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Güth U, Junker C, McMillan S, Elfgen C, Schneeberger AR. Long-term experience on assisted suicide in Switzerland: dementia, mental disorders, age-related polymorbidity and the slippery slope argument. Public Health 2023; 223:249-256. [PMID: 37690397 DOI: 10.1016/j.puhe.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/14/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES According to the Swiss medico-ethical guidelines valid between 2004 and 2018, the key criterion for assisted suicide (AS) was that the patients who wished to die suffered with a disease leading to death in the foreseeable future. Critics of AS fears that broadening of the medical indications will lead to an uncontrolled expansion to persons who are not terminally ill (slippery slope argument). We evaluated to what extent this broadening took place in practice over time. STUDY DESIGN Retrospective national cohort study. METHODS By using data of the Swiss Federal Statistical Office, we analyzed the long-term development of AS in Switzerland over a 20-year period (1999-2018; n = 8738 cases). We classified the cases into one of three categories regarding the aforementioned key criterion for AS. RESULTS In 43.6% of AS cases, the criterion 'end of life is near' was met. In 5.3% of cases, this criterion was not met (4.7%: mental disorders; 0.6%: dementia). In 51.1% of cases, the reason underlying AS comprised several, mostly age-related diseases and/or functional impairments; the aforementioned key criterion, however, was probably not met in most of the cases. Over time, the number of cases doubled over each 5-year period; this increase occurred similarly for the three categories. CONCLUSION The fact that many AS cases took place outside the valid medico-ethical guidelines might be interpreted as a development in the idea of the slippery slope argument. The fact that the percentage distribution of these cases remained unchanged over time argues against it.
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Affiliation(s)
- U Güth
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, Zurich CH-8008, Switzerland; University of Basel, Faculty of Medicine, Klingelbergstrasse 61, Basel CH-4056, Switzerland.
| | - C Junker
- Federal Statistical Office, Espace de l'Europe 10, Neuchâtel CH-2010, Switzerland.
| | - S McMillan
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, Zurich CH-8008, Switzerland.
| | - C Elfgen
- Brust-Zentrum Zürich, Department of Breast Surgery, Seefeldstrasse 214, Zurich CH-8008, Switzerland; University of Witten/Herdecke, Faculty of Medicine; Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany.
| | - A R Schneeberger
- University of California San Diego, Department of Psychiatry, 8950 Villa La Jolla Drive, La Jolla, CA 92037, USA.
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Montagna G, Junker C, Elfgen C, Schneeberger A, Güth U. Assisted suicide in patients with cancer. ESMO Open 2022; 7:100349. [PMID: 35066409 PMCID: PMC8789521 DOI: 10.1016/j.esmoop.2021.100349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/14/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background There are limited data on the long-term development and trends of assisted suicide (AS) among cancer patients. Patients and methods Using data of the Swiss Federal Statistical Office, we analyzed AS trends over an 18-year period (1999-2016; total number of cases = 6553). Results Among patients who underwent AS, cancer was the most common underlying disease (n = 2704, 41.3% of all AS cases). The most common cancer types were lung (14.0% of cancer-related AS cases), breast (11.0%) and prostate (10.1%). There was a slight preponderance of men compared with women (51.5% versus 48.5%). The proportion of AS cases within cancer types did not change over time. The ratio of cancer-related AS cases in relationship with all cancer-related deaths increased from 0.3% at the beginning of the study period (1999-2003) to 2.1% from 2014 to 2016 (change of age-standardized rates for men: +488%; for women: +417%). At the end of the study period (2014-2016), there were only minor differences between cancer-specific ratios, highest and lowest range: 1.1% (liver cancer) and 2.8% (breast, esophageal and lip/oral cavity/oropharynx cancer). Individuals who underwent AS because of cancer were considerably younger than those who choose AS on account of other diseases (73 years versus 80 years). The median age of people with cancer-related AS was similar to that of all cancer-related deaths (74 years): for women, the median age of cancer-related AS was 72, whereas for men it was 75. The median age at which AS took place increased over time. Conclusions During the study period, the proportion of people who chose cancer-related AS has approximately sextupled. However, AS among cancer patients remains rare and represents only ∼2% of all cancer-related deaths. Cancer was the most common underlying disease for AS (41.3% of all AS cases). The ratio of cancer-related AS to all cancer-related deaths has sextupled over time: from 0.3% (1991-2003) to 2.1% (2014-2016). There were only minor differences between the cancer-specific ratios; in 2014-2016, ranges were between 1.1% and 2.8%. Individuals with cancer-related AS were younger than those who choose AS due to other diseases (73 vs. 80 years). The median age of people with cancer-related AS (73 years) was similar to that of all cancer-related deaths (74 years).
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3
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Keiser O, Giudici F, Müllhaupt B, Junker C, Dufour JF, Moradpour D, Bruggmann P, Terziroli B, Semela D, Brezzi M, Bertisch B, Estill J, Negro F, Spoerri A. Trends in hepatitis C-related mortality in Switzerland. J Viral Hepat 2018; 25:152-160. [PMID: 29159841 DOI: 10.1111/jvh.12803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/07/2017] [Indexed: 12/24/2022]
Abstract
In order to accurately assess the burden of hepatitis C (HCV) and develop effective interventions, we must understand the magnitude and trends of mortality related to the disease. In the United States, HCV-related mortality is continuously increasing. We have no comparable data for Switzerland and other European countries, although a modelling study predicted a similar increase. We analysed time trends (1 January 1995-31 December 2014) in HCV-specific mortality rates in the Swiss general population using the death registry of the Swiss Federal Statistical Office (SFSO). We compared HCV-related mortality to HIV-related and hepatitis B (HBV)-related mortality. To determine potential under-reporting in HCV-related mortality, we probabilistically linked the SFSO data to persons who died in the Swiss Hepatitis C Cohort Study (SCCS). SFSO data showed that HCV-related mortality more than doubled between 1995 and 2003, but has since stabilized at ~2.5/100 000 person-years. Since 2000, HCV-related mortality has been higher than HIV-related mortality and was about fivefold higher in 2014. HBV-related mortality remained low at ~0.5/100 000 person-years. Of 4556 persons in the SCCS, 421 have died and 86.2% could be linked to the death registry. According to the SCCS, 133 deaths were HCV-related. HCV was not mentioned on the SFSO death certificate of 45% of these (n = 60/133). In conclusion, HCV-related mortality remained constant, possibly because quality of care was high, or because of under-reporting or because mortality has not yet increased. However, HCV-related mortality is now much higher than HIV- and HBV-related mortality, and under-reporting was common.
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Affiliation(s)
- O Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - F Giudici
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - B Müllhaupt
- Gastroenterology and Hepatology University Hospital Zurich, Zurich, Switzerland
| | - C Junker
- Federal Statistical Office, Neuchâtel, Switzerland
| | - J-F Dufour
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland.,University Clinic of Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland
| | - D Moradpour
- Division of Gastroenterology and Hepatology, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - P Bruggmann
- Arud Centres for Addiction Medicine, Zurich, Switzerland
| | | | - D Semela
- Division of Gastroenterology and Hepatology, St Gallen, Switzerland
| | - M Brezzi
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - B Bertisch
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Checkpoint Zurich, Zurich, Switzerland
| | - J Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - F Negro
- Divisions of Gastroenterology and Hepatology and of Clinical Pathology, University Hospitals Geneva, Geneva, Switzerland
| | - A Spoerri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Mølbak K, Espenhain L, Nielsen J, Tersago K, Bossuyt N, Denissov G, Baburin A, Virtanen M, Fouillet A, Sideroglou T, Gkolfinopoulou K, Paldy A, Bobvos J, van Asten L, de Lange M, Nunes B, da Silva S, Larrauri A, Gómez IL, Tsoumanis A, Junker C, Green H, Pebody R, McMenamin J, Reynolds A, Mazick A. Excess mortality among the elderly in European countries, December 2014 to February 2015. Euro Surveill 2015; 20. [DOI: 10.2807/1560-7917.es2015.20.11.21065] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since December 2014 and up to February 2015, the weekly number of excess deaths from all-causes among individuals?≥?65 years of age in 14 European countries have been significantly higher than in the four previous winter seasons. The rise in unspecified excess mortality coincides with increased proportion of influenza detection in the European influenza surveillance schemes with a main predominance of influenza A(H3N2) viruses seen throughout Europe in the current season, though cold snaps and other respiratory infections may also have had an effect.
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Affiliation(s)
- K Mølbak
- Statens Serum Institut, Copenhagen, Denmark
| | | | - J Nielsen
- Statens Serum Institut, Copenhagen, Denmark
| | - K Tersago
- Scientific Institute of Public Health, Brussels, Belgium
| | - N Bossuyt
- Scientific Institute of Public Health, Brussels, Belgium
| | - G Denissov
- National Institute for Health Devlopment, Tallinn, Estonia
| | - A Baburin
- National Institute for Health Devlopment, Tallinn, Estonia
| | - M Virtanen
- National Institute for Health and Welfare, Helsinki, Finland
| | - A Fouillet
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France
| | - T Sideroglou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - K Gkolfinopoulou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - A Paldy
- National Institute of Environmental Health, Budapest, Hungary
| | - J Bobvos
- National Institute of Environmental Health, Budapest, Hungary
| | - L van Asten
- National Institute of Public Health and The Environment (RIVM), the Netherlands
| | - M de Lange
- National Institute of Public Health and The Environment (RIVM), the Netherlands
| | - B Nunes
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - S da Silva
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - A Larrauri
- National Centre of Epidemiology; CIBER Epidemiología y Salud Pública (CIBERESP) Institute of Health Carlos III, Madrid, Spain
| | - I L Gómez
- National Centre of Epidemiology; CIBER Epidemiología y Salud Pública (CIBERESP) Institute of Health Carlos III, Madrid, Spain
| | - A Tsoumanis
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - C Junker
- Federal Statistical Office, Neuchâtel, Switzerland
| | - H Green
- Public Health England, London, United Kingdom
| | - R Pebody
- Public Health England, London, United Kingdom
| | - J McMenamin
- Health Protection Scotland, Glasgow, United Kingdom
| | - A Reynolds
- Health Protection Scotland, Glasgow, United Kingdom
| | - A Mazick
- Statens Serum Institut, Copenhagen, Denmark
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5
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Mazick A, Gergonne B, Nielsen J, Wuillaume F, Virtanen MJ, Fouillet A, Uphoff H, Sideroglou T, Paldy A, Oza A, Nunes B, Flores-Segovia VM, Junker C, McDonald SA, Green HK, Pebody R, Mølbak K. Excess mortality among the elderly in 12 European countries, February and March 2012. Euro Surveill 2012. [DOI: 10.2807/ese.17.14.20138-en] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In February and March 2012, excess deaths among the elderly have been observed in 12 European countries that carry out weekly monitoring of all-cause mortality. These preliminary data indicate that the impact of influenza in Europe differs from the recent pandemic and post-pandemic seasons. The current excess mortality among the elderly may be related to the return of influenza A(H3N2) virus, potentially with added effects of a cold snap.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark
| | - B Gergonne
- The National Board of Health and Welfare, Stockholm, Sweden
| | - J Nielsen
- Statens Serum Institut, Copenhagen, Denmark
| | - F Wuillaume
- Scientific Institute of Public Health, Brussels, Belgium
| | - M J Virtanen
- National Institute for Health and Welfare, Helsinki, Finland
| | - A Fouillet
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France
| | - H Uphoff
- Hesse State Health Office, Dillenburg, Germany
| | - T Sideroglou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - A Paldy
- Hungary National Institute of Environmental Health, Budapest, Hungary
| | - A Oza
- Health Protection Surveillance Centre, Dublin, Ireland
| | - B Nunes
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - C Junker
- Federal Statistical Office, Neuchâtel, Switzerland
| | - S A McDonald
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - H K Green
- Health Protection Agency, Colindale, United Kingdom
| | - R Pebody
- Health Protection Agency, Colindale, United Kingdom
| | - K Mølbak
- Statens Serum Institut, Copenhagen, Denmark
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6
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Mazick A, Gergonne B, Nielsen J, Wuillaume F, Virtanen MJ, Fouillet A, Uphoff H, Sideroglou T, Paldy A, Oza A, Nunes B, Flores-Segovia VM, Junker C, McDonald SA, Green HK, Pebody R, Mølbak K. Excess mortality among the elderly in 12 European countries, February and March 2012. Euro Surveill 2012; 17:20138. [PMID: 22516003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
In February and March 2012, excess deaths among the elderly have been observed in 12 European countries that carry out weekly monitoring of all-cause mortality. These preliminary data indicate that the impact of influenza in Europe differs from the recent pandemic and post-pandemic seasons. The current excess mortality among the elderly may be related to the return of influenza A(H3N2) virus, potentially with added effects of a cold snap.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark.
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7
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Junker C, Luostarinen T. SP3-75 Training in epidemiology in Europe. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976o.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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Mazick A, Gergonne B, Wuillaume F, Danis K, Vantarakis A, Uphoff H, Spiteri G, van 't Klooster T, Junker C, Holmberg M, Molbak K. Higher all-cause mortality in children during autumn 2009 compared with the three previous years: pooled results from eight European countries. Euro Surveill 2010; 15:19480. [PMID: 20144446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
The paper describes weekly fluctuations of all-cause mortality observed in eight European countries during the period between week 27 and 51, 2009, in comparison with three previous years. Our preliminary data show that the mortality reported during the 2009 influenza pandemic did not reach levels normally seen during seasonal influenza epidemics. However, there was a cumulative excess mortality of 77 cases (1 per 100,000 population) in 5-14-year-olds, and possibly also among 0-4-year-olds.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark.
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10
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Mazick A, Gergonne B, Wuillaume F, Danis K, Vantarakis A, Uphoff H, Spiteri G, van 't Klooster T, Junker C, Holmberg M, Mølbak K. Higher all-cause mortality in children during autumn 2009 compared with the three previous years: pooled results from eight European countries. Euro Surveill 2010. [DOI: 10.2807/ese.15.05.19480-en] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The paper describes weekly fluctuations of all-cause mortality observed in eight European countries during the period between week 27 and 51, 2009, in comparison with three previous years. Our preliminary data show that the mortality reported during the 2009 influenza pandemic did not reach levels normally seen during seasonal influenza epidemics. However, there was a cumulative excess mortality of 77 cases (1 per 100,000 population) in 5-14-year-olds, and possibly also among 0-4-year-olds.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark
| | - B Gergonne
- The National Board of Health and Welfare (Socialstyrelsen), Stockholm, Sweden
- Statens Serum Institut, Copenhagen, Denmark
| | - F Wuillaume
- Scientific Institute of Public Health, Brussels, Belgium
| | - K Danis
- Department for Surveillance and Intervention, Hellenic Centre for Disease Control and Prevention, Greece
| | - A Vantarakis
- Department of Public Health, Medical School, University of Patras, Greece
| | - H Uphoff
- Hessisches Landesprüfungs- und Untersuchungsamt im Gesundheitswesen, Dillenburg, Germany
| | - G Spiteri
- Infectious Disease Prevention and Control Unit, Department of Health Promotion and Disease Prevention, Msida, Malta
| | - T van 't Klooster
- Rijksinstituut voor Volksgezondheid en Milieu (RIVM, National Institute for Public Health and Environment), Bilthoven, Netherlands
| | - C Junker
- Federal Statistical Office, Neuchâtel, Switzerland
| | - M Holmberg
- The National Board of Health and Welfare (Socialstyrelsen), Stockholm, Sweden
| | - K Mølbak
- Statens Serum Institut, Copenhagen, Denmark
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Junker C, Sheahan JN, Jennings SG, O'Brien P, Hinds BD, Martinez-Twary E, Hansen ADA, White C, Garvey DM, Pinnick RG. Measurement and analysis of aerosol and black carbon in the southwestern United States and Panama and their dependence on air mass origin. ACTA ACUST UNITED AC 2004. [DOI: 10.1029/2003jd004066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C. Junker
- Atmospheric Research Group, Department of Experimental Physics; National University of Ireland; Galway Ireland
| | - J. N. Sheahan
- Department of Mathematics; National University of Ireland; Galway Ireland
| | - S. G. Jennings
- Atmospheric Research Group, Department of Experimental Physics; National University of Ireland; Galway Ireland
| | - P. O'Brien
- Atmospheric Research Group, Department of Experimental Physics; National University of Ireland; Galway Ireland
| | - B. D. Hinds
- US Army Research Laboratory; Adelphi Maryland USA
| | | | - A. D. A. Hansen
- Lawrence Berkeley National Laboratory; Berkeley California USA
| | - C. White
- Atmospheric Research Group, Department of Experimental Physics; National University of Ireland; Galway Ireland
| | - D. M. Garvey
- US Army Research Laboratory; Adelphi Maryland USA
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Jaggi A, Junker C, Minder C. [Does the structure of medical services affect the proportion of death in hospitals? An ecological analysis in the mobility regions of Switzerland?]. Soz Praventivmed 2002; 46:379-88. [PMID: 11851072 DOI: 10.1007/bf01321664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES With the discussion about measures to reduce over-capacities in the health services in mind, we examined the influence of medical supply structures and services on hospital utilisation directly before death. METHODS Based on the specification of the place of dying from the death certificates, we determined the proportions of deaths in hospitals in an ecological study. We analysed deaths of persons above age 65 in each of the 106 mobility regions of Switzerland in the years 1979 to 1980. RESULTS The proportion of deaths occurring in hospitals varied between 27% and 81%. Despite missing data regarding stationary and ambulatory care services, more than half of the variance could be explained by means of a multivariate regression analysis. Our results imply an inverse relation between the proportion of deaths in the hospital and the number of consultations provided by primary care physicians, as well as the number of nursing home beds. Further, we observe a direct relation to the number of hospital beds in a region. All indicators are calculated per inhabitant. CONCLUSIONS In health care supply planning, such systematic associations should be taken into account. We recommend to analyse regularly interregional differences in supply and outcome of medical performances with the best available data.
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Affiliation(s)
- A Jaggi
- Institut für Sozial- und Präventivmedizin, Universität Bern
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13
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Junker C, Hoppe T, Horstmann W, Gerhards H, Matiasek K. Studies on head and collum of the horse by means of Magnetic Resonance Imaging with case reports. PFERDEHEILKUNDE 2002. [DOI: 10.21836/pem20020403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PRINCIPLES Cigarette smoking causes an estimated 13% of all deaths in Switzerland. Though most smokers will eventually become ex-smokers of their own volition, physicians play an important role in accelerating the process of quitting among smoking patients. Even brief advice from physicians is effective in doing so. The purpose of this study was to investigate which smokers were asked about their smoking habits, and how often, whether they received advice to quit, and how this correlates with the patient's desire to quit. METHODS Telephone interviews were carried out with a random sample of smokers and ex-smokers from the German-speaking Swiss population (n = 993). We collected information on personal characteristics, smoking habits, and recall of physicians' advice. Data was analysed descriptively and by logistic regression. RESULTS 88% recalled being asked by a doctor about their smoking habits. In contrast, only 34% of smoking patients recalled being advised to stop. Women, older people and those in poor subjective health were asked more frequently. Heavier smokers and those in poor subjective health were advised more frequently. Current smokers more frequently express the desire to quit if they are heavier smokers and have been advised to quit by their physician, compared with those who have not received such advice. CONCLUSIONS Similarly to the international findings, smoking patients in Switzerland receive brief advice with insufficient frequency. Action should therefore be taken to encourage health professionals not only to question all smoking patients but to advise and motivate them to quit smoking.
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Affiliation(s)
- T Eckert
- Department of Social and Preventive Medicine, University of Berne.
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15
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Eckert T, Junker C. Motivation for smoking cessation: what role do doctors play? Swiss Med Wkly 2001; 131:521-6. [PMID: 11727671 DOI: 10.4414/smw.2001.09762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PRINCIPLES Cigarette smoking causes an estimated 13% of all deaths in Switzerland. Though most smokers will eventually become ex-smokers of their own volition, physicians play an important role in accelerating the process of quitting among smoking patients. Even brief advice from physicians is effective in doing so. The purpose of this study was to investigate which smokers were asked about their smoking habits, and how often, whether they received advice to quit, and how this correlates with the patient's desire to quit. METHODS Telephone interviews were carried out with a random sample of smokers and ex-smokers from the German-speaking Swiss population (n = 993). We collected information on personal characteristics, smoking habits, and recall of physicians' advice. Data was analysed descriptively and by logistic regression. RESULTS 88% recalled being asked by a doctor about their smoking habits. In contrast, only 34% of smoking patients recalled being advised to stop. Women, older people and those in poor subjective health were asked more frequently. Heavier smokers and those in poor subjective health were advised more frequently. Current smokers more frequently express the desire to quit if they are heavier smokers and have been advised to quit by their physician, compared with those who have not received such advice. CONCLUSIONS Similarly to the international findings, smoking patients in Switzerland receive brief advice with insufficient frequency. Action should therefore be taken to encourage health professionals not only to question all smoking patients but to advise and motivate them to quit smoking.
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Affiliation(s)
- T Eckert
- Department of Social and Preventive Medicine, University of Berne.
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16
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Kunst AE, Groenhof F, Andersen O, Borgan JK, Costa G, Desplanques G, Filakti H, Giraldes MDR, Faggiano F, Harding S, Junker C, Martikainen P, Minder C, Nolan B, Pagnanelli F, Regidor E, Vågerö D, Valkonen T, Mackenbach JP. Occupational class and ischemic heart disease mortality in the United States and 11 European countries. Am J Public Health 1999; 89:47-53. [PMID: 9987464 PMCID: PMC1508498 DOI: 10.2105/ajph.89.1.47] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences. METHODS Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively. RESULTS A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years). CONCLUSIONS The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments.
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Affiliation(s)
- A E Kunst
- Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
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Abstract
BACKGROUND Some randomised controlled trials (RCTs) done in German-speaking Europe are published in international English-language journals and others in national German-language journals. We assessed whether authors are more likely to report trials with statistically significant results in English than in German. METHODS We studied pairs of RCT reports, matched for first author and time of publication, with one report published in German and the other in English. Pairs were identified from reports round in a manual search of five leading German-language journals and from reports published by the same authors in English found on Medline. Quality of methods and reporting were assessed with two different scales by two investigators who were unaware of authors' identities, affiliations, and other characteristics of trial reports. Main study endpoints were selected by two investigators who were unaware of trial results. Our main outcome was the number of pairs of studies in which the levels of significance (shown by p values) were discordant. FINDINGS 62 eligible pairs of reports were identified but 19 (31%) were excluded because they were duplicate publications. A further three pairs (5%) were excluded because no p values were given. The remaining 40 pairs were analysed. Design characteristics and quality features were similar for reports in both languages. Only 35% of German-language articles, compared with 62% of English-language articles, reported significant (p < 0.05) differences in the main endpoint between study and control groups (p = 0.002 by McNemar's test). Logistic regression showed that the only characteristic that predicted publication in an English-language journal was a significant result. The odds ratio for publication of trials with significant results in English was 3.75 (95% CI 1.25-11.3). INTERPRETATION Authors were more likely to publish RCTs in an English-language journal if the results were statistically significant. English language bias may, therefore, be introduced in reviews and meta-analyses if they include only trials reported in English. The effort of the Cochrane Collaboration to identify as many controlled trials as possible, through the manual search of many medical journals published in different languages will help to reduce such bias.
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Affiliation(s)
- M Egger
- Department of Social Medicine, University of Bristol, UK
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Junker C, Egger M, Schneider M, Zellweger T, Antes G. The CONSORT statement. JAMA 1996; 276:1876-7; author reply 1877. [PMID: 8968009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Affiliation(s)
- C Junker
- Department of Industrial Engineering, University College, Galway, Ireland
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Grichting C, Junker C, Schaufelberger HJ. [Determinants in decisions for the utilization of an ambulatory medical service]. Soz Praventivmed 1986; 31:212-4. [PMID: 3765864 DOI: 10.1007/bf02083459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The purpose of this research is to know more about the factors determining the decision to see a doctor. Especially the influence of characteristics of the delivery system (e.g. differences between urban and rural regions) and characteristics of users (e.g. social class) are investigated. In this article the conceptual frame of the study is described. The model is based on assumptions of the action-decision-theory. It structures the process of decision and action into four phases: the first two, perception and interpretation, are summarized as "process of attention"; the subsequent ones, coping and evaluation, as "process of acting". The model describes the social system (the total of demographic, socio-structural and socio-economic variables) and the memory system (contained within the individual life history) as mediating factors influencing the decision to act.
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Cloetta B, Junker C. [Expectations concerning physician consultation]. Soz Praventivmed 1986; 31:214-5. [PMID: 3765865 DOI: 10.1007/bf02083460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Immediately prior to their consultation of a physician 259 ambulatory patients were interviewed concerning their expectations of the interaction with the physician, the course and results of the consultation. From the responses received to open and closed questions several quasi-scales were developed. These scales showed correlations to variables such as nature of the medical problem, type of practice and socio-economic indicators.
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Junker C, Junker H. [Experience with timolol in consulting patients (author's transl)]. Klin Monbl Augenheilkd 1980; 176:849-51. [PMID: 7442062 DOI: 10.1055/s-2008-1057568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Experience obtained in the treatment of 78 eyes of patients suffering from open-angle glaucoma with the beta-blocker Timolol 0.25% and 0.5%. Timolol was only given to patients whose intraocular pressure could no longer be adequately regulated by the medications previously employed. A synopsis is given of the medications used over many years. The intraocular pressures of the eyes that responded to Timolol remained below 23 mmHg even after prolonged use, so that a fistulizing operation was initially unnecessary.
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Sundmacher R, Junker C, Fanti P. [First experience with highly hydrophilic therapeutic soft contact lenses (With special reference to herpetic corneal disease) (author's transl)]. Klin Monbl Augenheilkd 1976; 169:422-30. [PMID: 994396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
74 therapeutic problem-cases of various corneal diseases were treated with the highly hydrophilic Weicon 72 (W 72) which proved to be a valuable therapeutic tool. Additional applications of hypertonic saline and of industrial preparations of steroids, antivirals and antibiotics were tolerated without observable side effects. Additional therapy is often inevitable to achieve an optimal therapeutic effect. Nearly all treated cases of chronic herpetic keratitis - mainly metaherpetic corneal diseases - responded well or excellently to W 72 therapy. If, however, the indication for soft lens therapy is somehow inadequate, if additional therapy is wrong or not applied at all and if the patient does not keep strictly to the therapeutic regime undesired side effects are likely to develop.
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Junker C. [Vision against the light as an aid to indication for cataract operation (author's transl)]. Klin Monbl Augenheilkd 1976; 169:348-51. [PMID: 1003825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The examination of visual acuity against the light may help the decision, whether or not a senile cataract should be operated on. We examined 84 eyes with different lens opacities, the visual acuity was analysed in relation to the axial, cortical and capsular cataract. We found in all cases a marked reduction of the visual acuity against the light. This has been general ophthalmological experience especially in the capsular cataract. This additional examination, we propose, is easily performed, and was given helpful information for all kinds of cataracts, where the indication for surgery was not clearcut.
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