Felix Gutzwiller

Methods of suicide: international suicide patterns derived from the WHO mortality database

OBJECTIVE Accurate information about preferred suicide methods is important for devising strategies and programmes for suicide prevention. Our knowledge of the methods used and their variation across countries and world regions is still limited. The aim of this study was to provide the first comprehensive overview of international patterns of suicide methods. METHODS Data encoded according to the International Classification of Diseases (10th revision) were derived from the WHO mortality database. The classification was used to differentiate suicide methods. Correspondence analysis was used to identify typical patterns of suicide methods in different countries by providing a summary of cross-tabulated data. FINDINGS Poisoning by pesticide was common in many Asian countries and in Latin America; poisoning by drugs was common in both Nordic countries and the United Kingdom. Hanging was the preferred method of suicide in eastern Europe, as was firearm suicide in the United States and jumping from a high place in cities and urban societies such as Hong Kong Special Administrative Region, China. Correspondence analysis demonstrated a polarization between pesticide suicide and firearm suicide at the expense of traditional methods, such as hanging and jumping from a high place, which lay in between. CONCLUSION This analysis showed that pesticide suicide and firearm suicide replaced traditional methods in many countries. The observed suicide pattern depended upon the availability of the methods used, in particular the availability of technical means. The present evidence indicates that restricting access to the means of suicide is more urgent and more technically feasible than ever.

Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: a follow-up study

BACKGROUND Heroin-assisted substitution treatment for severely opioid-dependent drug users has been available in Switzerland since 1994. Our aim was to ascertain the feasibility, safety, and efficacy of this treatment. METHODS We did a cohort study in 21 community outpatient treatment centres. We assessed 1969 opioid-dependent drug users, who began heroin-assisted substitution treatment between January, 1994, and December, 2000, to ascertain admission and discharge patterns, and patient characteristics. We also followed up a subset of 237 patients who began treatment between Jan 1, 1994, and March 31, 1995, and who stayed with the programme for at least 18 months. We used questionnaires, interviews, and medical examinations done at entry and after 6, 12, and 18 months to assess somatic and mental health, social integration, and treatment outcomes. FINDINGS More than 70% (1378) of patients remained in treatment for more than a year. Treatment showed positive effects with respect to health and social outcomes. A long stay in treatment was related to a higher chance of starting abstinence-oriented therapy than a short stay. INTERPRETATION Heroin-assisted substitution treatment might be an effective option for chronically addicted patients for whom other treatments have failed.

Age-Related Differences in the Use of Guideline-Recommended Medical and Interventional Therapies for Acute Coronary Syndromes: A Cohort Study

OBJECTIVES: To compare the use of guideline‐recommended medical and interventional therapies in older and younger patients with acute coronary syndromes (ACSs).

Cohort Profile: The Swiss National Cohort—a longitudinal study of 6.8 million people

For many years research on socio-economic inequalities in health in Switzerland was based on crosssectional data. Cross-sectional studies are problematic for several reasons. For example, results may be affected by numerator/denominator bias. Furthermore, occupational information from death certificates was used to describe the socio-economic position of individuals. However, this meant that those who do not work, older men and a substantial proportion of women, had to be excluded. Decennial censuses, conducted at the beginning of December every 10 years, have been done in Switzerland since 1850 (exceptions were 1890 and 1940, which were replaced by a census in 1888 and 1941, respectively). Deaths and causes of death have been registered since 1876, with data stored electronically since 1969. Death registration is anonymous. However, the date of death and birth are available, as well as gender, marital status, place of residence, date of birth of spouse and other variables. The 1990 census for the first time included the exact date of birth, which opened the possibility of linking census and mortality data. Based on the promising results of a pilot study that was done for one Canton at University of Zurich, the project was extended to cover the whole of Switzerland, linking the 1990 census with mortality records up to the end of 1997. The results indicated that linkage was less successful for foreign nationals and young adults, and led to the inclusion of additional data sources, including data on immigrants and emigrants and, importantly, the 2000 census. In 2005, an application by all five University Institutes of Social and Preventive Medicine (ISPMs) to obtain long-term funding for a Swiss National Cohort study (SNC) was successful within the framework of a Swiss National Science Foundation initiative to support longitudinal studies. Approval was obtained from the Ethics Committees of the Cantons of Zurich and Bern and a data centre was established at ISPM Bern.

Analysis of the relationship between total cholesterol, age, body mass index among males and females in the WHO MONICA Project

OBJECTIVE: To explore the relationship between hypercholesterolaemia, age and BMI among females and males.DESIGN: Population-based cross-sectional survey.SUBJECTS: The data came from the initial surveys of the WHO MONICA Project. In all, 27 populations with 48 283 subjects (24 017 males and 24 266 females) aged 25–64 y were used for the analysis.MEASUREMENTS: Total cholesterol, weight, height, BMI, prevalence of hypercholesterolaemia (PHC) defined as cholesterol ≥6.5 mmol/l, and the prevalence of obesity (POB) defined as BMI ≥30 kg/m2.RESULTS: PHC increased with age, with PHC in males being significantly higher than in females at age range 25–49 y and significantly lower than in females at age range 50–64 y. Age-related increase in hypercholesterolaemia was steeper in females than in males. There was a statistically significant positive association between hypercholesterolaemia and BMI. Multiple logistic regression analysis revealed a negative statistically significant (P<0.001) effect modification involving age and BMI on the risk of having hypercholesterolaemia both in females and males. The relation between PHC and BMI became weaker in higher age groups, with no statistically significant association in females aged 50–64 y.CONCLUSION: Public health measures should be directed at the prevention of obesity in young adults since the strongest effect of obesity on the risk of hypercholesterolaemia has been found in subjects aged 25–39 y.

Lower Mortality From Coronary Heart Disease and Stroke at Higher Altitudes in Switzerland

Background— Studies assessing the effect of altitude on cardiovascular disease have provided conflicting results. Most studies were limited because of the heterogeneity of the population, their ecological design, or both. In addition, effects of place of birth were rarely considered. Here, we examine mortality from coronary heart disease and stroke in relation to the altitude of the place of residence in 1990 and at birth. Methods and Results— Mortality data from 1990 to 2000, sociodemographic information, and places of birth and residence in 1990 (men and women between 40 and 84 years of age living at altitudes of 259 to 1960 m) were obtained from the Swiss National Cohort, a longitudinal, census-based record linkage study. The 1.64 million German Swiss residents born in Switzerland provided 14.5 million person-years. Relative risks were calculated with multivariable Poisson regression. Mortality from coronary heart disease (−22% per 1000 m) and stroke (−12% per 1000 m) significantly decreased with increasing altitude. Being born at altitudes higher or lower than the place of residence was associated with lower or higher risk. Conclusions— The protective effect of living at higher altitude on coronary heart disease and stroke mortality was consistent and became stronger after adjustment for potential confounders. Being born at high altitude had an additional and independent beneficial effect on coronary heart disease mortality. The effect is unlikely to be due to classic cardiovascular disease risk factors and rather could be explained by factors related to climate.

Acute coronary syndromes in young patients: Presentation, treatment and outcome

BACKGROUND Acute coronary syndromes (ACS) in very young patients have been poorly described. We therefore evaluate ACS in patients aged 35 years and younger. METHODS In this prospective cohort study, 76 hospitals treating ACS in Switzerland enrolled 28,778 patients with ACS between January 1, 1997, and October 1, 2008. ACS definition included ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). RESULTS 195 patients (0.7%) were 35 years old or younger. Compared to patients>35 years, these patients were more likely to present with chest pain (91.6% vs. 83.7%; P=0.003) and less likely to have heart failure (Killip class II to IV in 5.2% vs. 23.0%; P<0.001). STEMI was more prevalent in younger than in older patients (73.1% vs. 58.3%; P<0.001). Smoking, family history of CAD, and/or dyslipidemia were important cardiovascular risk factors in young patients (prevalence 77.2%, 55.0%, and 44.0%). The prevalence of overweight among young patients with ACS was high (57.8%). Cocaine abuse was associated with ACS in some young patients. Compared to older patients, young patients were more likely to receive early percutaneous coronary interventions and had better outcome with fewer major adverse cardiac events. CONCLUSIONS Young patients with ACS differed from older patients in that the younger often presented with STEMI, received early aggressive treatment, and had favourable outcomes. Primary prevention of smoking, dyslipidemia and overweight should be more aggressively promoted in adolescence.

Seasonality in suicide - A review and search of new concepts for explaining the heterogeneous phenomena

Seasonality is one of the oldest and most resistant-to-elucidation issues in suicide research. However, in recent years epidemiological research has yielded new results, which provide new perspectives on the matter. This qualitative review summarizes research published since the 1990 s. In particular, the focus is on studies dealing with the historical change of seasonality, cross-sectional comparisons including method-specific diversity, and the association with weather variables and other putative covariates. Recent research has shown that in Western countries the seasonality of suicide is tending to diminish and may, eventually, disappear. It can no longer be considered a universal and homogeneous phenomenon. In addition, different major seasonal cycles have now been determined which mainly depend on different suicide methods. Just as in the epidemiology of suicide methods, the (seasonal) availability and perceived adequacy of methods emerge as the major driving force beyond the seasonal phenomena in suicide.

HIV prevention in developed countries

HIV prevention in developed countries is marked by impressive successes and dismal failures. The successes point the way to what works; the failures highlight obstacles that must be overcome. Successes include important behavioural changes among gay and bisexual men, antiviral use to prevent vertical transmission, and securing the safety of the blood supply. New strategies are needed to reach the residual of individuals continuing with unsafe practices (a special hazard in high-prevalence areas); to reach young people who are beginning to engage in sexual relations and injection drug use; and to overcome political opposition to prevention strategies.

Changing Times: A Longitudinal Analysis of International Firearm Suicide Data

We investigated changes in the proportion of firearm suicides in Western countries since the 1980s and the relation of these changes to the change in the proportion of households owning firearms. Several countries had an obvious decline in firearm suicides: Norway, United Kingdom, Canada, Australia, and New Zealand. Multilevel modeling of longitudinal data confirmed the effect of the proportion of households owning firearms. Legislation and regulatory measures reducing the availability of firearms in private households can distinctly strengthen the prevention of firearm suicides.