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Despite insufficient data, multimorbidity is in Switzerland an emerging issue on the agenda of public health and medical institutions. In this article the most current issues for and obstacles towards valid prevalence figures are discussed. Available Swiss data sources which could be used for estimating prevalence of multimorbidity are illustrated. The biggest current challenge for the international research community is to create a uniform definition of multimorbidity concerning the types and a minimal number of included chronic conditions. Furthermore, to obtain valid and internationally comparable prevalence estimates in the future, methodological approaches regarding data assessment and the development of a measurement for the burden of multimorbidity should be broadly discussed in order to come to a consensus. [ABSTRACT FROM AUTHOR]

Patient Decision Aids for Values Clarification and Preference Elicitation - Challenges and Developments Abstract. Shared decision-making is especially appropriate when the available evidence does not indicate which medical intervention is the better option, so that the final decision depends on the patient's personal values and preferences. The process of value clarification and preference elicitation can be time-consuming and cognitively and emotionally demanding for patients. Increasingly, decision aids provide tasks (e.g., on benefit-harm trade-offs) to help patients work through this process, better prepare for medical consultations, and make values-congruent medical decisions with their physicians. Most clinically validated decision aids are paper-based flyers and educational brochures. There are also computer-, audio-, video-, or web-based decision aids. The web-based aids make little use of the potential of interactive technologies, despite the known benefits of these technologies. The aims of this paper are to provide an overview of decision aids for and challenges of values clarification and preference elicitation and to highlight some developments in interactive web-based technologies that might facilitate values clarification and preference elicitation.

Despite insufficient data, multimorbidity is in Switzerland an emerging issue on the agenda of public health and medical institutions. In this article the most current issues for and obstacles towards valid prevalence figures are discussed. Available Swiss data sources which could be used for estimating prevalence of multimorbidity are illustrated. The biggest current challenge for the international research community is to create a uniform definition of multimorbidity concerning the types and a minimal number of included chronic conditions. Furthermore, to obtain valid and internationally comparable prevalence estimates in the future, methodological approaches regarding data assessment and the development of a measurement for the burden of multimorbidity should be broadly discussed in order to come to a consensus.

It is known for many years that tick-borne diseases have worldwide a high economical impact on farming industry and veterinary medicine. But only in the last twenty years the importance of such diseases were notified in human medicine by the medical community and the public with emerging of the tick borne encephalitis virus and the description of Borrelia burgdorferi. It is often forgotten that many other infectious agents as bacteria, virus, Rickettsia or protozoa can be transmitted by ticks. Such diseases are rarely diagnosed in Europe either they are overlooked and misdiagnosed or they are connected with special professional activities. The development of new regions for tourism with different out door activities (adventure trips, trekking, hunting) leads to an exposure to different tick borne diseases, which are often misdiagnosed.

People visiting or living in tropical or subtropical regions are exposed to various factors, which can lead to edema. Tourists staying for only a short time in the tropics are exposed to different risks, with other disease patterns, than people living in the tropics or immigrants from tropical regions. The differential diagnosis of edema and swelling is extensive and it can sometimes be difficult to distinguish classical edema with fluid retention in the extravascular interstitial space, from lymphedema or swelling due to other aetiologies. The patients often connect the edema to their stay in the tropics although it may have been pre-existing with no obvious relation to their travels. Already the long trip in the plane can lead to an "economy class syndrome" due to deep venous thrombosis. Contacts with animal or plant toxins, parasites or parasitic larvae can produce peripheral edema. The diagnosis can often only be made by taking a meticulous history, checking for eosinophilia and with the help of serological investigations. Chronic lymphedema or elephantiasis of the limbs is often due to blocked lymph vessels by filarial worms. It has to be distinguished from other forms as e.g. podoconiosis due to blockage by mineral particles in barefoot walking people. The trend to book adventure and trekking holidays at high altitude leads to high altitude peripheral edema or non-freezing cold injuries such as frostbites and trench foot. Edema can be an unwanted side effect of a range of drugs e.g. nifedipine, which is used to prevent and treat high altitude pulmonary edema. Protein malnutrition, (Kwashiorkor), and vitamin B6 deficiency, (Beri-Beri) are very rarely observed in immigrants and almost never in tourists. A very painful swelling of fingers and hands in children and young adults of African origin can be observed during a sickle cell crisis. Many protein loosing nephropathies connected with plant and animal toxins but also bacterial, viral or parasitic agents, can lead to edema. But very often edema in tourists or immigrants from the tropics is not related to their stay abroad. To take an accurate history of the itinerary, eating habits and exposure to water etc. is very important. Knowledge of the precise epidemiology and geographic distribution of diseases are essential.

Ileus due to a colorectal carcinoma is still an illness with high mortality currently between 15 and 20%. Advanced tumor stages are found in the majority of the patients. Today one-staged procedures are preferred, although a clear advantage in postoperative mortality was not proven so far. We recommend a concept, depending on localization, general condition and tumor stage. For patients in very bad general condition a primary colostomy is still a good option today. In case of a damaged intestine we recommend either a two-staged procedure with primary resection and colostomy and secondary closure of the stoma or a subtotal colectomy in patients who are in a good general condition. For patients in very good condition an one-staged procedure should be performed, whereby we prefer the resection with on table lavage.

An estimated 20,000 to 30,000 cases of imported malaria are annually diagnosed in industrialised countries. Some 700 of them concern Swiss travellers and foreign guests. Exposure prophylaxis and chemoprophylaxis for high risk destinations lower the risk of malarial disease. The latter is defined as regular intake of antimalarial drugs in subtherapeutic dosage in order to suppress the development of clinical disease. Drugs are usually taken from one week before travel until four weeks after return from an endemic area. Mefloquine, doxycycline, chloroquine plus proguanil, and presumably soon also atovaquone plus proguanil are available in Switzerland for chemoprophylaxis.

The indication and the optimal surgical procedure of complicated diverticulitis are still under discussion. The choice of the surgical therapy has its highest priority in the cure of the infection by sigmoid resection. Resection with primary anastomosis can be done in cases of covered perforation (Hinchey 1 + 2) with a low mortality. Diffuse peritonitis should be treated depending on the individual local situation.

The Swiss Working Group for Health Advice to Travellers regularly publishes its recommendations for malaria prophylaxis and vaccination as supplement to the 'Bulletin' of the Federal Office of Public Health. In this review the strategy with respect to information, to clever behavior abroad, to chemoprophylaxis and immunization prophylaxis is analyzed. A critical evaluation of emergency self-therapy describes remaining questions in particular.

Strongyloidiasis is a parasitic disease of tropical regions and to some extent of the South of Europe. In immunocompromised patients, particularly under steroid medication, infestation by this nematode may sometimes lead to life-threatening hyper-infestation. Diagnosis is often difficult because of a polymorphic clinical picture and usually low larvae excretion in the stool. The case is reported of a Yugoslavian patient who under corticosteroid therapy suffered from severe diarrhea and dehydration due to hyperinfestation by nematode larvae. Several attempts at treatment were necessary to eradicate the infestation.

A world-wide increase of malaria infections is observed. Malaria is imported into Switzerland mainly by tourists and recently by refugees from South East Asia. The strains of P. falciparum resistant to treatment are of increasing importance. A patient with P. falciparum infection from Cambodia is reported, who suffered from three episodes of malaria recrudescence within ten weeks, in spite of adequate therapy with quinine and Fansidar. The definition, the significance and the geographical distribution of resistances and the possible cause for a P. falciparum recrudescence are discussed. For the treatment of repeating recrudescence quinine and Fansidar are recommended, followed by a suppressive Fansidar prophylaxy for 4--8 weeks.

Travellers' hepatitis has been investigated by comparing clinical and serological data. The histories of 876 persons examined after their return from tropical countries were analysed for type, location, and length of stay abroad, prophylactic administration of gamma-globulin and past hepatitis. In addition to clinical investigations, 528 of the patients underwent radioimmunoassays for hepatitis markers. HBs antigen was detected in 1.1%, anti-HBs antibodies in 14.2%, and anti-HA antibodies in 37.3% of the patients. The prevalence of anti-HA antibodies increased with age, but the mean value for those over 20 years was only 8% above the mean for the corresponding age groups of Swiss residents. Significant differences in prevalence of anti-HA antibodies were only observed in persons who had stayed in the tropics for more than 5 years. The prevalence of hepatitis B markers was 2-3 times higher in persons returning from the tropics than in volunteer Swiss blood donors. Contrary to hepatitis A, the hepatitis B markers were related neither to age nor to the length of stay abroad. Patient's histories and serological tests revealed a high frequency of unapparent infections, i.e. 74% of hepatitis A and 88% of hepatitis B infections. Acute viral hepatitis was newly diagnosed in 17 out of the 2032 tropical patients who consulted us during 1979. The yearly incidence of hepatitis in this population was thus 8.5%, which is about 10 times higher than that estimated for the Swiss population as a whole. Only 5 of the 17 cases showed hepatitis of type A. One third of the cases were anicteric. The study clearly shows the importance of non-A hepatitis among travellers. In consequence, questions arise as to the prophylactic use of gamma-globulin and the epidemiology of traveller's hepatitis.

Recently many refugees from Sri Lanka have arrived in Europe. The purpose of the present investigation was to analyze the subjective complaints and diagnoses in these refugees. One hundred refugees (97 males, 3 females, age 19 to 42 years) were investigated. The most common reasons for consulting a general internist were cough (23%), general pain in soft tissue and joints (21%), disorders of the gastrointestinal tract (19%) and ear or throat complaints (15%). In 43% of the patients no diagnosis could be established. 58 patients were investigated for parasites in stool: 57% of these patients had hookworms, 12% non-pathogenic protozoon, 9% Entamoeba histolytica cysts, and 2% Giardia lamblia. In 12% of the patients the diagnosis was tonsillitis or pharyngitis, in 7% bronchitis, pneumonia or asthma and in 5% arterial hypertension. Various other diagnoses were established in 48 patients. With the exception of the high frequency of intestinal parasites, complaints and diagnoses in these refugees were the same as in a comparable European population.