State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006

BACKGROUND Emergency departments (EDs) are an essential component of any developed health care system. There is, however, no national description of EDs in Switzerland. Our objective was to establish the number and location of EDs, patient visits and flow, medical staff and organization, and capabilities in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland. METHODS In 2007, we started to create an inventory of all hospital-based EDs with a preliminary list from the Swiss Society of Emergency and Rescue Medicine that was improved with input from ED physicians nationwide. EDs were eligible if they offered acute care 24 h per day, 7 days per week. Our goal was to have 2006 data from at least 80% of all EDs. The survey was initiated in 2007 and the 80% threshold reached in 2012. RESULTS In 2006, Switzerland had a total of 138 hospital-based EDs. The number of ED visits was 1.475 million visits or 20 visits per 100 inhabitants. The median number of visits was 8,806 per year; 25% of EDs admitted 5,000 patients or less, 31% 5,001-10,000 patients, 26% 10,001-20,000 patients, and 17% >20,000 patients per year. Crowding was reported by 84% of EDs with >20,000 visits/year. Residents with limited experience provided care for 77% of visits. Imaging was not immediately available for all patients: standard X-ray within 15 min (70%), non-contrast head CT scan within 15 min (38%), and focused sonography for trauma (70%); 67% of EDs had an intensive care unit within the hospital, and 87% had an operating room always available. CONCLUSIONS Swiss EDs were significant providers of health care in 2006. Crowding, physicians with limited experience, and the heterogeneity of emergency care capabilities were likely threats to the ubiquitous and consistent delivery of quality emergency care, particularly for time-sensitive conditions. Our survey establishes a benchmark to better understand future improvements in Swiss emergency care.

International Regulation of Postal Communications

The article provides a concise overview of the rules applicable to postal communications at the international level. Particular attention is paid to the regulations of the Universal Postal Union (UPU), the General Agreement on Trade in Services (GATS) of the World Trade Organization (WTO), as well as the relationship between the two. Outlook on possible future developments accounting for the rapid technological advances and the liberalisation of markets wraps the analysis up. This is a 2010 update that takes into consideration the changes made in the UPU acts in 2008, as well as the latest developments in the WTO's Doha Round negotiations.

Bridging Research and Development : Partnership Actions for Mitigating Syndromes (PAMS) in the Swiss National Centre of Competence (NCCR) North-South - Capitalising on Experience

Within the framework of Switzerland’s international NCCR North-South research programme, Partnership Actions for Mitigating Syndromes (PAMS) are a practice-oriented component with a transdisciplinary approach. By linking research and development practice, they bring together researchers, practitioners and local communities in a common effort to test and evaluate research findings in concrete development contexts. They provide unique insights into innovative approaches and opportunities for promoting sustainable development in countries of the South and East. After an initial four-year phase, the PAMS projects implemented to date were evaluated in order to learn about their potentials and limits, as well as to decide on the direction of the component for the next phase of the programme. The present publication presents the results of this evaluation.

Unresolved Grief in a National Sample of Bereaved Parents: Impaired Mental and Physical Health 4 to 9 Years Later

PURPOSE: To assess unresolved parental grief, the associated long-term impact on mental and physical health, and health service use. PATIENTS AND METHODS: This anonymous, mail-in questionnaire study was performed as a population-based investigation in Sweden between August 2001 and October 2001. Four hundred forty-nine parents who lost a child as a result of cancer 4 to 9 years earlier completed the survey (response rate, 80%). One hundred ninety-one (43%) of the bereaved parents were fathers, and 251 (56%) were mothers. Bereaved parents were asked whether or not, and to what extent, they had worked through their grief. They were also asked about their physical and psychological well-being. For outcomes of interest, we report relative risk (RR) with 95% CIs as well as unadjusted odds ratios and adjusted odds ratios. RESULTS: Parents with unresolved grief reported significantly worsening psychological health (fathers: RR, 3.6; 95% CI, 2.0 to 6.4; mothers: RR, 2.9; 95% CI, 1.9 to 4.4) and physical health (fathers: RR, 2.8; 95% CI, 1.8 to 4.4; mothers: RR, 2.3; 95% CI, 1.6 to 3.3) compared with those who had worked through their grief. Fathers with unresolved grief also displayed a significantly higher risk of sleep difficulties (RR, 6.7; 95% CI, 2.5 to 17.8). Mothers, however, reported increased visits with physicians during the previous 5 years (RR, 1.7; 95% CI, 1.1 to 2.6) as well as a greater likelihood of taking sick leave when they had not worked through their grief (RR, 2.1; 95% CI, 1.2 to 3.5). CONCLUSION: Parents who have not worked through their grief are at increased risk of long-term mental and physical morbidity, increased health service use, and increased sick leave.

Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort

U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe asthma, mild/moderate asthma and healthy controls from 11 European countries consisted of analyses of patient-reported outcomes, lung function, blood and airway inflammatory measurements.Patients with severe asthma (nonsmokers, n=311; smokers/ex-smokers, n=110) had more symptoms and exacerbations compared to patients with mild/moderate disease (n=88) (2.5 exacerbations versus 0.4 in the preceding 12 months; p<0.001), with worse quality of life, and higher levels of anxiety and depression. They also had a higher incidence of nasal polyps and gastro-oesophageal reflux with lower lung function. Sputum eosinophil count was higher in severe asthma compared to mild/moderate asthma (median count 2.99% versus 1.05%; p=0.004) despite treatment with higher doses of inhaled and/or oral corticosteroids.Consistent with other severe asthma cohorts, U-BIOPRED is characterised by poor symptom control, increased comorbidity and airway inflammation, despite high levels of treatment. It is well suited to identify asthma phenotypes using the array of "omic" datasets that are at the core of this systems medicine approach.

Report from the National Institute of Allergy and Infectious Diseases workshop on drug allergy

Allergic reactions to drugs are a serious public health concern. In 2013, the Division of Allergy, Immunology, and Transplantation of the National Institute of Allergy and Infectious Diseases sponsored a workshop on drug allergy. International experts in the field of drug allergy with backgrounds in allergy, immunology, infectious diseases, dermatology, clinical pharmacology, and pharmacogenomics discussed the current state of drug allergy research. These experts were joined by representatives from several National Institutes of Health institutes and the US Food and Drug Administration. The participants identified important advances that make new research directions feasible and made suggestions for research priorities and for development of infrastructure to advance our knowledge of the mechanisms, diagnosis, management, and prevention of drug allergy. The workshop summary and recommendations are presented herein.

Na 1 Nachlass Max Horkheimer, 705 - Studien über Nationalismus und Autorität; Darmstädter Gemeindestudie; "Project on Attitudes of German Youth" u.a. (p. IX 176 - IX 181a)

"Gruppenuntersuchung über Nationalismus", Juni 1950. Typoskript mit handschriftlichen Ergänzungen von Friedrich Pollock, 18 Blatt; "Beitrag des Instituts für Sozialforschung zu dem Forschungsobjekt (Forschungsprojekt?) über Autorität", 1950/51, a) Typoskript, 5 Blatt, b) Typoskript mit dem Titel "New Project on Authority" mit handschriftlichen Korrekturen, 7 Blatt; "Memorandum über eine Studie zum Problem der Autorität im deutschen Erziehungswesen", ca. 1950. Typoskript, 4 Blatt; "Darmstädter Gemeindestudie", 1950-52: 1. Theodor W. Adorno: "Memorandum re: Stand der Darmstädter Gemeindestudie bei der Abreise von Theodor W. Adorno", 15.10.1952. Typoskript mit eigenhändigen Korrekturen, 2 Blatt; 2. Ansprache bei der Überreichung der ersten Publikationen der Studie an den Minister und den Bürgermeister von Darmstadt, 2.7.1952, Typoskript, 9 Blatt; 3. Max Horkheimer: "Gutachten über die Darmstädter Gemeindestudie", 1.4.1952. Typoskript, 2 Blatt; 4. "Memorandum on the Participation of the Institute of Social Research in the Darmstadt Community Study", 31.3.1952. Typoskript, 3 Blatt; 5. Theodor W. Adorno: 'Memorandum re: Darmstadt', 4.9.1951. Typoskript, 1 Blatt; 6. "Eine Untersuchung über die Einstellung der Arbeitnehmer zu ihren wirtschaftlichen Interessenvertretungen (Darmstädter Gemeindestudie). Entwurf", 20.7.1951. Typoskript mit handschriftlichen Korrekturen, 6 Blatt; 7. Theodor W. Adorno: "Memorandum über zwei an das Institut für Sozialforschung zu vergebende Aufträge im Rahmen der Darmstädter Gemeindestudie". Typoskripte, 6 Blatt; 8. Theodor W. Adorno: "Aktennotiz über die Besprechung am 20. November 1950 zwischen den Leitern der Darmstädter Gemeindestudie, insbesondere Dr. Grigsy und Magnifizenz Rolfes, und Theodor W. Adorno". Typoskript, 2 Blatt; 9. Bemerkungen zum Abbruch und zur Neuorganisation der Studie, für eine Rede in Chicago, Typoskript, englisch, ohne Datum, 1 Blatt; "Outline of a Study of In-Between-Culture" ("Edelkitsch"), Anfang der 1950er Jahre. Typoskript, englisch, 1 Blatt; "Project on Attitudes of German Youth", 1951: 1. "Some Remarks of the Present German Social Situation", a) Typoskript, 24 Blatt, b) Typoskript mit handschriftlichen Korrekturen, 23 Blatt, c) Typoskript, 23 Blatt, d) Typoskript, 21 Blatt, e) Entwurf, Typoskript, 23 Blatt; 2. "Estimate for six month project on Attitudes of German Youth", 2 Blatt; Institut für Sozialforschung: "Umfrage unter Frankfurter Studenten" (Max Horkheimer: "Vorbemerkung"): Über die soziale Situation und die Einstellun der Studenten, 1952, Ergebnisse eines Praktikums zur empirischen Sozialforschung, Wintersemester 1951/52, als Typoskript vervielfältigt, gebunden, 126 Blatt;

Evaluation of the causal pathways through which subjective norms influence mammography intention and stage of change in a national sample of women veterans

Few studies have investigated causal pathways linking psychosocial factors to each other and to screening mammography. Conflicting hypotheses exist in the theoretic literature regarding the role and importance of subjective norms, a person's perceived social pressure to perform the behavior and his/her motivation to comply. The Theory of Reasoned Action (TRA) hypothesizes that subjective norms directly affect intention; while the Transtheoretical Model (TTM) hypothesizes that attitudes mediate the influence of subjective norms on stage of change. No one has examined which hypothesis best predicts the effect of subjective norms on mammography intention and stage of change. Two statistical methods are available for testing mediation, sequential regression analysis (SRA) and latent variable structural equation modeling (LVSEM); however, software to apply LVSEM to dichotomous variables like intention has only recently become available. No one has compared the methods to determine whether or not they yield similar results for dichotomous variables. ^ Study objectives were to: (1) determine whether the effect of subjective norms on mammography intention and stage of change are mediated by pros and cons; and (2) compare mediation results from the SRA and LVSEM approaches when the outcome is dichotomous. We conducted a secondary analysis of data from a national sample of women veterans enrolled in Project H.O.M.E. (H&barbelow;ealthy O&barbelow;utlook on the M&barbelow;ammography E&barbelow;xperience), a behavioral intervention trial. ^ Results showed that the TTM model described the causal pathways better than the TRA one; however, we found support for only one of the TTM causal mechanisms. Cons was the sole mediator. The mediated effect of subjective norms on intention and stage of change by cons was very small. These findings suggest that interventionists focus their efforts on reducing negative attitudes toward mammography when resources are limited. ^ Both the SRA and LVSEM methods provided evidence for complete mediation, and the direction, magnitude, and standard errors of the parameter estimates were very similar. Because SRA parameter estimates were not biased toward the null, we can probably assume negligible measurement error in the independent and mediator variables. Simulation studies are needed to further our understanding of how these two methods perform under different data conditions. ^

Is family medicine meeting the HIV/AIDS challenge? A national survey of family physicians' beliefs, clinical competence, and experience regarding HIV disease

A national sample of family physicians was surveyed to (1) assess family physicians' beliefs about the human immunodeficiency virus (HIV) and individuals at risk for infection, their clinical competence regarding HIV-related issues, and their experiences with HIV disease; (2) present conclusions to the American Academy of Family Physicians (AAFP) to effect the development of an early clinical care protocol and a continuing medical education curriculum; and (3) collect base-line data for use in the evaluation of an early clinical care protocol and a continuing medical education curriculum, in the case that such programs are developed and disseminated. After considering retired or deceased respondents, of the 2,660 physicians surveyed, 1,678 (63.7%) responded. The resulting sample was representative of the active members of the AAFP. About 77% of the respondents were unable to accurately identify the universal precautions for blood and body fluids to prevent occupational transmission of HIV or hepatitis B virus (HBV). Residency trained and board certified physicians expressed fewer "external constraints," such as fear of losing patients, obviating them from providing treatment to individuals with HIV disease (p =.004 and p $<$.001, respectively). These physicians also manifested fewer "internal constraints" to the provision of HIV treatment, such as fear of becoming infected (p $<$.001 and p =.012, respectively). Residency trained physicians also expressed a greater comfort with discussing sexually-related topics with their patients than did non-residency trained physicians (p $<$.001). There were 67.1% of the physicians surveyed who reported never providing treatment to an individual with HIV disease. Residency trained and board certified physicians expressed a greater likelihood to provide treatment to HIV-infected patients (p $<$.001) than non-residency trained and non-board certified physicians.^ Among the various primary care specialties, family medicine is especially vulnerable to the current challenges of HIV/AIDS. These challenges are augmented by the epidemiologic pattern that characterizes AIDS. For the past several years, we have seen AIDS in this country assume a similar pattern to that seen in most other countries; HIV is becoming increasingly prevalent in the heterosexual population as well as in locations removed from metropolitan centers. This current phase of the epidemic generates greater pressures upon primary care physicians, particularly family physicians, to become better acquainted with the means to provide early care to HIV/AIDS patients and to prevent HIV/AIDS among their patients. Family medicine is especially appropriate for providing care to HIV patients because family medicine involves treatment to all age groups and conditions; other primary care specialties focus on limited patient populations or specific conditions. Family physicians should be armed with the expertise to confront HIV/AIDS. However, family physicians' clinical competence and experience with HIV is not known. The data collected in this survey describes their competencies, attitudes, and experiences. ^