, 10 and 14 years. The age-specific levels of total and LDL-cholesterol found in our study were slightly higher and HDL-cholesterol lower than, for example, those found in the Bogalusa Heart Study. For total cholesterol no significant tracking correlations over the 5 and 9 year periods were found. Tracking of LDL- and HDL-cholesterol differed between nationalities and sexes. The total cholesterol/HDL-cholesterol index tracked slightly better. Italian girls showed the best 9-year tracking for HDL-cholesterol (r = 0.56). The differences between this and other studies can only partially be explained by different sampling and laboratory methods. Individual changes in cholesterol levels between the ages of 5 and 14 were marked. Sexual maturation was found to be of minor influence. Body mass index was the most consistent risk factor in our population. Changes of sex or growth hormone levels during puberty, but also changes of nutritional habits or physical activity might influence the individual cholesterol levels. Before recommendations on mass screening of cholesterol in children are made, the different longitudinal patterns of changes in cholesterol levels, and subpopulation-specific changes of nutritional habits and physical activity, should be discussed. The results of the Kindergarten study Basel suggest that attention should be paid to screening for obesity and to health education regarding nutrition and physical activity.

Incidence of yersiniosis in children with suspected acute appendicitis A prospective study

Infection with Yersinia enterocolitica and Y. pseudotuberculosis has been associated with acute appendicitis. Data for northern European countries show an incidence of up to 20% in patients with acute abdominal pain and up to 30% in acute appendicitis. There are no data for these infections in children in Switzerland; therefore, a prospective study was started. Repeated serum samples were tested for antibodies against Y. enterocolitica 0:3, 0:9 and Y. pseudotuberculosis in 100 consecutive patients who underwent appendectomy for presumed appendicitis. In 85 patients acute appendicitis was histologically ascertained, but no acute infection with one of the tested bacteria was found. In the remaining 15, in which appendicitis was not proved histologically, an infection with Y. enterocolitica 0:3 was found in only 1 patient. Our data do not support an emphasis on yersiniosis in the differential diagnosis of appendicitis in Switzerland at the present time.

Immunodiagnosis of toxocarosis in humans: evaluation of a new enzyme-linked immunosorbent assay kit

Excretory/secretory (E/S) antigen derived from second-stage larvae of Toxocara canis maintained in defined medium in vitro has been well established worldwide for the immunodiagnosis of human toxocarosis by enzyme-linked immunosorbent assay. Such an enzyme-linked immunosorbent assay, based on the detection of human anti-T. canis (E/S antigen) serum immunoglobulin G, has recently been commercialized by Biokema-Affinity Products (Crissier-Lausanne, Switzerland). This commercial test kit was evaluated with regard to its application in a routine diagnostic laboratory and the reliability of the results. Of 78 patients with suspected clinical toxocarosis, 71 had anti-T. canis antibodies (positive serological result) corresponding to a diagnostic sensitivity of 91%; 14% of serum samples (n = 199) from patients with protozoan or with helminthic infections also showed positive reactions mainly related to infections with Trichinella, Strongyloides, and Fasciola species. An epidemiological study with 1,000 serum samples from randomly selected healthy blood donors and children in Switzerland demonstrated a seroprevalence of 2.7%. The test kit under evaluation had an overall diagnostic sensitivity of 91% and a relative specificity of 86%, the latter being related to some protozoan and helminthic infections. Because of the scarcity of such infections, potential cross-reactivity does not play a major role under the conditions found in the middle part of Europe. In conclusion, the application of the test kit provided for use in this study can be recommended for routine diagnostic use.

Childhood cancer in Switzerland: mortality from 1951 to 1984.

Cancer mortality among children in Switzerland was analysed using (1) age-specific and age-standardized (0-14) rates from 1951 to 1984 and (2) comparison of observed numbers of deaths over the period 1960-1984 with expected one obtained by application of age-specific rates for the period 1951-1959 to the population structure of subsequent 5-year calendar periods. Certified mortality fell about 60% for leukaemias, 21% for lymphomas, 66% for Wilms' tumours, 40% for bone sarcomas and 30% for other and unspecified sites. Thus, the overall decline in childhood cancer mortality in Switzerland was around 45%, slightly more marked in females (-48%) than in males (-42%), and more pronounced in younger children (over 50% before age 5). This corresponds to an absolute number of about 50 deaths from childhood cancer per year avoided in the early 1980s as compared with expected numbers computed on the basis of rates registered in the 1950s (30 deaths per year for leukaemias alone). The estimated total number of deaths avoided during the whole period 1960-1980 was 820 (430 leukaemias alone). Trends in childhood cancer mortality persisted steadily downwards in the early 1980s, suggesting that further progress is being achieved in the treatment of these neoplasms.

Parents' Reactions to Teacher Practices of Parent Involvement

The Elementary School Journal Volume 86, Number S O 1986 by The University of Chicago. All rights reserved. 0013-5984/86/8603-0002$01.00 Teachers have strong opinions about parent involvement. Some believe that they can be effective only if they obtain parental assistance on learning activities at home. Others believe that their professional status is in jeopardy if parents are involved in activities that are typically the teachers' responsibilities. The different philosophies and beliefs of teachers reflect the two main, opposing theories of school and family relations. One perspective emphasizes the inherent incompatibility, competition, and conflict between families and schools and supports the separation of the two institutions (Parsons, 1959; Waller, 1932; Weber, 1947). It assumes that school bureaucracies and family organizations are directed, respectively, by educators and parents, who can best fulfill their different goals, roles, and responsibilities independently. Thus, these distinct goals are achieved most efficiently and effectively when teachers maintain their professional, general standards and judgments about the children in their classrooms and when parents maintain their personal, particularistic standards and judgments about their children at home.

Speech--language rehabilitation for children in Switzerland.

Speech therapy for children is well known in Switzerland, but not all regions get the same supply. The average age of children who receive speech therapy is 7.9 years. This late beginning of treatment leads to longer duration of therapy. Therapy costs are shared by various institutions, to a wide extent by the Schweizerische Invaliden-Versicherung. The public has to be further informed about the meaning of speech and language rehabilitation.

Sozialmedizinische Aspects in Der Paediatrie (Postgraduate Courses in Pediatrics) Vol. 20

Volume 20 of the popular Swiss Postgraduate Courses in Pediatrics, edited so expertly by Professor E. Rossi, is devoted to social pediatrics. The papers included cover such topics as accidents in children and adolescents, the mild forms of mental retardation, the handling of health problems by the school physician, caries prophylaxis, the care of the neglected child, and left-handedness as a cause for learning difficulty in school. Except for the chapters concerning legal aspects of adoption under Swiss law and insurance coverage for handicapped children in Switzerland, the approaches to the problems discussed are not different from those in the English-speaking world.

The Education of Physically Handicapped Children In Switzerland

Ellen Zangger, Assistant Secretary-General of Pro Infirmis, provided much of the information for this article.

The Plenum System of Ventilation

Background Drug therapy in children is challenging. Due to the lack of licensed drugs for paediatric use, off-label or unlicensed prescription is frequent. To improve quality and safety of prescription of medicinal products for children in Switzerland, the requirement to create and continuously run a national database was added in the revision of the therapeutic products act (TPA Art. 67a). The task of operating the database was given to SwissPedDose, an association representing eight Swiss children’s hospitals, the Swiss Society of Paediatrics (SGP) and the Swiss Association of Public Health Administration and Hospital Pharmacists (GSASA). Methods Substances used in three therapeutic areas ‘general paediatrics’, ‘infectious diseases’ and ‘neonatology’ are selected according to their frequency of use in the eight participating hospitals. Dosage data of substance-indication pairs are requested from the hospital pharmacists. Based on these data and literature review a dosage suggestion consisting of substance, indication, route of administration, dose, daily repetitions and, if applicable, additional remarks is then elaborated by a specialised pharmacist of SwissPedDose. This suggestion is then discussed by experienced physicians delegated from the eight clinics. The elaboration, discussion and agreement on a national dosage recommendation takes place and is documented in an online platform specially programmed for this structured harmonisation process. Once an agreement has been achieved, the national dosage recommendation is sent to the eight participating clinics and published in a free accessible public database. Results As of December 31st 2018, 195 dosage recommendations for children including 87 indications and 54 substances have been harmonised and published and are available for medical professionals on https://swisspeddose.ch/database. Conclusion The goal of published recommendations for 100 substances by March 2021 is feasible to reach due to interprofessional collaboration. SwissPedDose may thus contribute to a more efficient and safe use of drugs prescribed to children in Switzerland. Disclosure(s) Source of Funding: Project funded by the Federal Office of Public Health. Conflict of interest: None, for all listed authors.