Regional differences in symptomatic fever management among paediatricians in Switzerland: the results of a cross-sectional Web-based survey

AIMS In symptomatic fever management, there is often a gap between everyday clinical practice and current evidence. We were interested to see whether the three linguistic regions of Switzerland differ in the management of fever. METHODS A close-ended questionnaire, sent to 900 Swiss paediatricians, was answered by 322 paediatricians. Two hundred and fourteen respondents were active in the German speaking, 78 in the French speaking and 30 in the Italian speaking region. RESULTS Paediatricians from the French and Italian speaking regions identify a lower temperature threshold for initiating a treatment and more frequently reduce it for children with a history of febrile seizures. A reduced general appearance leads more frequently to a lower threshold for treatment in the German speaking than in the French and Italian speaking areas. Among 1.5 and 5-year-old children the preference for the rectal route is more pronounced in the German than in the French speaking region. French speaking respondents more frequently prescribe ibuprofen and an alternating regimen with two drugs than German speaking respondents. Finally, the stated occurrence of exaggerated fear of fever was higher in the German and Italian speaking regions. CONCLUSIONS Switzerland offers the opportunity to compare three different regions with respect to management of febrile children. This inquiry shows regional differences in symptomatic fever management and in the perceived frequency of exaggerated fear of fever. The gap between available evidence and clinical practice is more pronounced in the French and in the Italian speaking regions than in the German speaking region.

New Freedom through Medical Devices Based on the Global System for Mobile Communications: A Prospective Survey of 620 Users of the Swiss Limmex Emergency Wristwatch-An Original Study from Switzerland

About 500,000 elderly people in Switzerland suffer a fall each year. Thus medical attention and help are essential for these people, who mostly live alone without a caregiver. Only 3% of people aged over 65 in Switzerland use an emergency system. Personal telehealth devices allow patients to receive enough information about the appropriate treatment, as well as followup with their doctors and reports of any emergency, in the absence of any caregiver. This increases their quality of life in a cost-effective fashion. "Limmex"-a new medical emergency watch-was launched in Switzerland in 2011 and has been a great commercial success. In this paper, we give a brief review of this watch technology, along with the results of a survey of 620 users conducted by the Department of Emergency Medicine in Bern.

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.

Post-immigration education of adult immigrants in Switzerland

In 2000, 20 per cent of the Swiss resident population was constituted by foreigners (Fibbi and Wanner 2009). As in other European countries, the migrant population in Switzerland can broadly be differentiated into three groups: 1) Migrant groups from less-developed regions with substantially lower educational attainments and an increased risk for unemployment than in the reference population, 2) Migrant groups that are rather more successful, although still somewhat behind the majority population, 3) Migrant groups who even outperform the majority population in terms of educational and employment success (Heath et al. 2008). Given these inequalities – in particular in the first migrant group – participation in further education in the country of destination might contribute to better integrate migrants in the Swiss society in general and the labour market in particular. On the basis of the pooled SAKE data set (1991-2000), patterns of participation in further education of adult migrants are analysed. As the results show, many migrant groups differ from the Swiss reference population regarding participation in further education. While inequalities are often explained by educational attainments and occupational status, in some cases they hold even if controlled for the determinants explaining participation in further education in general. Regarding migrant-specific determinants, type of residence permit proved to be an important indicator explaining the disadvantages in access to further education encountered by migrants originating from Former Yugoslavia.

Gender differences at the transition to higher education between migrants and non-migrants: A comparison between Switzerland and France

Within Western societies women or girls meanwhile outperform men or boys with regard to attainments in primary and secondary education. For example concerning upper secondary degrees the share of females attaining the Matura approaches two thirds in Switzerland, while the share of females attaining the Baccalaureate exceeds fifty per cent in France. However, if transitions to higher education are regarded, the share of entitled females entering such institutions is significantly lower than among men in Switzerland. An opposite pattern is observed in France where females outperform men at this educational stage, too. With regard to migrant background, it has been shown by previous research focussing on secondary effects of ethnic origin that such youths enter the more demanding educational tracks (e.g. higher education) more often than their non-migrant peers if controlled for eligibility, their lower socioeconomic status and performances. However, so far only a few studies refer to the question of a possible gender gap regarding secondary effects of ethnic origin (e.g. Fleischmann et al., mimeo). Thus, with regard to a possible interaction of a migrant background and - for example - a female gender, it is important to note that in both countries many migrant groups have their origins in countries and regions where male advantage remains very strong. This is in particular the case for migrant groups from non-Western countries, e.g. Turkey, Algeria, Marocco or Tunisie, where gender gaps in the literacy rates of up to 18 per cent are still observed. In order to investigate the question of a possible disadvantages of women with a migrant background stemming from such countries when compared to non-migrant females two panel studies - the Tree data in Switzerland and the Panel d’élèves 1995 in France -, are analysed.

Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE).

There is a need to validate risk assessment tools for hospitalised medical patients at risk of venous thromboembolism (VTE). We investigated whether a predefined cut-off of the Geneva Risk Score, as compared to the Padua Prediction Score, accurately distinguishes low-risk from high-risk patients regardless of the use of thromboprophylaxis. In the multicentre, prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study, 1,478 hospitalised medical patients were enrolled of whom 637 (43%) did not receive thromboprophylaxis. The primary endpoint was symptomatic VTE or VTE-related death at 90 days. The study is registered at ClinicalTrials.gov, number NCT01277536. According to the Geneva Risk Score, the cumulative rate of the primary endpoint was 3.2% (95% confidence interval [CI] 2.2-4.6%) in 962 high-risk vs 0.6% (95% CI 0.2-1.9%) in 516 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.5% vs 0.8% (p=0.029), respectively. In comparison, the Padua Prediction Score yielded a cumulative rate of the primary endpoint of 3.5% (95% CI 2.3-5.3%) in 714 high-risk vs 1.1% (95% CI 0.6-2.3%) in 764 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.2% vs 1.5% (p=0.130), respectively. Negative likelihood ratio was 0.28 (95% CI 0.10-0.83) for the Geneva Risk Score and 0.51 (95% CI 0.28-0.93) for the Padua Prediction Score. In conclusion, among hospitalised medical patients, the Geneva Risk Score predicted VTE and VTE-related mortality and compared favourably with the Padua Prediction Score, particularly for its accuracy to identify low-risk patients who do not require thromboprophylaxis.