Content of health status reports of people seeking assisted suicide: a qualitative analysis

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)Two right-to-die organisations offer assisted suicide in Switzerland. The specific legal situation allows assistance to Swiss and foreign citizens. Both organisations require a report of the person's health status before considering assistance. This qualitative study explored these reports filed to legal authorities after the deaths of individuals in the area of Zurich. Health status reports in the legal medical dossiers of the deceased were analysed using content analysis and Grounded Theory. From 421 cases of assisted suicide (2001-2004), 350 reports on health status were filed. Many cases contained diagnosis lists only. Other reports had more elaborate reports revealing that some physicians were aware about the patient's death wish and the intention to solicit assisted suicide. Physicians' attitudes ranged from neutral to rather depreciative. Few physicians openly referred the patient to the organisations and supported the patient's request by highlighting a history of suffering as well as reporting understanding and agreement with the patient's wish to hasten death. In the health status reports five categories could be identified. Some files revealed that physicians were aware of the death wish. The knowledge and recognition of the patient's death wish varied from no apparent awareness to strongly supportive. This variety might be due to difficulties to discuss the death wish with patients, but might also reflect the challenge to avoid legal prosecution in the country of origin. To require comparable health status reports as requirements for the right-to-die organisations might be difficult to pursue

Content of health status reports of people seeking assisted suicide: a qualitative analysis

Two right-to-die organisations offer assisted suicide in Switzerland. The specific legal situation allows assistance to Swiss and foreign citizens. Both organisations require a report of the person's health status before considering assistance. This qualitative study explored these reports filed to legal authorities after the deaths of individuals in the area of Zurich. Health status reports in the legal medical dossiers of the deceased were analysed using content analysis and Grounded Theory. From 421 cases of assisted suicide (2001-2004), 350 reports on health status were filed. Many cases contained diagnosis lists only. Other reports had more elaborate reports revealing that some physicians were aware about the patient's death wish and the intention to solicit assisted suicide. Physicians' attitudes ranged from neutral to rather depreciative. Few physicians openly referred the patient to the organisations and supported the patient's request by highlighting a history of suffering as well as reporting understanding and agreement with the patient's wish to hasten death. In the health status reports five categories could be identified. Some files revealed that physicians were aware of the death wish. The knowledge and recognition of the patient's death wish varied from no apparent awareness to strongly supportive. This variety might be due to difficulties to discuss the death wish with patients, but might also reflect the challenge to avoid legal prosecution in the country of origin. To require comparable health status reports as requirements for the right-to-die organisations might be difficult to pursu

Content of health status reports of people seeking assisted suicide: a qualitative analysis

Two right-to-die organisations offer assisted suicide in Switzerland. The specific legal situation allows assistance to Swiss and foreign citizens. Both organisations require a report of the person's health status before considering assistance. This qualitative study explored these reports filed to legal authorities after the deaths of individuals in the area of Zurich. Health status reports in the legal medical dossiers of the deceased were analysed using content analysis and Grounded Theory. From 421 cases of assisted suicide (2001-2004), 350 reports on health status were filed. Many cases contained diagnosis lists only. Other reports had more elaborate reports revealing that some physicians were aware about the patient's death wish and the intention to solicit assisted suicide. Physicians' attitudes ranged from neutral to rather depreciative. Few physicians openly referred the patient to the organisations and supported the patient's request by highlighting a history of suffering as well as reporting understanding and agreement with the patient's wish to hasten death. In the health status reports five categories could be identified. Some files revealed that physicians were aware of the death wish. The knowledge and recognition of the patient's death wish varied from no apparent awareness to strongly supportive. This variety might be due to difficulties to discuss the death wish with patients, but might also reflect the challenge to avoid legal prosecution in the country of origin. To require comparable health status reports as requirements for the right-to-die organisations might be difficult to pursu

Reasons why people in Switzerland seek assisted suicide : the view of patients and physicians

Background: Assisted suicide is permitted in Switzerland provided that assistance is not motivated by selfish reasons. Suicides are commonly performed with the assistance of right-to-die organisations and the use of a lethal dose of barbiturates prescribed by a participating physician. We examined the reasons physicians provided for writing the prescription and the reasons patients gave for requesting assistance in dying. Methods: We analysed all reported cases of assisted suicide that were facilitated by right-to-die organisations between 2001 and 2004 in the city of Zurich, and for which both the medical report and the optional letter written by the decedent providing information on their reasons for seeking assistance in suicide (N = 165). Results: The reasons most often reported by physicians (ph), as well as persons who sought help (p), were: pain (ph: 56% of all assisted suicides, p: 58%), need for long-term care (ph: 37%, p: 39%), neurological symptoms (ph: 35%, p: 32%), immobility (ph: 23%, p: 30%) and dyspnoea (ph: 23%, p: 23%). Control of circumstances over death (ph: 12%, p: 39%); loss of dignity (ph: 6%, p: 38%); weakness (ph: 13%, p: 26%); less able to engage in activities that make life enjoyable (ph: 6%, p: 18%); and insomnia and loss of concentration (ph: 4%, p: 13%) were significantly more often mentioned by decedents than by physicians. Conclusions: Both prescribing physicians and;patients provided with assistance to die quite often mentioned pain and other concerns, many of which were objectively assessable and related to unbearable suffering or unreasonable disability. Concerns referable to autonomy and individual judgement were more often noted by people seeking help than by the prescribing physicians

Association of lung clearance index with survival in individuals with cystic fibrosis.

BACKGROUND The lung clearance index (LCI) assesses global ventilation inhomogeneity and is a sensitive biomarker of airway function in cystic fibrosis (CF) lung disease. OBJECTIVES We examined the association of LCI with the risk of death or lung transplantation (LTX) in individuals with CF. METHODS We performed a retrospective analysis in a cohort of individuals with CF aged≥5 years with LCI and FEV1 measurements performed between 1980 and 2006. The outcome was time until death or LTX. We used the earliest available LCI and FEV1 values in a Cox proportional hazard regression adjusted for demographic and clinical variables. For sensitivity analyses, we used the mean of the first three LCI and FEV1 measurements, stratified the cohort based on age, and investigated individuals with normal FEV1. RESULTS In total, 237 individuals with CF with a mean (range) age of 13.9 (5.6-41.0) years were included. The time-to-event analysis accrued 3813 person-years and 94 (40%) individuals died or received LTX. Crude hazard ratios [95% CI] were 1.04 [1.01-1.06] per one z-score increase in LCI and 1.25 [1.11-1.41] per one z-score decrease in FEV1. After adjusting LCI and FEV1 mutually in addition to sex, age, BMI and the number of hospitalisations, hazard ratios were 1.04 [1.01-1.07] for LCI, and 1.12 [0.95-1.33] for FEV1. Sensitivity analyses yielded similar results and using the mean LCI strengthened the associations. CONCLUSIONS Increased ventilation inhomogeneity is associated with greater risk of death or LTX. Our data support LCI as novel surrogate of survival in individuals with CF

Vielfalt der Nutztiere erhalten: Gefährdete Rassen in Sachsen – Stand und Aktivitäten

Die vorliegende Broschüre gibt einen Überblick über vom Aussterben bedrohte einheimische Nutztierrassen, ihre Geschichte, züchterische Aktivitäten und ihre Bestandsentwicklung. Ergänzend dazu wird über staatliche Initiativen und Aufgaben zur Sicherung der tiergenetischen Ressourcen informiert. Redaktionsschluss: 31.08.202

Durchflusskennwerte und Querbauwerke: Leitfaden zur Web-Anwendung „Ausgewählte Durchflusskennwerte und Querbauwerke sächsischer Fließgewässer, Stand 2015“

Der Leitfaden informiert über Methodik und Ergebnisse der Regionalisierung von ausgewählten Durchflusskennwerten. Über die Internet-Anwendung »Durchflusskennwerte und Querbauwerke« können für beliebige Querschnitte der sächsischen Fließgewässer die Durchflusskennwerte abgefragt werden (Stand 2015). Die Kennwerte werden u. a. benötigt bei der Ermittlung von Mindestwasserführungen und mittleren Durchflussdargeboten sowie bei der Planung wasserbaulicher Anlagen und der Ausweisung von Überschwemmungsgebieten. Die Publikation richtet sich an Wasserbehörden und Planungsbüros, aber auch an Gewässernutzer in Sachsen. Redaktionsschluss: 21.06.201

Data accuracy, consistency and completeness of the national Swiss cystic fibrosis patient registry: Lessons from an ECFSPR data quality project.

BACKGROUND Good data quality is essential when rare disease registries are used as a data source for pharmacovigilance studies. This study investigated data quality of the Swiss cystic fibrosis (CF) registry in the frame of a European Cystic Fibrosis Society Patient Registry (ECFSPR) project aiming to implement measures to increase data reliability for registry-based research. METHODS All 20 pediatric and adult Swiss CF centers participated in a data quality audit between 2018 and 2020, and in a re-audit in 2022. Accuracy, consistency and completeness of variables and definitions were evaluated, and missing source data and informed consents (ICs) were assessed. RESULTS The first audit included 601 out of 997 Swiss people with CF (60.3 %). Data quality, as defined by data correctness ≥95 %, was high for most of the variables. Inconsistencies of specific variables were observed because of an incorrect application of the variable definition. The proportion of missing data was low with 5 % of missing documents). After providing feedback to the centers, availability of genetic source data and ICs improved. CONCLUSIONS Data audits demonstrated an overall good data quality in the Swiss CF registry. Specific measures such as support of the participating sites, training of data managers and centralized data collection should be implemented in rare disease registries to optimize data quality and provide robust data for registry-based scientific research

The effectiveness of bariatric surgery on long term psychosocial quality of life – A systematic review

© 2015 Asia Oceania Association for the Study of Obesity Background Little is known about the psychological effects of bariatric surgery. This review aimed to assess long term effectiveness of bariatric surgery on psychosocial quality of life (QoL) of obese adults compared to non-surgical interventions. Methods A systematic review of the literature was conducted, six electronic databases, plus other relevant sources were searched from inception to January 2014. The main outcome sought was a QoL measure with a minimum 12 months follow-up. Three reviewers screened records, extracted data and independently read through full articles for eligibility and quality using standardised forms. Findings were analysed using narrative synthesis. Results Of 4383 identified references included in the review, 11 studies showed bariatric surgery to be effective long term for overall QoL than non-surgical treatments with specifically modest benefits psychosocially. Significant improvements in psychosocial QoL alongside improved physical QoL were observed after 2 year follow-up post-surgery compared to non-surgical interventions. However improvements in psychosocial QoL after surgery at 10 year follow up were minimal when compared to non-surgical interventions. When compared to untreated control groups, long term psychosocial QoL did not improve after bariatric surgery despite major improvements in physical QoL, significant weight loss and co-morbidities. Conclusions Results on long term psychosocial QoL remain uncertain with some suggestion of psychological disorder persisting. This highlights need for psychological intervention post-surgery and further research to provide more data on long-term psychosocial QoL following bariatric surgery

The N-Terminal Domain of the Arenavirus L Protein Is an RNA Endonuclease Essential in mRNA Transcription

Arenaviridae synthesize viral mRNAs using short capped primers presumably acquired from cellular transcripts by a ‘cap-snatching’ mechanism. Here, we report the crystal structure and functional characterization of the N-terminal 196 residues (NL1) of the L protein from the prototypic arenavirus: lymphocytic choriomeningitis virus. The NL1 domain is able to bind and cleave RNA. The 2.13 Å resolution crystal structure of NL1 reveals a type II endonuclease α/β architecture similar to the N-terminal end of the influenza virus PA protein. Superimposition of both structures, mutagenesis and reverse genetics studies reveal a unique spatial arrangement of key active site residues related to the PD…(D/E)XK type II endonuclease signature sequence. We show that this endonuclease domain is conserved and active across the virus families Arenaviridae, Bunyaviridae and Orthomyxoviridae and propose that the arenavirus NL1 domain is the Arenaviridae cap-snatching endonuclease