Origin and outcome of multiple pregnancies in Bern, Switzerland, 1995-2006 and the current proposal of the Swiss parliament to revise the Swiss law of reproductive medicine: Switzerland quo vadis?

INTRODUCTION: Infertility treatments are a major source of the increase in multiple pregnancies (MPs). AIMS: The aims of the present study were (1.) to investigate the origin and maternal/neonatal outcomes of MP and (2.) to review the different measures that can be adopted to reduce these serious complications. METHODS: The study included all women with multiple births between 1 January 1995 and 31 December 2006 at the University Hospital of Bern, Switzerland. The outcomes associated with the various origins of MP (natural conception, ovarian stimulation [OS] ‒ in-vitro fertilisation [IVF-ICSI]) were analysed using a multinomial logistic regression model. An analysis of the Swiss law on reproductive medicine and its current proposed revision, as well as a literature review using Pubmed, was carried out. RESULTS: A total of 592 MP were registered, 91% (n = 537) resulted in live births. There was significantly more neonatal/maternal morbidity in MP after OS compared with natural conception and even with the IVF-ICSI group. With a policy of elective single embryo transfer (eSET), twin rates after IVF-ICSI can be reduced to <5% and triplets to <1%. CONCLUSIONS: After OS, more triplets are found and the outcome of MP is worse. MP is known to be associated with morbidity, mortality, and economic and social risks. To counteract these complications (1.) better training for physicians performing OS should be encouraged and (2.) the Swiss law on reproductive medicine needs to be changed, with the introduction of eSET policies. This would lead to a dramatic decrease in neonatal and maternal morbidity/mortality as well as significant cost reductions for the Swiss healthcare system.

Conseit aux fumeurs: mise à jour épidémiologique et clinique [Smoking cessation intervention: 2006 update]

Recent Swiss reports confirmed that several chemical products added to cigarettes may increase the level of dependence and therefore the consumption of cigarettes. Observational studies demonstrated the association between smoking and type II diabetes, that smoking one to four cigarettes daily increases significantly the risk of disease and that the relative risk of breast cancer among non smoking women exposed to passive smoking is increased by 30%. The safety of nicotine replacement therapy for patients with cardiovascular disorders has been confirmed. Among new pharmacological approaches, varenicline, rimonabant, topiramate and nicotine vaccine all appear promising.

Opinions on tobacco control policies in Lausanne, Switzerland, 2003-2006.

OBJECTIVE: To assess the determinants of opinions regarding tobacco control policies in the Swiss general population. METHODS: Cross-sectional study conducted between 2003 and 2006 on a random sample of adult residents of Lausanne, Switzerland, aged 35-75 years (2601 women and 2398 men). Nine questions on smoking policies were applied. RESULTS: Ninety-five percent of responders supported policies that would help smokers to quit, 92% no selling of tobacco to subjects aged less than 16 years, 87% a smoking ban in public places and 86% a national campaign against smoking. A further 77% supported a total ban on tobacco advertising, 74% the reimbursement of nicotine replacement therapies and 70% an increase in the price of cigarettes. A lower support was found for two non-evidence-based interventions total ban of tobacco sales (35%) and promotion of light cigarettes (22%). Never smokers, women, physically active subjects, teetotallers and subjects with lower educational level were more likely to favour stronger measures while no differences were found between age groups. Reimbursement of nicotine replacement therapies was favoured more by current smokers and inactive subjects. CONCLUSION: The vast majority of responders supported the recommended tobacco control policies. Opinions regarding specific interventions vary according to the policy and subjects' characteristics.

Interruptions de grossesse dans le canton de Vaud en 2006

En 2006, un total de 1306 interruptions de grossesse ont été pratiquées dans le canton de Vaud, soit 89 (7%) de plus que l'année précédente. La grande majorité (93%) de ces interruptions de grossesse concernent des femmes résidant dans le canton de Vaud. Si le nombre absolu d'interruptions de grossesse est en nette augmentation, le taux pour 1000 résidentes âgées de 15 à 49 ans ne marque qu'une légère progression, passant de 6,7 pour-mille en 2004 à 7,2 pour-mille en 2006. Un écart important se maintient entre les femmes de nationalité étrangère (2006 : 12,1 pour-mille) et les Suissesses (4,6 pour-mille). Dans les deux groupes, néanmoins, l'augmentation des interruptions de grossesse parmi les adolescentes (15-19 ans) semble se confirmer. Depuis 2003, les taux sont passés de 4,4 pour-mille à 6,2 pour-mille chez les Suissesses et de 9,1 pour-mille à 14,4 pour-mille chez les femmes de nationalité étrangère. [Extrait des conclusions, p. 26]