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Telemedicine aims to create new forms of health care delivery by the use of information and communication technologies (ICT),for example, to improve the access to health care for patients in rural regions. There is a need for assistive technologies and innovative technological solutions due to the demographic change. Population trends of western societies show concurrently an ageing population and the wish of elderly people to live at home as long as possible while there is a tendency that older people live in greater distances to their kin nowadays. More complex diseases and multimorbidity urge improved interconnectedness between different health care professionals. Hence, different health systems pursue e-health strategies with the aim to implement electronic patient records (EPR) and similar technological solutions as a first approach to tackle those challenges. Telemedicine represents an open and evolving concept which is subject to a regular process of further development as a consequence of accelerated technological progress. The increased articulated demand for patient centered health care is one driver for the use of telemedicine. In the context of the trend of shorter hospital stays technological solutions can provide an opportunity for better support and care at home to reduce health risks and improve caregiving quality after hospital discharges. Despite the still prevalent reservations of elderly people about the use of ICT research shows that acceptance and the willingness to use technical devices is increasing. The article describes different aspects of telemedicine in the context of the aging population: definitions, an overview of trends and various fields of use with specific practical examples. A synoptic view of research results of evaluations of telemedicine applications regarding their effectiveness and cost-benefit analysis complement the paper.

In the last decade the indication of antipsychotics has been expanded from the treatment of psychoses to the treatment of impulsive-aggressive behaviors in mentally retarded children and adolescents with conduct disorder or autism spectrum disorders. As a consequence the use of antipsychotics in children and adolescents has increased worldwide. This increase of prescriptions is under critical discussion. In this paper the indication and the potential side-effects of antipsychotics in children and adolescents are described. The risks of antipsychotic medication are contrasted with the potential benefits to arrive at rational treatment recommendations.

The issue of the capacity of judgement or the lack thereof and the validity of legal actions performed in such conditions will become more and more important considering the longer life expectancy and the increasing number of people with diseases like dementia. This paper will discuss the capacity of judgement from a legal point of view. According to article 16 of the swiss civil code a person is capable of judgement within the meaning of the law if he or she does not lack the capacity to act rationally by virtue of being under age or because of a mental disability, mental disorder, intoxication or similar circumstances. Therefore, the incapacity of judgement requires the existence of one of the aforementioned conditions (objective aspect) which have to result in the lack of capacity to act rationally (subjective aspect). The capacity of judgement is relative and must always be evaluated within a given context, i. e. the capacity of judgement has to be confirmed or refuted for a specific transaction at a specific time. By law, the capacity of judgement is assumed (statutory presumption) and the opposite has to be proven. As part of a notarial procedure the capacity of judgement has to be verified by the notary public, although only in a brief and limited manner. If the capacity of judgement is disputed, only the competent civil judge has the power to render a legally binding judgement.

It is not uncommon for patients with an advanced disease to express a desire to their physician to hasten their death. Recent studies show that the motivation of such a desire is multifactorial and multidimensional, including depression, physical, psycho-social and spiritual suffering, fears about the process of dying and/or misunderstandings about the options for end-of-life care. The objective of this paper is to propose to the physician how to explore the dimensions of this request and some elements to answer it.

The purpose of this current paper is to give a simple update and overview about vaccinations for dental health care workers considering the new guidelines published in February 2014 by the Swiss Federal Office of Public Health. It is recommended to have at least a valid protection against hepatitis B, measles, mumps, rubella, influenza, varicella, diphtheria, tetanus, poliomyelitis and pertussis. Dental health care workers are highly exposed and high risk carriers for inoculable diseases, therefore regular refreshment of vaccinations is necessary for public health and their own health.

During World War II and the early Cold War period, a rapid development of the blood transfusion service and a boom in blood group research occurred in Switzerland. Unprecedented volumes of blood were stored and enormous quantities of blood group data were recorded. In the following paper I will argue that this mobilization of blood was strongly shaped by military institutions and aims. The military worked closely with the Red Cross in order to build a blood transfusion service that was supposed to guarantee a permanent readiness for war and help prepare the nation for an imagined nuclear conflict. Concurrently, geneticists, anthropologists, and physicians obtained new opportunities for scientific research in collaboration with the military and the Red Cross enabling them access to comprehensive military data and modern serological laboratories. The paper points out how this cooperation between the military and the sciences influenced and transformed the cultural meanings, the medical uses of as well as the knowledge about human blood.

Background: Evidence-based information materials about the pros and cons of cancer screening are important sources for men and women to decide for or against cancer screening. The aim of this paper was to compare recommendations from different cancer institutions in German-speaking countries (Austria, Germany, and Switzerland) regarding screening for breast, cervix, colon, and prostate cancer and to assess the quality and development process of patient information materials., Methods: Relevant information material was identified through web searches and personal contact with cancer institutions. To achieve our objective, we employed a qualitative approach. The quality of 22 patient information materials was analysed based on established guidance by Bunge et al. In addition, we conducted guided interviews about the process of developing information materials with decision-makers of cancer institutes., Results: Overall, major discrepancies in cancer screening recommendations exist among the Austrian, German, and Swiss cancer institutes. Process evaluation revealed that crucial steps of quality assurance, such as assembling a multi-disciplinary panel, assessing conflicts of interest, or transparency regarding funding sources, have frequently not been undertaken. All information materials had substantial quality deficits in multiple areas. Three out of four institutes issued information materials that met fewer than half of the quality criteria., Conclusion: Most patient information materials of cancer institutes in German-speaking countries are fraught with substantial deficits and do not provide an objective source for patients to be able to make an informed decision for or against cancer screening., (Copyright © 2015. Published by Elsevier GmbH.)

Background: Patient centred and individually-tailored counselling of older people with a chronic condition who live at home is a useful intervention to support their independence., Aim: The paper presents the development and psychometric testing of the APN-BQ Instrument, to measure patient-centeredness., Method: To measure the quality of an in-home counselling intervention, a 23-item questionnaire was developed and tested with 206 people 80 years and older. Principal component analysis with Varimax Rotation was conducted (n = 206)., Results: Analysis revealed a four factor (fs = 0.91) model scoring in 19 items. All factors loaded > 0.45. Cronbach's alpha was 0.86. The utility and acceptance of the instrument was confirmed by the high response rate (100 %) and the fact that participants answered 98.8 % of all questions., Conclusions: The APN-BQ has shown to be a reliable Instrument with good content and construct validity. It is a tool for APNs to measure structure, process, and outcome quality of a patient-centred and individually-tailored counselling program, including the degree of patient participation, and patient empowerment.

Background: Surgical treatment of osteoporotic distal radius fractures with locking plates does not completely prevent loss of reduction. Additional bone deficit stabilisation with the use of bone substitute materials is receiving increased attention. Most knowledge on the in vivo behavior of bone substitutes originates from a small number of animal models after its implantation in young, good vascularized bone., Purpose: This paper investigates the osteoconductivity, resorption and biocompatibility of beta-tricalcium phosphate as a temporary bone replacement in osteoporotic type distal radius fractures., Patients and Methods: 15 bone samples taken from the augmented area of the distal radius of elderly people during metal removal were examined., Results: The material was found to be osteoconductive, good degradable, and biocompatible. Degrading process and remodelling to woven bone seem to require more time than in available comparative bioassays., Conclusions: The material is suitable for temporary replacement of lost, distal radius bone from the histological point of view., (© Georg Thieme Verlag KG Stuttgart · New York.)

Clinical investigations on patients suffering from halitosis clearly reveal that in the vast majority of cases the source for an offensive breath odor can be found within the oral cavity (90%). Based on these studies, the main sources for intra-oral halitosis where tongue coating, gingivitis/periodontitis and a combination of the two. Thus, it is perfectly logical that general dental practitioners (GDPs) should be able to manage intra-oral halitosis under the conditions found in a normal dental practice. However, GDPs who are interested in diagnosing and treating halitosis are challenged to incorporate scientifically based strategies for use in their clinics. Therefore, the present paper summarizes the results of a consensus workshop of international authorities held with the aim to reach a consensus on general guidelines on how to assess and diagnose patients’ breath odor concerns and general guidelines on regimens for the treatment of halitosis.

This paper aims to provide an overview of the accepted techniques of pain relief and castration and guidelines of how to best perform these painful interventions in an animal-friendly way under Swiss conditions. Calves should be castrated at the age of 14 days or less, at least 10 minutes after local anesthesia with lidocaine, applying a single rubber ring. Concurrently, a NSAID should be administered intravenously (ketoprofen, 3 mg/kg of bodyweight) and Tetanus-serum subcutaneously (off label use). If possible, ketoprofen(4.5 mg/kg BW) should be orally administered for 3 - 5 days postoperatively. At 10 days after applying the rubber ring, the dried-off scrotum including the rubber ring should be removed with a clean knife or a scalpel. Local anesthesia is not necessary for this procedure. Ram lambs should be castrated at the age of 14 days or less, at least 10 minutes after local anesthesia with lidocaine, applying a rubber ring. The toxic dose of 4 mg lidocaine/kg BW (corresponds to 1 ml lidocaine 2 % per lamb of 5 kg BW) should not be exceeded. Concurrently, a NSAID (off label use) and Tetanus-serum should be administered systemically. Immunization against GnRH represents an animal-friendly and economically feasible alternative to rubber ring castration. With two immunizations at an interval of 3 - 4 weeks testicular development can be inhibited for at least 3 months and the onset of puberty clearly delayed. However, a specific vaccine for use in ruminants is currently registered neither in Switzerland nor in Europe.

Objective: This paper describes socio-demographic, clinical, and treatment-related parameters of psychiatric patients who were hospitalized for at least two months on an acute psychiatric ward compared to patients with a shorter inpatient treatment episode. Furthermore, it is evaluated how frequent these long-staying patients are awaiting a room in a sheltered housing facility., Methods: We investigated the longest inpatient treatment period of all patients aged between 18 and 65 years on an acute ward of the Psychiatric University Hospital Zurich (n = 3,928) using the basic documentation of the years 2006 to 2010., Results: 20 % of all patients on acute wards had a stay of more than 60 days. Socio-demographic and clinical characteristics are similar to those of "heavy users" of mental health services. Social work is involved more frequently, and placement in sheltered housing facilities is intended in one third of those patients., Conclusions: A substantial part of the patients who stay at least once longer than two months on an acute ward are discharged to sheltered housing. Besides severity of illness it is likely that lack of availability of an adequate housing option contributes to length of stay. Intensified cooperation of the psychiatric clinic with sheltered housing facilities as well as alternative options for those in need of assisted housing and mental health care might help to reduce their extensive usage of inpatient treatment capacities. Interventions and services have to be adapted to local conditions., (© Georg Thieme Verlag KG Stuttgart · New York.)

Hundreds scores and dozens staging systems exist in Oncology. They provide for example information on the spread and prognosis of a disease or are included in treatment decisions. Because of the existing diversity a description of all oncological codes would exceed the scope of this paper, the following articles focuses in the first part on some exemplary and lesser-known scores and in the second part on main staging systems in Oncology. Internet sites such as Wikipedia or Onkopedia provide answers to many other questions regarding ongologic scores and stages. As an example of a tumor graduation the Gleason score in prostate cancer is described. It provides not only information about the prognosis of the disease, but influences the primary treatment. In metastasic disease, the general condition of the patient is decisive on the question of whether a (further) systemic therapy should be applied. The general condition is classified with the Karnofsky index and in Oncology more frequently with the ECOG- or WHO-performance status. In solid tumors the response to treatment is assessed with RECIST criteria. The spread of solid malignancies is documented according to the TNM classification. This classification is regularly updated according to latest prognostic and therapeutic results. In contrast the Ann Arbor criterias - the staging system of lymphomas - have little changed since their initial description.

According to the international guidelines of COPD (GOLD) and asthma (GINA) diagnosis and treatment of both diseases necessitate spirometry in the private practice as well as in hospital setting. However today, spirometry is not sufficiently used in Switzerland. This paper intends to give an easy overview how spirometry is performed and spirometric values can be interpreted.

Digitization is found everywhere in sonography. Printing of ultrasound images using the videoprinter with special paper will be done in single cases. The documentation of sonography procedures is more and more done by saving image sequences instead of still frames. Echocardiography is routinely recorded in between with so called R-R-loops. Doing contrast enhanced ultrasound recording of sequences is necessary to get a deep impression of the vascular structure of interest. Working with this data flood in daily practice a specialized software is required. Comparison in follow up of stored and recent images/sequences is very helpful. Nevertheless quality control of the ultrasound system and the transducers is simple and safe - using a phantom for detail resolution and general image quality the stored images/sequences are comparable over the life cycle of the system. The comparison in follow up is showing decreased image quality and transducer defects immediately.

Heritable thrombophilia as a concept in hemostasis has been continuously discovered parallel to the knowledge on physiology of bleeding disorders. Since the 1980s it has become increasingly popular to search for thrombophilia in patients with thromboembolism and their relatives. Although initially no direct evidence existed for any advantage for the patients, successive clinical studies have helped to understand the risk of thrombosis and to stratify the patients in relation to the thrombophilic defect. In the meantime national and international guidelines have been published, suggesting which candidates should be examined and what tests should be performed. In the present paper we summarise and explain the rationale of these guidelines from the european point of view.

Surveillance programs have been recommended for colorectal and breast cancer patients in several countries, and appropriate surveillance guidelines have been issued by various societies. The Swiss Society of Gastroenterology consensus paper recommends a surveillance program for patients after curative resection of colorectal cancer (CRC), and the respective guidelines are updated regularly. Early detection of recurrent disease from CRC allows treatment with intention to cure. Five year survival rates after treatment for recurrent CRC can reach up to 50 % or more. Therefore tumor surveillance in CRC is important, and there is compelling evidence that patients benefit from intensive surveillance. In addition to clinical controls, measurements of carcinoembryonal antigen, colonoscopies and thoraco-abdominal CT scans should be performed on a regular basis. For surveillance of breast cancer (BC) patients, a regular schedule is recommended as well. However, this surveillance program is more focussing on the detection of possible loco-regional tumor relapse, as curative therapy of BC metastases is much less frequently possible than in CRC patients. Irrespective of the underlying tumor entity, surveillance is an important and challenging process that should be coordinated by one single physician. It is crucial that all involved physicians are aware of their responsibility and that they are informed about the respective surveillance program and its benefit to the patient.

This article contributes to the history of obstetrics as it was performed in the context of general practice during the 19th century. It focuses on the Swiss physician Cäsar Adolf Bloesch (1804-1863) from the town of Biel, Canton Bern. Drawing upon Bloesch's extensive practice records, it raises the question whether this physician participated in the local market for obstetrical activities. Furthermore, the paper tries to make an estimate about the importance this field of action took for Bloesch's practice. To achieve this, results of a smaller study about obstetrical cases within the practice records during the years 1832 to 1850 are being presented.I will argue that physicians like Bloesch were aware of the problems obstetrics brought with it, and as a consequence, he tried to limit it in favor of his general practice.

Various instruments and utensils used during milking as well as teat dip solutions were examined for contamination with coagulase-negative staphylococci (CNS). The goal of this study was to investigate the relationship between contaminated fomites and udder infection in dairy cows. A total of 344 cows from ten dairy farms with the highest rate of clinical mastitis among the farms serviced by the Ambulatory Clinic of the University of Zurich were included in the study. Each farm was visited five times. All lactating cows, with the exception of those undergoing antibiotic treatment, were examined immediately before milking using the California Mastitis Test (CMT). A milk sample was collected from positive quarters. Items used to clean the udder, which included wood wool, paper towels and disinfecting towels as well as the milker's hands and the teat dip cup were swabbed for bacteriological examination. Water samples, samples of teat dip and cleaning solutions were also collected and cultured. Our results demonstrate that cleaning and disinfecting solutions have the potential to transmit udder pathogens and cause clinical mastitis. The most common CNS isolated from quarter samples were S. saprophyticus, S. sciuri and S. chromogenes, and the most common CNS isolated from utensils, cleaning and disinfecting solutions were S. fleuretii, S. vitulus, S. equorum, S. sciuri, S. haemolyticus, S. succinus and S. saprophyticus.

Many consequences of an illness or an accident that are treated in the form of basic medical practice consequences concerned can either be directly caused by the illness or accident, or result from the ensuing treatment. A physician providing basic medical care is therefore often confronted with traffic medicine issues. Moreover, most Swiss cantons have charged general practitioners with carrying out the legally prescribed regular check-ups for motorists aged over 70. General practitioners thus assume the role of medical examiner for these bi-annual check-ups. This paper discusses basic aspects in connection with general practitioners' evaluation of a person's aptitude for driving and with frequent traffic medicine issues dealt with in basic medical practice. Special emphasis is placed on best practice in the regular check-ups for over 70-year-old motorists.

In 16 rural communities of the Canton of Zurich, school-children of all age groups participated in dental examinations conducted at intervals of 4 years since 1963/64. The same standardised method was used throughout the entire period. This study documents the caries experience over a period of 45 years. From 1964 to 2009, the DM*FT per 14-year-old child fell from 12.50 to 1.31, corresponding to a caries reduction of 90%. The caries experience in 8-, 10- and 12-year-olds decreased by 90% to 92%. From 1964 to 2009, the "Significant Caries Index" (the mean DM*FT in the third of 12-year-olds with the highest DM*FT values) fell from 13.09 to 2.20, corresponding to a caries reduction of 83%. The observed caries decline was unexpectedly high. The effect of fluorides may explain a caries reduction of roughly 50%. A large part of the decline, however, remains unexplained. Possible causes are discussed in this paper.

Allergic diseases represent a major health problem in Europe. They are increasing in prevalence, severity and costs. GA2LEN (Global Allergy and Asthma European Network), an FP6 Network of Excellence, was created in 2005 as a vehicle to ensure excellence in research bringing together research and clinical institutions to combat fragmentation in the European research area and to tackle allergy as a whole. GA2LEN benefited greatly from the voluntary efforts of researchers who are strongly committed to this model of pan-European collaboration. The network was organized in order to increase networking for scientific projects in allergy and asthma around Europe and to make GA2LEN the world leader in the field. Besides these activities, research has been jointly made and the first papers are being published. GA2LEN achievements in general can be grouped as those for a durable infrastructure built up during the project phase those which are project-related work based on these novel infrastructures, and the development and implementations of guidelines. The major achievements of GA2LEN are reported in this paper.

Previous research showed that children in classes with reduced curriculum ("ready for school classes") perform systematically poorer in short-term memory, attention control and motor coordination skills than children in regular classes. Based on these results, a training to improve children's planning, sequencing, and executive control of motor actions was developed. It includes body coordination, (bi-) manual coordination, rhythm and balance. The tasks stress flexibility of action, interference control and focused attention. Training sessions proceed from easy to complex, from action accuracy to speed, and from teacher guidance to children's self monitoring. Over the course of 3 weeks, 53 children were trained daily for 20 mins. In pre- and posttests, motor coordination was assessed with the M-ABC; focused attention, short-term memory performance, and self-concept was tested with paper-pencil and computerized tasks. Half of the children were trained between pre- and posttest, the other half received the training after posttest. Results revealed no global training effects; however, children in the training condition caught up during training in specific cognitive and motor tasks, and trained children showed a more optimistic self-concept. Training effects were pronounced for children with balance problems. The findings are discussed in terms of reasons for the weak training effects, and potential improvements of the training.

The present paper describes an effectiveness-study to analyze the effectiveness of psychotherapeutic treatments. In the documentation phase of three years 24 therapists documented 93 psychotherapies. The patients represent a general population of health care takers. The treatments have an average duration of 45 appointments over 62 weeks. Good results are being achieved within this short period of treatment. The reduction of symptoms (global severity index GSI of SCL-90-R) reaches a high effectsize; regarding their symptoms 46 % of the patients can be considered as cured and 74 % as cured or improved., (© Georg Thieme Verlag KG Stuttgart · New York.)

Based on his clinical experience and knowledge in the humanities, phenomenology, and natural sciences, the Swiss psychiatrist and Rorschach expert Roland Kuhn discovered the specific antidepressant effect of imipramine in the treatment of vital depressive disorder. This discovery of the first tricyclic antidepressant drug shows how an education covering the various fields of psychiatry facilitates therapeutic and scientific achievements. Kuhn's methods as a psychiatrist and his papers can show present and future generations of psychiatrist ways to make new discoveries in the field of psychiatry, psychotherapy, and psychopharmacology.

GreenLight laser vaporisation has been successfully implemented in the treatment of benign prostatic hyperplasia in the last decade. Besides enhancement of the efficacy of the laser through increase of the power output to a maximum of 80 W and eventually 120 W, the encouraging clinical achievements resulted in a growing popularity of the laser system application. Swiss medical centres have been significantly involved in the evaluation of the clinical adoption of this surgical technique. Particularly the low peri- and post-operative morbidity as well as promising short- to medium-term functional results are noteworthy. In the present paper we present major results of the clinical evaluation of the technique. In addition to the important advantages of the technique, especially the virtually bloodless procedure, we also highlight the drawbacks and limitations of laser vaporisation, which possibly might entail adverse clinical effects. The future significance of this technique will thus have to be re-evaluated taking into account the yet unavailable long-term effects.

Child abuse may result in dramatic short and longtime damage of children's physical and emotional well being. This underscores the clinician's special responsibility to contribute a sound professional and scientific approach to the multiprofessional diagnosis and intervention in suspected child abuse cases. The approach is to correlate the probability of a given finding with the history and comparing it to biomechanical principles. Of concern are especially all serious injuries with an alleged trivial or inadequate for age mechanism, missing, vague or changing patterns of explanation, injuries of different age, delay of medical care and allegations by independent observers or even the child. Exact documentation of all medical examinations is the basis of any forensic expertise if child abuse is to be considered. This paper ist dealing with morhological findings following various kinds of violence which can often be observed in connection with child abuse, as well as the interpretation of characteristic patterns of findings. Furthermore, practicable procedures after diagnosing child abuse ar being discussed on the basis of legal terms.

Disasters can have a severe impact on whole communities, but the impact can be especially difficult for the more vulnerable in our societies: women and children. This paper identifies a number of ways that women and children can be impacted, and explores some practical approaches that can serve to effectively address the special needs of women and children after a disaster. Specific community-based psychosocial practices are identified that can enhance the healthy psychological processes in children and women. This can be accomplished through the fostering of protective factors that strengthen what is known as "resilience processes". This is a new approach how to care to those who experienced disaster-related trauma or stress. It offers psychosocial methods that can be useful, practical and effective in post-emergency circumstances alternatively or integrated into standard medico-psychotherapy approaches where large populations of women and children are affected, particularly where people from cultures unfamiliar with western therapeutic concepts or interventions are affected. Possible applications and considerations for encouraging resilience processes in women and children who have experienced disasters are explored, along with a commentary about implications for applications in Switzerland.

Migrants from Turkey face several barriers to a successful integration in Switzerland including equal access to the health care system; most important are language problems, cultural and economic barriers. According to the scientific report of the Federal Bureau of Health "Migration and Health " current forms of therapy do not fulfil the needs of this patient population. Ambulatory and in-hospital services are devoted to the acute phase of a pain disorder; they are not imbedded into the circumstances of daily living. Re-Adjusting to daily life however, is crucial for patients' attempt to return to normality. Therefore therapeutic offers are needed to close the gap between high intensity treatment in hospitals and almost no treatment in the ambulatory setting. We developed an integrative post acute model of patient care, consisting of assisted self-help groups that is presented in the current paper.

Burn injuries are very frequent, most being trifle cases. Nevertheless every year about 200 patients need to be treated in one of the two specialised Swiss burns centres. Admission criteria are burns > 15% body surface or burns to critical areas (face neck, hands, genitalia, joints) and electrical injuries. The paper reviews the physiophathology of the burn wound which differs depending on the thermal or electrical aetiology. The airway may be threatened due to true inhalation, but also to burns to the face or neck. In major burns >20% body surface in adults, or > 10% in children, fluid resuscitation will be required; oral hydration is generally sufficient by smaller burns. Surgical treatment of 2nd and 3rd degree burns starts within the first 24 days after injury. While complex treatment is generally available in peace time, a major accident such as a disco-fire that can generate hundreds casualties in a few minutes, can threaten our system and force the adoption of triage rules, and simplified treatments. Attitudes to adopt in such conditions are discussed.

In the 1940s there occurred an ethical conflict in the Women's Hospital of Basle. It arose in the context of a shortage of nurses, the introduction of the Swiss national criminal law, the change of the hospital director, the increase of abortion and the nursing ideal of obedience and serving. The conflict showed the social change towards measures of birth control such as abortion and sterilisation. Different political opinions and strong convictions clashed. The paper is focusing on denominationally affiliated nurses, the deaconesses of Riehen, who were standing between the religious conviction to protect unborn life and the professional principle of unconditional nursing. Finally they decided to leave the hospital.

Patients' letters are among historical sources that have been recently put forward in the history of medicine in order to shed light on the perspective of the sick and explore the dynamics of therapeutic relationships. They enable historians to focus on the active participation, initiatives and strategies of lay people in the handling of their health and illness. Based on the analysis of letters written by patients to the Swiss physician Samuel-Auguste Tissot in the second part of the 18th Century, this paper deals with the relative autonomy that sick people are able to claim in the process of interpreting and explaining of their medical trajectories. It is argued that they possess a "narrative authority", which can be defined as the possibility to defend one's own point of view in the organisation of one's narrative, thanks to the interpretative latitude due to polyphony and plurality of meanings inherent in the intersubjective construction of the illness experience.

New investigations on Otto Hauser's skeleton findings and the excavations of this Swiss citizen in Southwest France from 1906 until 1914 placed the activities of this archaeologist again in the focus of scientific and public interest. This paper describes life and oeuvre of Otto Hauser and discusses the importance of the skeletons found by him and Hermann Klaatsch as well as the consequences of their discovery. The efforts of Otto Hauser to publish his discoveries, to present and spread his view concerning the evolution of man were remarkably manifold as well as the parallels between ancient man and contemporary ethnic groups living on a low technological level drawn by him and to wake and to promote the interest in prehistory. Many books, brochures, articles and public lectures contributed to this intention as well as co-operation with local historians and scientists of other disciplines, and also many films, teaching and illustrative materials. The scientific collection of the authors of this article comprises more than 6,500 written documents and photos.

Three hundred randomly selected nurses employed at the university hospital of Berne were asked by means of a questionnaire as to the application of complementary methods (CM) in patients of this hospital. 75% of the questionnaires were completed. 95% of the nursing staff indicated that they had recommended or applied CM's. The most frequently used methods being compresses, aroma therapy and homoeopathy. The members of the nursing staff, who use CM are ecology-minded, have had higher education and are nutrition conscious. CM training was found in 21%. The application of CM is usually suggested by members of the nursing staff, less frequently by the patients and rarely by physicians. One quarter of the nursing staff consults a physician before applying CM. Motivations for the application of CM are often based on the experiences of others and experiences from one's own childhood. Homoeopathy is the most prevalent method. CM is regarded to be integral, supplementary and conducive for the integration of orthodox medicine and psyche. In arrangement with the nursing staff direction we do not critically discuss our observations in this paper.

In 1964, Werner Leibbrand (1896-1974) was the first German medical historian to present, in Sudhoffs Archiv, a review of the work of Michel Foucault (1926-1984). This paper examines some of the reasons leading to the fact that Leibbrand's own generation refused to acknowledge the importance of Foucault's ideas, while, later on, younger German medical historians, although impressed with Foucault's writings, failed to acknowledge, first, the close relationship between Leibbrand's and Foucault's world views, and, second, Leibbrand's attempts at introducing Foucault to German medical historians. Leibbrand with his Jewish wife had survived the Nazi period partly in hiding. His attempts at clearing post-war German psychiatry and medical historiography of NS-sympathizers isolated him among his colleagues, many of whom had begun their career during the Third Reich. Leibbrand enjoyed the support by the Swiss medical historian and avowed Communist Erwin Ackerknecht (1906-1988), but later turned against him, possibly because Acknerknecht had called Leibbrand's writings "unscientific". Leibbrand was unable to overcome his antagonisms with his contemporaries. At the same time, opposition to Ackerknecht made him appear a respresentative of the past in the eyes of the younger generation. Thus, when Foucault was accepted by the latter, they were not prepared to examine the work of Leibbrand and realize how close some of the ideas developed by Leibbrand and Foucault had been.

Living as a poor pietist spinner, weaver and cotton trader in the rural Toggenburg area in Eastern Switzerland in late eighteenth-century, self-help was central to Ulrich Bräker's (1735-1798) reaction towards illness. Two initial examples exemplify this central position of self-help: Bräker's cure from migraine in the year of 1784 and a quantitative analysis of his diaries. Based on the journals (which he maintained between 1768 and 1798) and Bräker's autobiography this article scrutinizes the resources of self-help amongst the rural and poor population in the late eighteenth century. Methodologically, I am applying Pierre Bourdieu's capital theory to the analysis of Bräker's writings. The paper first elaborates how self-help, i.e. self-treatment, drew upon a rich, vivid, and at times conflicting stock of "cultural capital" acquired in upbringing and through tradition, through a large scale of educated medical literature, and by personal experience. With regard to "social capital" it is then shown how Bräker at times provided and achieved assistance within various direct or indirect, pre-existing or specifically on the purpose of self-help established relations (i.e. among family members, relatives, neighbors, friends and patrons, as well as acquaintances) as social resources. Finally the article demonstrates the interaction of self- and help from outside on multiple levels (either in the form of medical assistance or of poor relief).

Given the great prevalence of mood disorders in early motherhood, the danger of chronic, particularly depressive mood disorders and the negative long-term effects on the socio-emotional development of the child requires specific and individual treatment. Midwives could serve as mediators between women patients and health care professionals. Therefore the project "Early detection and care of peripartum mood disorders, increasing options for reaching affected women" was initiated by the "German chapter of the International Marce Society" in cooperation with midwives. This paper presents results of the preliminary investigation. 111 midwives were interviewed in 12 centres in Germany, Switzerland and Austria regarding their experience and knowledge of psychic disturbances in early motherhood. Psychic disturbances are seen as an essential issue by the participating midwives. In their estimation 39 % of the pregnant women they cared for are exceptionally psychically burdened. In approximately 43 % of the cases they believe that the physical complaints of pregnant women have a psychic background. In addition to "classic" mood complaints, midwives often perceive dysfunctions in the relationship between the mother and her child and that with her partner in the context of psychic disturbances during the peripartum period. In the diagnosis of psychic disturbances in early motherhood, attention should be paid to possible dysfunctional interactions between the mother and her child and that with her partner. Successful treatment of women with psychic disturbances in early motherhood requires cooperation between midwives, obstetricians and other health professionals.

In the last decades phytopharmaceuticals have stabilized their significance in human medicine. The aim of this study was to obtain information about the present situation of phytomedicine in three German-speaking countries. For that purpose questionnaires were sent via internet to 2675 veterinarians in Austria, Germany and Switzerland and the collected 189 answers were statistically evaluated. As shown in this paper, there is an increasing interest in veterinary phytotherapy. Presently three-quarters of the veterinarians are using phytoproducts in clinical practice. Herbal medicinal products are only seldom used in eye and ear infections as well as in endo- and ectoparasitoses but more often in diseases of the liver, joints, kidneys, heart and skin. Generally, phytodrugs are more frequently applied in chronic diseases as well as secondary medication, whereas the time of treatment usually exceeds one month. Basic advantages of medicinal phytoproducts have been shown to be the low side effects and the acceptance of the pet-owners and the only disadventage has been reported to be the lack of information. This study clearly shows the upward trend in using herbal drugs by veterinarians but the results also point to the lack of scientific knowledge about phytotherapeuticals in animal health.

To learn from errors is not always easy, especially if they happened to others! This paper describes the organization and management of a critical incident reporting system for primary care physicians in Switzerland and reports about the difficulties and experiences during the first 18 months since the start of the program. It seems to be particularly difficult to enhance the attentiveness of physicians for apparently harmless daily critical incidents and to motivate them to report it even in an anonymous reporting system. As incentives for more intensive participation there are the hope for comments on reported cases by other participants and the expectation that reported errors will be avoided by the readers.

The first reliable diagnostic tools for the diagnosis of HIV infection, Western blot and ELISA, were created 20 years ago in the U.S., using initially sera from AIDS patients diagnosed clinically in Switzerland. In Swiss laboratories the diagnosis of HIV infection today is established by using 4th generation screening tests which detect both antibodies and p24 antigen while in the doctor's surgery a rapid antibody assay is used. Confirmation in authorized confirmatory labs relies on a set of different minimal combinations of positive test results derived from both the first and second blood specimen. In patients with a confirmed diagnosis of HIV infection, two further principal questions arise concerning, on the one hand, the virus load and, on the other hand, some clinically relevant properties of the infecting virus (type or subtype, resistance against antiretroviral drugs). The paper starts with a personal flashback to the first days of HIV diagnostics and describes the sensible use of tests available today for answering the above-mentioned principal questions. Alternative methods which can be used when standard tests fail or appear unreliable are mentioned also.

The development and establishment of Advanced Nursing Practice is an important step toward an effective and sustainable care. Five diploma nurses of the Children's Hospital of Zurich started an ANP project in the field of children with cleft lip and palate under the guidance of an ANP Nurse. The purpose of this project was to address the needs of the families and to establish state-of-the-art care. Action research methodology built the background because it offers methods that connect theory and practice. Family management and organizational elements (project team, organization and new services) were the basic elements of the project. The goal of this paper is to present the first evaluation of this project. For instance, today, the families have the opportunity to visit the hospital before the first surgery. For the children, pain management and nutrition after surgery were adapted to state of the art knowledge. The evaluation also shows areas that need to be further developed in the future. The results emphasize, that the ANP-team projects with family management as core activity empowered the team members and led to an adaptation of nursing practices towards the needs of the families.

Aim: The paper is aimed at investigating what the actual topics of social-psychiatric research in German speaking countries are., Method: German and international journals covering psychiatry and adjacent disciplines were screened for articles dealing with social-psychiatric topics. All in all, 426 relevant articles were identified and subjected to a content analysis., Result: Almost one third of all articles was dealing with research on mental health services. Another research area that was strongly represented was epidemiology. By contrast, articles devoted to the study of psycho-social causes of mental disorders and psycho-social determinants of its course were rather rare., Discussion: Possible reasons for the observed trends in social-psychiatric research are discussed. Potential risks for social psychiatry resulting from a too one-sided emphasis on health service research are pointed out.

Aim: The present paper aims at analysing and discussing managed care with its opportunities and risks. This analysis should be a further basis for a reasonable discussion concerning the implementation of managed care elements in the German Health Care system., Method: On the basis of an update literature research the relevant international experiences with managed care in several health care systems--especially in the United States and Switzerland--are analysed and described. Most relevant opportunities and risks of managed care are deduced from this analysis., Results: The most important opportunities of managed care are the stabilisation of health care costs, an improvement of health care processes and quality and a stronger consideration of preventive measures. The possibility of choosing between several health care models and more convenient health insurance fees are opportunities for the patients. Relevant risks of managed care involve the potential withholding of medical care with the necessity of a comprehensive quality assurance and negative influences on the physicians' autonomy. Furthermore, managed care may have negative effects on the relationship between patients and physicians or between general practitioners and medical specialists., Conclusions: Managed care has proven advantages in respect of cost stabilisation and quality improvement compared with traditional health care systems. If the risks and known problems of managed care are realised and avoided, the available opportunities could be an important option to reform the German Health Care system in respect of costs and quality.

The 7th annual meeting of the memory clinics of Germany, Switzerland and Austria in March 2002 in Göttingen, Germany was an optimal opportunity to make an inventory about the state of the art in diagnostic and therapy of dementia and mild cognitive impairment in German-speaking memory clinics. Several problems were discussed including difficulties in 1) diagnosis of patients with aphasia or foreign patients, 2) handling of demented patients without a caregiver, 3) psychological support for patients, who have been diagnosed in a very early stage, 4) misunderstandings between general practitioners, neurologists and psychiatrists in private practice on the one hand and the memory clinics on the other hand, 5) recommendations for prevention of dementia, 6) recommendations concerning dementia and car driving and 7) questions of genetic counselling. The following paper is a summary of the results of a workshop in Göttingen and gives practical recommendations based on the experiences of the memory clinics.

The rising costs of the Swiss health care system are currently a source of discussion. Precise facts about the treatment costs in Switzerland are not available. The aim of this paper is to assess the price of the acute therapy of multiple trauma patients at the University Hospital of Zurich. We analysed the exact treatment costs of 16 patients with an average Injury Severity Score (ISS) of 33.9. All these cases had a private or a supplementary insurance coverage, were foreigners or were otherwise invoiced according to the so-called hospital tariff (Spitalleistungskatalog/SLK). We developed a concept to measure the expenditure not covered by the insurance of those with a basic insurance, who entail the largest percent of all hospitalized patients. The average amount invoiced was 128,135 Swiss Francs (31,266-310,358 CHF). After subtracting the profit, gained on cases charged according to the SLK, the remaining deficit per ordinary insured was 42-65% or 33,703-138,829 CHF The range of this amount depends on the insurance status of the afflicted person. If hospitals are required to work with a balanced budget, then these losses can no longer be neglected. New forms of invoicing multiply trauma patients must be found in Switzerland.

Some dentists feel insecure in the management of medical emergencies as it has been pointed out in the SMfZ already. The focus on a national investigation by means of questionnaire was the training supply in emergencies as well as the course attendance by dentists. The results of this investigation proved, that about half of the dentists, practicing in Switzerland keep themselves more or less up-to-date. They know about the right measures in case of an accident that may put vital functions at risk. However, this investigation also showed that we know little or nothing about the other half of practicing dentists in our country. In the last part of the paper a project of an e-learning course on medical emergencies in the dental office is disclosed.

The goal of Continuous medical education is to increase knowledge and skills of medical doctors to guarantee a high standard of medical care. According to the published literature on the effect of Continuous medical education interactive didactic methods seems to be more effective to reach the mentioned goal compared to lectures. These results are in accordance with the constructivist learning theory. The assessment of the learning needs, one of the fundamental elements of this theory, is a complex issue. A potential method to evaluate the needs is presented in the following paper.

Objective: The present paper describes the type and prevalence of co-morbid psychiatric disorders in a group of opioid dependent addicts., Methods: In 17 Swiss centres for heroin-assisted treatment 85 opiate addicts were assessed at entry using the SKID interview., Results: Lifetime prevalence of co-morbid Axis I or Axis II disorders was 86 %. Most frequently patients were diagnosed with a personality disorder (58 %). Second frequently were mood disorders with a prevalence of 55 %, followed by anxiety disorders with a prevalence of 26 %., Conclusions: The high prevalence of co-morbid psychiatric disorders indicate the urgent necessity to further develop and adapt health services for opioid addicts.

The paper presents a case report of a serial but from the social point of view rather inconspicuous theft offender. The motivation of this perpetrator cannot be reduced to a simple money-making-intention. It seems to be of a more complex origin which offers possibilities for a psychological interpretation. On the other hand, this offender does clearly not fulfill the criteria of kleptomania. For such cases, Anglo-American literature offers a new concept named the "atypical theft offender" ATO, witch is outlined and critically discussed by the author.

Since September 1, 2001, castration of male calves and small ruminants in Switzerland is not allowed without anesthesia. The use of rubber rings for that purpose is forbidden. This change of the legislation has been claimed by the Swiss consumers and is aimed to increase the animal welfare. The current paper provides a review of the different techniques of anesthesia and castration that may be advocated in male ruminants. Sedation with xylazine and injection of lidocaine in the area of the base of the scrotum, followed by closed castration with the Burdizzo represents a safe technique for painfree castration of calves and lambs.