Swiss medical weekly最新文献

Introduction: Human childbirth remains a complex and risky process for both mothers and infants, even with modern advancements in medical care. This study investigated the prevalence of obstetric interventions, namely caesarean sections, episiotomies, and forceps deliveries, along with the role of maternal-foetal body size mismatch in influencing delivery outcomes.

Methods: Utilising two datasets from similar archival sources in two Swiss cities (Basel and Lausanne) from the 1920s, we explored the relevance of a mismatch between the body size of the mother and the foetus as a risk factor for obstetrical interventions and the duration of the expulsion phase during delivery.

Results: Over 91% of births (1290/1407 in Basel and 1062/1145 in Lausanne) featured the foetal head in a normal position (either the right or left occiput anterior position). Episiotomies were performed in 8-17% of cases (233/1407 in Basel and 98/1145 in Lausanne) and forceps deliveries in 1-5% (17/1407 in Basel and 54/1145 in Lausanne). Caesarean sections were rare (<1%, 19/1407 in Basel and 6/1145 in Lausanne). Key findings indicated that larger foetal head diameters and narrower pelvic measurements were linked to prolonged expulsion phases and an increased likelihood of intervention. Abnormal head positions and first-time births were also associated with obstetrical interventions. Additionally, rickets was documented in 2% of mothers (23/1145) in Lausanne, correlating with increased forceps use and caesarean section rates.

Conclusion: This research provides insights into obstetric practices and maternal health conditions over a century ago, emphasising the significant impact of maternal-foetal body size mismatches on childbirth complications in a historical context.

Background: In 2018, a hospital-based surveillance system for influenza (CH-SUR) was established in six tertiary care hospitals in Switzerland. From March 2020 onwards, this surveillance system was expanded to include more institutions, as well as COVID-19.

Aim: To quantitatively evaluate the timeliness and completeness of CH-SUR data and to qualitatively assess stakeholder perceptions of the importance, reliability and adaptability of the surveillance system.

Methods: All patients admitted to one of the participating centres for more than 24 hours and who had a laboratory-confirmed influenza virus or SARS-CoV-2 infection were included in CH-SUR. For all cases, we evaluated the timeliness and completeness of reporting to CH-SUR. A qualitative survey among CH-SUR stakeholders assessed perceived importance, understanding, reliability and adaptability of CH-SUR.

Results: Up to 20 centres participated in CH-SUR. Between December 2018 and October 2023, 7375 cases of influenza were reported and between March 2020 and October 2023, 49,235 cases of COVID-19 were reported to CH-SUR. During the COVID-19 pandemic, time to data entry and completeness improved over time; the median delay of data entry in CH-SUR was 5 days (interquartile range [IQR]: 2-23) for COVID-19 and 4 days (IQR: 2-15) for influenza during the period 2018-2023. The completeness of variables was high (99.4%), with the exception of COVID-19 or annual influenza vaccination status (respectively, 15% and 72% "Unknown" responses). Stakeholders perceived the system as important, relevant, understandable and adaptable.

Conclusion: CH-SUR provided critical epidemiological and clinical information on hospitalised influenza and COVID-19 cases across Switzerland during the pandemic. Our evaluation highlighted the importance and relevance of this system among CH-SUR stakeholders, as well as its importance for preparedness and response to future infectious disease outbreaks.

Objectives: The primary objective was to measure the impact of passive exposure to an educational video about Chlamydia trachomatis infection shown in a gynaecology department waiting room on young women's knowledge on the subject. The secondary objective was to explore the participants' interest in improving their knowledge of Chlamydia trachomatis and their opinions on receiving this information during a consultation in the emergency room.

Methods: A prospective, interventional, controlled, non-randomised study. Participants were recruited between January and June 2022. 120 women aged 15-35 years were included. The intervention consisted of passive exposure to a 2-minute cartoon presenting basic foundational points of Chlamydia trachomatis displayed in the waiting room. The control group was not exposed to the video. After the intervention, an in-person knowledge interview was performed with each participant.

Main outcome measures: The main outcome measures were the knowledge scores obtained in the interviews with the exposed and control groups.

Results: Both groups were similar regarding sociodemographic variables. The average knowledge scores from the interview were similar in the two groups. Video exposure was not associated with diminution of lower scores. Participants' baseline knowledge was higher than expected on the basis of a literature review.

Conclusion: The passive learning intervention described in this study did not improve the participants' knowledge about Chlamydia trachomatis. During the one-to-one interview, participants were keen to receive information about Chlamydia trachomatis but the quantitative results show that the short video in the waiting room had no impact on their knowledge. Future studies should focus on pre-assessed, randomised, one-to-one or small-group active interventions.

Background: Psychosocial maturity is one of the key factors for understanding the course of criminal offences in juveniles and young adults. Until recently, forensic-psychiatric assessments to diagnose a severe disorder of personality development remained mostly unguided because validated instruments were not available. A new tool, the Young Adult Personality Development (YAPD) instrument, was introduced in 2021 and consists of three dimensions related to psychosocial maturity: YAPD environmental, YAPD pathology and YAPD developmental tasks failure. The current study tested the reliability (internal consistency, interrater reliability) and concurrent validity of these dimensions.

Methods: We analysed files of a consecutive sample of young adults in the Canton of Zurich (2007 to 2020, n = 234, mean age: 21.33 years, SD: 1.74 years), who were either assigned to specialised institutional treatment for young adults (Swiss Penal Code [SPC] Article 61) or outpatient treatment (SPC Article 63). Intraclass correlation coefficient (ICC) agreements were used to analyse interrater reliability of YAPD dimensions across three independent raters. In the absence of a gold standard, we analysed concurrent validity by measuring the associations of the YAPD dimensions with expert opinion and sample status (judicial decisions on measures) using multiple logistic regressions.

Results: Expert-rated personality development disorder was found to be highly prevalent in both samples. The YAPD dimensions showed adequate-to-good interrater reliability (ICC: 0.74-0.92). In logistic regression models, YAPD developmental tasks failure was related to diagnoses of severe development disorder and juridical decision on a measure for young adults according to SPC Art. 61. YAPD environmental was related to the diagnosis of a severe development disorder. YAPD pathology was found to be unrelated to the diagnosis of severe personality development disorder.

Conclusions: Our findings support the YAPD developmental tasks failure dimension and to a lesser degree the YAPD environmental dimension as valid dimensions to diagnose severe personality development disorder. Structured assessment instruments such as the YAPD may further improve diagnostic decision-making in forensic psychiatry and psychology.

Gathering nuanced sex and gender data in biomedical research is mandated by Swiss law and ethical recommendations but not supported by current practices in clinical medicine. Exploring this issue in the intensive care context, we highlight the urgent need for differentiated data collection to support inclusive and equitable clinical research.

Study aims: A history of gestational diabetes mellitus is a known risk factor for developing type 2 diabetes in the future. Therefore, screening for persistent dysglycaemia in the postpartum period is of utmost importance. However, follow-up rates tend to be low. The aim of this study was to investigate postpartum screening adherence at a tertiary care centre and to identify factors contributing to persistent dysglycaemia.

Methods: A cohort of women with gestational diabetes mellitus diagnosed between 2015 and 2018 at the department of Obstetrics and Gynaecology, University Hospital Bern, Switzerland, was retrospectively studied. Ethnicity, parity, pre-pregnancy BMI, family history of diabetes mellitus, first trimester glycosylated haemoglobin (HbA1c), 75 g oral glucose tolerance test during pregnancy and in the postpartum period were analysed. Postpartum dysglycaemia was defined as overt diabetes (fasting plasma glucose ≥7.0 mmol/l and/or 2 hours plasma glucose ≥11.1 mmol/l for the 75 g oral glucose tolerance test), impaired glucose tolerance (2 hours plasma glucose 7.8-11.0 mmol/l) or impaired fasting glucose (plasma glucose 5.6-6.9 mmol/l). Parametric and non-parametric tests as well as multivariate regression were used. ROC analyses were performed to assess the prognostic accuracy of HbA1c and oral glucose tolerance test results at predicting postpartum dysglycaemia.

Results: We included 489 women with gestational diabetes mellitus in our study. Of these, 217 (44.4%) returned for postpartum testing and 59/217 (27.2%) had an abnormal oral glucose tolerance test. Ethnicity was found to be a factor in adherence to follow-up. Specifically, women of African origin showed a significantly higher compliance than Asian or Caucasian women (61.8% vs 47.8% vs 34.5%, respectively; p = 0.04). The multivariate analysis revealed that obesity (OR: 3.64, 95% CI: 1.41-9.37) and first trimester HbA1c >5.7% (OR: 3.67, 95% CI: 1.28-10.52) are significantly associated with an increased risk of postpartum dysglycaemia.

Conclusion: Our study indicates that adherence to postpartum screening after gestational diabetes mellitus is low but in line with the existing experience. This is of particular concern as 1 of 4 women undergoing postpartum screening show some sort of disturbed glucose metabolism. In particular, women with higher first trimester HbA1c and/or obesity may warrant closer observation and motivation for testing as the risk for persistent metabolic disorders is increased.

Study aims: Community pharmacies serve as important partners in reducing the tobacco burden in the population by delivering effective smoking cessation interventions. This study depicts the current clinical practice of smoking cessation interventions in Swiss community pharmacies and assesses pharmacists' attitudes towards integrating alternative nicotine delivery systems in smoking cessation interventions.

Methods: An interprofessional group developed and distributed an online survey to all community pharmacies affiliated with the Swiss Pharmacists' Association. One pharmacist per pharmacy was invited to complete the survey. Surveys completed between 1 April and 9 May 2022 were used in the data analysis. Using R, the frequencies and proportions of the answers to the categorical questions were reported. To evaluate responses to questions rated on a 6-point Likert-type scale, the mean, standard deviation, and 95% confidence interval were calculated.

Results: Of the 1612 surveys distributed, 259 (16%) were completed. Most participants counselled their clients during nicotine replacement therapy sales (71%) or conducted brief opportunistic smoking cessation counselling (51%) at least once a month. Fewer than 21% of pharmacists offered dedicated smoking cessation counselling. Of the participating pharmacists, 69% recommended nicotine replacement therapies, and approximately 21% reported recommending e-cigarettes in some situations. By contrast, 90% reported never recommending tobacco heating systems, snus, or nicotine pouches. Pharmacists stated that a higher demand (mean = 4.78, standard deviation [SD] = 1.42 on a 6-point Likert scale), a decision aid (mean = 4.58, SD = 1.51), more training (mean = 4.39, SD = 1.43), financial compensation (mean = 4.35, SD = 1.63), and better collaboration with other healthcare professionals (mean = 4.25, SD = 2.13) would enhance the frequency of smoking cessation interventions.

Conclusions: According to this online survey distributed to pharmacists in Switzerland, basic smoking cessation interventions are common, but counselling on smoking cessation could be intensified. Although Swiss pharmacists are currently reluctant to offer alternative nicotine delivery systems as smoking cessation aids, they show interest in receiving training on such products. Greater financial incentives, targeted campaigns, clear decision aids, and improved interprofessional collaboration could help strengthen future smoking cessation interventions in Swiss community pharmacies.

Vaccine hesitancy threatens to erode one of medicine's greatest achievements. Recent measles outbreaks in Europe and the United States illustrate the consequences of declining confidence. At the centre lies misinformation, amplified through digital networks, from the discredited vaccine-autism claim to the misconception that COVID-19 mRNA vaccines were rushed. Such narratives echo longstanding resistance to vaccination, magnified by political polarisation and compounded by inequities in access. Yet pathogens continue to evolve, requiring sustained innovation in immunology, genomic surveillance, artificial intelligence and mRNA platforms. Science alone, however, cannot overcome mistrust. Transparent communication, broad engagement by healthcare teams and equitable distribution are indispensable. Protecting trust is essential if vaccines are to prevent disease, reduce mortality and prepare society for future infectious threats.