[Drug therapy knowledge in ambulatory cardiovascular patients]

To analyse drug therapy knowledge of prescribed drugs and self-administered medicinal products we interviewed 222 ambulatory cardiovascular patients. Spontaneous mentions of drugs (at least 3 preparations on average) were completed later on specific questioning. 40% of patients once interrupted their therapy due to adverse drug reactions. Most patients knew the labels of their medicaments but the effects and indications only in 50%. Nevertheless 70% were satisfied with the informations of the physician. Drugs available over the counter were consumed in many of the respondents: 50% consumed analgetics, and--mainly female patients--25% sedatives and 15% laxatives or diuretics. We conclude that specific questioning on self-administation of OTC preparations or formerly prescribed drugs results in an improved overview of medication and a better handling of polymedication and drug compliance.

[Cost analysis for ambulatory patients in internal medicine]

We analyzed the diagnostical and therapeutical costs of 300 ambulatory patients over a two year period in a Swiss university policlinic of internal medicine. The calculations were based on the catalogue of hospital services (Spitalleistungskatalog) and the drugstore prices for pharmaceuticals (Apothekenpreise). The overall costs for the 300 patients were about 238,400 CHF. The refund by the health insurances represented 56% (excluding specific services such as radiological examinations). The main costs concerned analytical laboratory services (32%), physicians services (27%), technical services (26%), and pharmaceuticals (15%). Some analytical and technical services were prescribed unexpectedly frequently. Prevalent among the emitted pharmaceuticals were protone pump inhibitors, modern cardiovascular drugs and statins. Presumed reasons may be a minor cost awareness of the physicians and a trend towards modern but expensive therapies. An adequate cost awareness can only emerge from precise data of effective costs.

[Postmenopausal hormone replacement therapy and cardiovascular risk: role of conjugated equine estrogens and medroxyprogesterone acetate]

Atherosclerosis is a chronic systemic inflammatory disease of the vasculature that accounts for the majority of morbidity and mortality in women. The incidence of atherosclerosis is low in premenopausal women and increases after ovariectomy. Experimental studies demonstrate inhibitory effects of natural estrogens on the progression of atherosclerosis. In contrast, results from recent hormone replacement trials using conjugated equine estrogens and medroxyprogesterone acetate in postmenopausal women showed no effects or even an increase in cardiovascular morbidity and mortality such as thrombosis or stroke. Therefore, conjugated equine estrogens alone or in combination with medroxyprogesterone acetate should not be recommended for the prevention or treatment of cardiovascular disease. Optimizing the risk factor profile such as cessation of smoking, normalizing body weight and blood pressure, regular physical activity, and statin treatment of patients with coronary artery disease remain important treatment options.

[Is the Swiss population gaining body weight? Body mass index in insurance applications between 1950 and 1990]

In this study 4435 insurance applications to the Swiss Life insurance company ("Rentenanstalt") by individuals aged 20-39 years from the time period 1950-1990 were evaluated. Each application contained the self-reported body weight, height, and other informations such as martial status or city of residence. For each individual the body mass index (BMI) was computed and the prevalence of overweight and obesity for each year was calculated using standard definitions. This is the first study which tries to determine the prevalence rates of overweight and obesity in Switzerland over time. The absolute body weight (kg) increased continuously from 1950 to the year 2000. The most pronounced increase was seen in individuals (aged 20-29 years) above the 90th percentile of body weight and BMI, i.e. already overweight and/or obese individuals showed the largest increase in body weight. In men (aged 20-29 years) the prevalence of overweight increased between 1980 and 1990 by more than 10% to a prevalence rate of 25%. In women (aged 20-29 years) the prevalence of overweight increased continuously from 1960 onward and reached a rate of 10.5% in 1990. In the age group of the 30-39 years old individuals no change in the prevalence rates was observed. These data suggest that there is a trend for an increased prevalence of overweight in Switzerland. Since the study sample was not representative for the Swiss population the results have to be interpreted with caution only. Nevertheless the results are in agreement with the trends in other countries and it can be assumed that similar developments do occur also in Switzerland.