Prevalence of substance use in a Swiss psychiatric hospital: interview reports and urine screening.

BACKGROUND: Co-morbid substance misuse is common in psychiatric disorders, has potentially severe adverse consequences and may be frequently undetected. AIMS: To measure the prevalence of substance use among patients admitted to a Swiss psychiatric hospital and to examine the potential utility of routine urine drug screening in this setting. METHOD: 266 inpatients were included. 238 patients completed the interview and 240 underwent a urine drug screening. RESULTS: Lifetime prevalence of substance use among psychiatric patients was very high for alcohol (98%; 95% CI: 96-100), benzodiazepines (86%; 95% CI: 82-91) and cannabis (53%; 95% CI: 47-60), but also for "hard drugs" like cocaine (25% ; 95% CI: 19-30) or opiates (20%; 95% CI: 15-25). Regular current use of alcohol (32%; 95% CI: 26-38) or cannabis (17%; 95% CI: 12-22) was the most frequent. Substance use was associated with male sex, younger age, unmarried status and nicotine smoking. Urine screening confirms reports from patients on recent use, and remained positive for cannabis during hospitalisation, but not for cocaine nor for opiates. CONCLUSION: Substance use is frequent among psychiatric patients. Systematic interviewing of patients about their substance use remains essential, and is usually confirmed by urine screening. Urine screening can be useful to provide specific answers about recent use.

Beyond the silence : institutional racism, social welfare and swiss citizenship

Cette thèse doctorale étudie le rôle de la citoyenneté Suisse et le modèle libérale de l'Etat social dans la production du racisme institutionnel au sein des services sociaux en Suisse. Cette thèse pose la question comment le régime de la citoyenneté Suisse rend possible et contraint les travailleurs sociaux à racialiser et discriminer leur clients avec des différences culturelles alors que les normes de l'aide sociale (normes de CSIAS) ne prévoient pas des traitements différentialistes selon la culture ou l'origine. Le modèle théorique du racisme institutionnel développé se passe sur une approche néo- institutionaliste et des ethnie and racial studies, prenant en compte le niveau individuel, collectif et institutionnel. En incluant ces deux approches, on dépasse le déterminisme des structuralistes dans les études sur le racisme institutionnel. Cette recherche qualitative montre que les travailleurs sociaux utilisent les ressources de la citoyenneté Suisse, de l'Etat social Suisse et leur expériences personnelles quand ils interagissent avec des clients. En plus, cette thèse démontre que le workfare logique en combinaison avec l'idée de l'assimilation culturelle rend possible la production d'un discours sur la nécessité de mériter d'être un membre de la communauté nationale et d'accéder à l'aide sociale. Cette compréhension néo-libérale de la citoyenneté renforce et légitime les travailleurs sociaux de racialiser et pratiquer la discrimination à l'égard de leurs clients et les rend incapable de développer une réflexivité critique. Toutefois, cette thèse montre également que les travailleurs sociaux produisent du travail social interculturel s'ils ont pu développer une telle réflexivité critique dans les institutions de l'aide sociale qui mettent en avant une conception "individuelle" de l'aide sociale.-Cette thèse vise à aller au-delà du silence qui constitue les débats publiques et la recherche sur le racisme au sein des institutions publiques en Suisse. - This thesis questions the role of the Swiss citizenship regime and the Swiss liberal social welfare model in the production of institutional racism in social services in Switzerland. Considering the absence of intercultural formal guidelines in the norms of social welfare (SKOS norms), this research investigates how the Swiss citizenship regime constrains and enables social workers to racialise and discriminate against their clients with cultural differences. This thesis develops a model of institutional racism, taking into account ethnic and racial studies and a neo-institutionalist approach on institutions, addressing the individual, collective and institutional level. In this framework, this thesis allows to overcome the structuralist determinism in the studies on institutional racism. Based on a qualitative inquiry, this research shows that social workers use the resources from the Swiss citizenship regime, social welfare model and their personal experiences when they interact with their clients. This study also shows that the workfare logic in combination with the idea of cultural assimilation enables to produce a discourse on deserving social welfare and earning membership to the national community. This neo-liberal citizenship understanding reinforces and legitimises social workers to racialise and discriminate against their clients and hinders them to develop critical reflexivity. However, this thesis also shows that social workers are able to produce intercultural social work when they could develop such a reflexivity in social services with an "individual" social welfare conceptions. This thesis aims to go beyond a persisting silence regarding public debates and research on racism in public institutions in Switzerland.

Design and methodology of the Swiss Transplant Cohort Study (STCS): a comprehensive prospective nationwide long-term follow-up cohort.

In Switzerland, organ procurement is well organized at the national-level but transplant outcomes have not been systematically monitored so far. Therefore, a novel project, the Swiss Transplant Cohort Study (STCS), was established. The STCS is a prospective multicentre study, designed as a dynamic cohort, which enrolls all solid organ recipients at the national level. The features of the STCS are a flexible patient-case system that allows capturing all transplant scenarios and collection of patient-specific and allograft-specific data. Beyond comprehensive clinical data, specific focus is directed at psychosocial and behavioral factors, infectious disease development, and bio-banking. Between May 2008 and end of 2011, the six Swiss transplant centers recruited 1,677 patients involving 1,721 transplantations, and a total of 1,800 organs implanted in 15 different transplantation scenarios. 10 % of all patients underwent re-transplantation and 3% had a second transplantation, either in the past or during follow-up. 34% of all kidney allografts originated from living donation. Until the end of 2011 we observed 4,385 infection episodes in our patient population. The STCS showed operative capabilities to collect high-quality data and to adequately reflect the complexity of the post-transplantation process. The STCS represents a promising novel project for comparative effectiveness research in transplantation medicine.

Recommandations suisses pour la prise en charge des cancers cutanés chez les patients transplantés d'organe [Swiss clinical practice guidelines for skin cancer in organ transplant recipients]

Swiss clinical practice guidelines for skin cancer in organ transplant recipients Transplant patients have increased over the last decades. As a consequence of long-term immunosuppression, skin cancer, in particular squamous cell carcinoma (SCC), has become an important problem. Screening and education of potential organ transplant recipients (OTRs) regarding prevention of sun damage and early recognition of skin cancer are important before transplantation. Once transplanted, OTRs should be seen yearly by a dermatologist to ensure compliance with sun avoidance as well as for treatment of precancerosis and SCC. Early removal is the best treatment for SCC. Reduction of immunosuppression, switch to mTOR inhibitors and chemoprevention with acitretin may reduce the incidence of SCC. The dermatological follow-up of OTRs should be integrated into a comprehensive post-transplant management strategy.

Trends in cardiovascular risk factors (1984-1993) in a Swiss region: results of three population surveys.

BACKGROUND: This study attempted to assess the time trends in lifestyle and cardiovascular risk factors in the Swiss region of Vaud-Fribourg (population 784,000). METHODS: Three surveys (1984/1985, 1988/1989, and 1992/1993), based on independent representative samples (n = 3,300) of the population ages 25 to 74, were conducted within the framework of the international WHO-MONICA Project. RESULTS: The most favorable changes were observed in reported behaviors: increased physical activity in leisure time, healthier dietary habits (switch from unskimmed milk, butter, and meat to skimmed milk, margarine, and fish, with no change for fruits and vegetables), and lower prevalence of regular smoking among men (from 32 to 28%). Body mass index did not vary significantly, apart from an increase in the prevalence of obesity among men (from 11 to 15%). Total cholesterol varied only slightly, while the HDL cholesterol levels decreased steadily (from 1.37 to 1.19 mmol/L among men; from 1.59 to 1.51 among women). Average systolic blood pressure regressed among women (from 127.2 to 124.4 mm Hg), while the prevalence of untreated hypertension increased among older men. CONCLUSION: The self-reported changes in lifestyle were only partially reflected by favorable trends in objective measurements. Physical activity, even at moderate intensity, and consumption of fruits, vegetables, and fiber in general should be promoted.

Hypertension and intra-operative incidents: a multicentre study of 125000 surgical procedures in Swiss hospitals

Background: It is debated whether chronic hypertension increases the risk of cardiovascular incidents during anaesthesia. Methods: We studied all elective surgical operations performed in adults under general or regional anaesthesia between 2000 and 2004, in 24 hospitals collecting computerised clinical data on all anaesthetia since 1996. The focus was on cardiovascular incidents, though other anaesthesia-related incidents were also evaluated. Results: Among 124 939 interventions, 27 881 (22%) were performed in hypertensive patients. At least one cardiovascular incident occurred in 7549 interventions (6% [95% CI 5.9-6.2%]). The average adjusted odds ratio of cardiovascular risk in patients with chronic hypertension was 1.38 (95% CI 1.27-1.49). However, across hospitals, adjusted odd ratios varied from 0.41 up to 2.25. Hypertension did not increase the risk of other incidents. Conclusions: Hypertensive patients are still at risk of intra-operative cardiovascular incidents. The heterogeneity of the risk to develop cardiovascular incidents varied across hospitals, despite taking into account casemix and hospital characteristics. These variations suggest that anaesthetic practices differ across anesthesia services

The Effect of Tax Revenue Budgeting Errors on Fiscal Balance : Evidence from Swiss cantons

This study is an empirical analysis of the impact of direct tax revenue budgeting errors on fiscal deficits. Using panel data from 26 Swiss cantons between 1980 and 2002, we estimate a single equation model on the fiscal balance, as well as a simultaneous equation model on revenue and expenditure. We use new data on budgeted and actual tax revenue to show that underestimating tax revenue significantly reduces fiscal deficits. Furthermore, we show that this effect is channeled through decreased expenditure. The effects of over and underestimation turn out to be symmetric.