Shared decision making development in Switzerland: room for improvement!

In Switzerland there is a strong movement at a national policy level towards strengthening patient rights and patient involvement in health care decisions. Yet, there is no national programme promoting shared decision making. First decision support tools (prenatal diagnosis and screening) for the counselling process have been developed and implemented. Although Swiss doctors acknowledge that shared decision making is important, hierarchical structures and asymmetric physician-patient relationships are still prevailing. The last years have seen some promising activities regarding the training of medical students and the development of patient support programmes. Swiss direct democracy and the habit of consensual decision making and citizen involvement in general may provide a fertile ground for SDM development in the primary care setting.

Dosimetry of 90Y-ibritumomab tiuxetan as consolidation of first remission in advanced-stage follicular lymphoma: results from the international phase 3 first-line indolent trial.

The objective of this analysis was to assess the radiation exposure associated with (90)Y-ibritumomab tiuxetan when used as consolidation therapy in adults with low or minimal tumor burden after first-line therapy of advanced follicular lymphoma (FL). METHODS: The patients who were enrolled in the phase 3 first-line indolent trial were 18 y or older, with CD20(+) grade 1 or 2 stage III or IV FL, and a partial response, complete response, or unconfirmed complete response to first-line chemotherapy. The patients were allocated randomly to receive a single infusion of unlabeled rituximab 250 mg/m(2) on day -7 and consolidation on day 0 with a single dose of (90)Y-ibritumomab tiuxetan, 14.8 MBq/kg, immediately after unlabeled rituximab, 250 mg/m(2), or no further treatment. On day -7, a subset of patients received an injection of 185 MBq of (111)In-ibritumomab tiuxetan immediately after unlabeled rituximab, 250 mg/m(2), for central dosimetry analysis. Correlations were assessed between organ radiation absorbed dose and toxicity, body weight, body mass index, and progression-free survival. RESULTS: Central dosimetry evaluations were available from 57 of 70 patients. Median radiation absorbed doses were 100 cGy (range, 28-327 cGy) for the red marrow and 72 cGy (range, 46-106 cGy) for the whole body. Radiation absorbed doses did not differ significantly between patients who had a partial response or complete response to initial therapy. Progression-free survival correlated significantly with the whole-body (r = 0.4401; P = 0.0006) and bone marrow (r = 0.2976; P = 0.0246) radiation dose. Body weight was significantly negatively correlated with whole-body radiation dose (r = -0.4971; P < 0.0001). Neither the whole-body radiation dose nor the bone marrow radiation dose correlated with hematologic toxicity. CONCLUSION: In patients with low or minimal residual tumor burden after first-line chemotherapy of advanced FL, whole-body and bone marrow exposure after (90)Y-ibritumomab tiuxetan consolidation showed a significant positive correlation with progression-free survival, whereas dosimetric data could not predict hematologic toxicity.

International perspectives on general internal medicine and the case for "globalization" of a discipline.

General internal medicine (GIM) has flourished in the United States (U.S.). Unlike other subspecialties of internal medicine, however, GIM's evolution has not been global in scope, but rather appears to have occurred in isolation within countries. Here, we describe international models of GIM from Canada, Switzerland, Australia/New Zealand, Argentina, and Japan, and compare these with the U.S. model. There are notable differences in the typical clinical roles assumed by General Internists across these 7 countries, but also important overlap in clinical and academic domains. Despite this overlap, there has been a relative lack of contact among General Internists from these and other countries at a truly international GIM meeting; the time is now for increased international exchange and the "globalization" of GIM.

Swiss population exposure to radiation by interventional radiology in 2008.

The aim of this study was to investigate the radiation exposure of the Swiss population to interventional procedures. A nationwide survey was conducted in Switzerland. The annual effective dose per capita due to interventional procedures was found to be 0.14 mSv, corresponding to 12% of the total dose. Coronary angiography and percutaneous coronary interventions were found to be the most frequent and the most irradiating interventional procedures, accounting for 52% of the total examination frequency and 64% of the dose delivered to the population. Switzerland stands at the same level as other countries in terms of effective dose per capita due to interventional radiology.

The environmental roots of non-communicable diseases (NCDs) and the epigenetic impacts of globalization

BACKGROUND: Non-communicable diseases (NCDs) are increasing worldwide. We hypothesize that environmental factors (including social adversity, diet, lack of physical activity and pollution) can become "embedded" in the biology of humans. We also hypothesize that the "embedding" partly occurs because of epigenetic changes, i.e., durable changes in gene expression patterns. Our concern is that once such factors have a foundation in human biology, they can affect human health (including NCDs) over a long period of time and across generations. OBJECTIVES: To analyze how worldwide changes in movements of goods, persons and lifestyles (globalization) may affect the "epigenetic landscape" of populations and through this have an impact on NCDs. We provide examples of such changes and effects by discussing the potential epigenetic impact of socio-economic status, migration, and diet, as well as the impact of environmental factors influencing trends in age at puberty. DISCUSSION: The study of durable changes in epigenetic patterns has the potential to influence policy and practice; for example, by enabling stratification of populations into those who could particularly benefit from early interventions to prevent NCDs, or by demonstrating mechanisms through which environmental factors influence disease risk, thus providing compelling evidence for policy makers, companies and the civil society at large. The current debate on the '25 × 25 strategy', a goal of 25% reduction in relative mortality from NCDs by 2025, makes the proposed approach even more timely. CONCLUSIONS: Epigenetic modifications related to globalization may crucially contribute to explain current and future patterns of NCDs, and thus deserve attention from environmental researchers, public health experts, policy makers, and concerned citizens.

Välimiesmenettely, yrityksen vaihtoehtoinen riidanratkaisumenetelmä

Tämän tutkielman tavoitteena on tutkia yrityksen näkökulmasta niin kansallista kuin kansainvälistä ad hoc välimiesmenettelyä, välimiesmenettelylain ja YK:n kansainvälisen kauppaoikeuden toimikunnan UNCITRAL:in sääntöjen pohjalta. Tutkielmassa käsitellään välimiesmenettelyn käynnistymisen edellytyksiä ja itse menettelyä välimiesoikeudessa sekä ulkomaisen välitystuomion tunnustamista ja täytäntöönpanoa Suomessa. Tutkimuksessa käytettävä tutkimusmetodologia on käsiteanalyyttinen. Välimiesmenettely on lisännyt suosiotaan vaihtoehtoisena riidanratkaisumenetelmänä ja sitä käytetään varsinkin kaupan, teollisuuden ja rakennustoiminnan piirissä. Välimiesmenettelyn merkitys on suuri kansainvälisen kaupan alalla ja se on vakiinnuttanut asemansa yritysten välisten riitojen ratkaisukeinona sen tuomien etuuksien, kuten joustavuuden, nopeuden ja kansainvälisyyden johdosta.

Clinically meaningful parameters of progression and long-term outcome of Parkinson disease: An international consensus statement.

Parkinson disease (PD) is associated with a clinical course of variable duration, severity, and a combination of motor and non-motor features. Recent PD research has focused primarily on etiology rather than clinical progression and long-term outcomes. For the PD patient, caregivers, and clinicians, information on expected clinical progression and long-term outcomes is of great importance. Today, it remains largely unknown what factors influence long-term clinical progression and outcomes in PD; recent data indicate that the factors that increase the risk to develop PD differ, at least partly, from those that accelerate clinical progression and lead to worse outcomes. Prospective studies will be required to identify factors that influence progression and outcome. We suggest that data for such studies is collected during routine office visits in order to guarantee high external validity of such research. We report here the results of a consensus meeting of international movement disorder experts from the Genetic Epidemiology of Parkinson's Disease (GEO-PD) consortium, who convened to define which long-term outcomes are of interest to patients, caregivers and clinicians, and what is presently known about environmental or genetic factors influencing clinical progression or long-term outcomes in PD. We propose a panel of rating scales that collects a significant amount of phenotypic information, can be performed in the routine office visit and allows international standardization. Research into the progression and long-term outcomes of PD aims at providing individual prognostic information early, adapting treatment choices, and taking specific measures to provide care optimized to the individual patient's needs.

A comparison of indices of glucose metabolism in five black populations: data from modeling the epidemiologic transition study (METS).

BACKGROUND: Globally, Africans and African Americans experience a disproportionate burden of type 2 diabetes, compared to other race and ethnic groups. The aim of the study was to examine the association of plasma glucose with indices of glucose metabolism in young adults of African origin from 5 different countries. METHODS: We identified participants from the Modeling the Epidemiologic Transition Study, an international study of weight change and cardiovascular disease (CVD) risk in five populations of African origin: USA (US), Jamaica, Ghana, South Africa, and Seychelles. For the current study, we included 667 participants (34.8 ± 6.3 years), with measures of plasma glucose, insulin, leptin, and adiponectin, as well as moderate and vigorous physical activity (MVPA, minutes/day [min/day]), daily sedentary time (min/day), anthropometrics, and body composition. RESULTS: Among the 282 men, body mass index (BMI) ranged from 22.1 to 29.6 kg/m(2) in men and from 25.8 to 34.8 kg/m(2) in 385 women. MVPA ranged from 26.2 to 47.1 min/day in men, and from 14.3 to 27.3 min/day in women and correlated with adiposity (BMI, waist size, and % body fat) only among US males after controlling for age. Plasma glucose ranged from 4.6 ± 0.8 mmol/L in the South African men to 5.8 mmol/L US men, while the overall prevalence for diabetes was very low, except in the US men and women (6.7 and 12 %, respectively). Using multivariate linear regression, glucose was associated with BMI, age, sex, smoking hypertension, daily sedentary time but not daily MVPA. CONCLUSION: Obesity, metabolic risk, and other potential determinants vary significantly between populations at differing stages of the epidemiologic transition, requiring tailored public health policies to address local population characteristics.

What do they expect? : A case study on the work expectations of the working German Generation Y

Purpose – The purpose of this paper is to identify the expectations of the workingGerman Generation Y regarding its current work and employer. As a result, the mainelements which could be considered by companies to retain the Generation Y inGermany will be pointed out and discussed.Design/methodology/approach – Semi-structured interviews were used in order toexplore the work expectations of this young generation within a German company. Anon-probability and purposive sample was used and six respondents part of theGeneration Y and working in the same company were interviewed. Furthermore, aseventh interview was conducted with the HMR of the company.Findings – Several findings are consistent with previous results of Gen Y from othernationalities than Germany such as the importance of varied tasks, opportunities forself-development, responsibilities and a pleasant working atmosphere. However,differences were found in particular regarding the importance of the work-life balanceand new expectations such as trust, autonomy and internationality have been broughtto light. Furthermore, several findings are also consistent with other studies aboutemployee retention, commitment and job satisfaction.Originality/value – This research extended previous studies of the expectations of theGeneration Y by providing firstly findings for Germany, a country where such studieshave not been conducted yet and secondly by focusing on the Generation Y who isalready working and therefore not studying anymore.

Tradición e internacionalidad : Archivos de Ciencias de la Educación (3ra. Época) y el pensamiento educacional en los años sesenta

El artículo analiza los procesos de cambio en el pensamiento educacional durante los años sesenta, a partir de una relectura de la revista Archivos de Ciencias de la Educación en su 3ra época (1961-1967). El trabajo también constituye un primer intento de apropiación del concepto de externalización desarrollado por Jurguen Schriewer (1993 y 2010) para el estudio del conocimiento educacional, siguiendo la sociología de Niklas Luhmann. La relevancia de esta perspectiva teórica radica -a nuestro juicio- en que posibilita reinscribir las derivas del pensamiento pedagógico local en el contexto más amplio de las dinámicas de circulación, difusión y apropiación selectiva del conocimiento educacional a nivel mundial y regional

Tradición e internacionalidad : Archivos de Ciencias de la Educación (3ra. Época) y el pensamiento educacional en los años sesenta

El artículo analiza los procesos de cambio en el pensamiento educacional durante los años sesenta, a partir de una relectura de la revista Archivos de Ciencias de la Educación en su 3ra época (1961-1967). El trabajo también constituye un primer intento de apropiación del concepto de externalización desarrollado por Jurguen Schriewer (1993 y 2010) para el estudio del conocimiento educacional, siguiendo la sociología de Niklas Luhmann. La relevancia de esta perspectiva teórica radica -a nuestro juicio- en que posibilita reinscribir las derivas del pensamiento pedagógico local en el contexto más amplio de las dinámicas de circulación, difusión y apropiación selectiva del conocimiento educacional a nivel mundial y regional