Quality assurance of medical education: a case study from Switzerland

In the light of ongoing changes and challenges in the European health systems which also have significant implications for undergraduate medical education, the present paper describes the accreditation of medical education programmes in Switzerland focussing on undergraduate medical education. A summary of the methodology used is provided and first experiences as well as future perspectives are discussed in the light of the aim to achieve continuous quality assurance and improvement in medical education

Prevention of Travelers' Diarrhea by Nonantibiotic Drugs

Travelers have resorted to a variety of drugs for prevention of diarrhea. No beneficial prophylactic effect has been confirmed for halogenated hydroxyquinolines, lactobacilli, antimotility drugs, ethacridine, and various other agents. In contrast, bismuth subsalicyate (BSS) in liquid form reduced the incidence of diarrhea in students from the United States living in Mexico and in tablet form in volunteers challenged by enterotoxigenic Escherichia coli. In tourists visiting various developing countries, a randomized, double-blind study was conducted in which 390 persons received a total of 2.1 or 1.05 g of BSS daily or placebo in tablet form in two doses. BSS reduced the incidence of diarrhea by 41% in the high-dose group and by 35% in the low-dose group without causing important adverse reaction

Demenz, Depressionen und Aktivitäten des täglichen Lebens als Risikofaktoren von Stürzen bei Betagten

Summary: Objectives: Falls among elderly are a well-recognised public health problem. The purpose of the present study was to explore the relation between dementia, number of depressive symptoms, activities of daily living, setting, and risk of falling. Methods: Data for the analysis came from a cross-sectional study about dementia, depression, and disabilities, carried out 1995/96 in Zurich and Geneva. The random sample stratified, by age and gender consisted of 921 subjects aged 65 and more. The interview was conducted by means of the Canberra Interview for the Elderly, extended by short questionnaire. The subject was classified as a faller if the subject and/or the informant had reported a fall within the last 12 months prior to the interview. Logistic-regression analysis was used to determine the independent impact of dementia, depressive symptoms, and ADL-score on risk of falling. Results: The stepwise logistic regression analysis has revealed a statistically significant association between dementia (OR 2.14, 95% Cl 1.15-3.96), two resp. three depressive symptoms (OR 1.64, 95% Cl 1.04-2.60) as well as four or more depressive symptoms (OR 2.64, 95% Cl 1.39-5.02) and the risk of falling. There was no statistically significant relationship between studied risk factors and the risk of being one-time faller. However, we found a strong positive association between dementia (OR 3.92, 95% Cl 1.75-8.79), four or more depressive symptoms (OR 3.90, 95% Cl 1.55-9.83) and the risk of being recurrent faller. Moreover, residents of nursing homes (OR 8.50, 95% Cl 2.18-33.22) and elderly aged 85 or more (OR 2.29, 95% Cl 1.08-4.87) were under statistically significant higher risk of sustaining recurrent falls. Conclusions: The results of the present study confirm that dementia and depression substantially increase the risk of fallin

Human papillomavirus genotype distribution and socio-behavioural characteristics in women with cervical pre-cancer and cancer at the start of a human papillomavirus vaccination programme: the CIN3+ plus study.

The Swiss Federal Office of Public Health has recommended vaccination against human papillomavirus (HPV) to prevent cervical cancer since 2008. To establish monitoring of the future public health impact of vaccination, baseline population-based data are required. The objectives of this study were to examine the distribution of oncogenic HPV genotypes in biopsies with cervical intraepithelial neoplasia stage 3 or more severe lesions (CIN3+) at the beginning of HPV vaccination programmes and to compare sociodemographic and behavioural factors of women with CIN3+ with women in the Swiss general population. We conducted a retrospective and prospective cross-sectional study with women diagnosed with CIN3+ in Switzerland. Ten pathology institutes from six cantons and three language regions participated. We conducted HPV typing on formaldehyde fixed-paraffin embedded specimens from 2014 and 2015. Women enrolled in 2015 were asked to complete a questionnaire. We described frequencies of HPV types. We also compared demographic characteristics and socioeconomic status in the CIN3 + plus group with the Swiss National Cohort in 2014 and compared risk factors for HPV infection with the Swiss Health Survey in 2012. We included 768 biopsies from 767 women. Four hundred and seventy-five (61.8%) biopsies were positive for HPV 16 and/or 18, 687 (89.5%) were positive for oncogenic HPV genotypes 16, 18, 31, 33, 45, 52, and/or 58 and five (0.7%) were HPV negative. Twenty-eight (10.3%) of the 273 women who completed the patient questionnaire reported having received at least one dose of an HPV vaccine. When compared with Swiss women in the six study cantons, fewer women in the CIN3+ plus study group were of Swiss nationality, more were born abroad and more were single. The study group also had a higher proportion of women with ≥2 partners in the last year, current smokers and was younger at age of first sexual intercourse. Introduction of the nonavalent vaccine could cover approximately 90% of CIN3+ lesions in Swiss women compared with around 60% with the quadrivalent vaccine. Surveillance of HPV genotype distribution in CIN3+, together with information about vaccination and CIN3+ incidence will allow monitoring of the public health impact of vaccination programmes. ClinicalTrials.gov, NCT02323997 . Registered 24 December 2014