Begegnungen : Beiträge von Assistierenden zum 50. Geburtstag von Thomas Gächter

Sozialversicherungsrecht, Gesundheitsrecht und öffentliches Recht – in diesen Rechtsgebieten prägt das wissenschaftliche Schaffen von Thomas Gächter die juristische und gesellschaftliche Diskussion. Aus Anlass seines 50. Geburtstags denken (ehemalige) Assistentinnen und Assistenten über aktuelle sozialversicherungsrechtliche, gesundheitsrechtliche und öffentlichrechtliche Problemstellungen nach, die sich aus Begegnungen mit Thomas Gächter ergaben. Die Beiträge vermitteln einen Überblick über Entwicklungstendenzen in den genannten Rechtsgebieten sowie über gegenwärtige und zukünftige Fragen, mit denen sich Praxis und Rechtsetzung zu befassen haben werden

Evaluationsregister als Allheilmittel bei umstrittenen Leistungen

Gesundheitsbezogene Evaluationsregister können wertvolle Daten aus der Alltagsversorgung liefern. Sie werden deshalb regelmässig für gesundheitsökonomische Fragestellungen herangezogen, um zu beurteilen, ob eine Leistung vergütet wird oder nicht. Doch damit sie wirklich zur Schliessung von Evidenzlücken beitragen können, muss einiges beachtet werden

Grundprobleme der Invaliditätsbemessung in der Invalidenversicherung

Der faire Zugang zu Invalidenleistungen war in den vergangenen Jahren Gegenstand grösserer Kontroversen. Insbesondere die Thematik der medizinischen Einschränkungen und deren Begutachtung standen im Vordergrund. Die vorliegende Studie richtet den Fokus auf die Invaliditätsbemessung in der Invalidenversicherung, insbesondere auf die allgemeine Methode des Einkommensvergleichs bei unselbstständig erwerbenden Personen. Es zeigt sich, dass der für die Bestimmung des Invaliditätsgrades vergleichsweise herangezogene ausgeglichene Arbeitsmarkt immer mehr in Richtung einer abstrakten Fiktion gerückt wird und sich vom real existierenden Arbeitsmarkt zunehmend entfernt, zumal auch die lohnstatistischen Grundlagen nicht sachgerecht herangezogen werden. Zudem führt die restriktive Handhabung von Korrekturinstrumenten (Einkommensparallelisierung, Tabellenlohnabzüge) zu erheblichen Verzerrungen. Die Studie zeigt die Entwicklungen sowie die Praxis detailliert auf, analysiert Schwachstellen und zeigt Perspektiven für eine künftige, näher an der wirtschaftlichen Realität liegende Bemessung auf

Regional spread of an atypical ESBL-producing Escherichia coli ST131H89 clone among different human and environmental reservoirs in Western Switzerland

We describe the inter-regional spread of a novel ESBL-producing Escherichia coli subclone (ST131H89) in long-term care facility residents, general population, and environmental water sources in Western Switzerland between 2017 and 2020. The study highlights the importance of molecular surveillance for tracking emerging antibiotic-resistant pathogens in healthcare and community settings

Frequency of serological non-responders and false-negative RT-PCR results in SARS-CoV-2 testing: a population-based study.

Objectives The sensitivity of molecular and serological methods for COVID-19 testing in an epidemiological setting is not well described. The aim of the study was to determine the frequency of negative RT-PCR results at first clinical presentation as well as negative serological results after a follow-up of at least 3 weeks. Methods Among all patients seen for suspected COVID-19 in Liechtenstein (n=1921), we included initially RT-PCR positive index patients (n=85) as well as initially RT-PCR negative (n=66) for follow-up with SARS-CoV-2 antibody testing. Antibodies were detected with seven different commercially available immunoassays. Frequencies of negative RT-PCR and serology results in individuals with COVID-19 were determined and compared to those observed in a validation cohort of Swiss patients (n=211). Results Among COVID-19 patients in Liechtenstein, false-negative RT-PCR at initial presentation was seen in 18% (12/66), whereas negative serology in COVID-19 patients was 4% (3/85). The validation cohort showed similar frequencies: 2/66 (3%) for negative serology, and 16/155 (10%) for false negative RT-PCR. COVID-19 patients with negative follow-up serology tended to have a longer disease duration (p=0.05) and more clinical symptoms than other patients with COVID-19 (p<0.05). The antibody titer from quantitative immunoassays was positively associated with the number of disease symptoms and disease duration (p<0.001). Conclusions RT-PCR at initial presentation in patients with suspected COVID-19 can miss infected patients. Antibody titers of SARS-CoV-2 assays are linked to the number of disease symptoms and the duration of disease. One in 25 patients with RT-PCR-positive COVID-19 does not develop antibodies detectable with frequently employed and commercially available immunoassays

A peripheral epigenetic signature of immune system genes is linked to neocortical thickness and memory

Increasing age is tightly linked to decreased thickness of the human neocortex. The biological mechanisms that mediate this effect are hitherto unknown. The DNA methylome, as part of the epigenome, contributes significantly to age-related phenotypic changes. Here, we identify an epigenetic signature that is associated with cortical thickness (P=3.86 × 10(-8)) and memory performance in 533 healthy young adults. The epigenetic effect on cortical thickness was replicated in a sample comprising 596 participants with major depressive disorder and healthy controls. The epigenetic signature mediates partially the effect of age on cortical thickness (P&lt;0.001). A multilocus genetic score reflecting genetic variability of this signature is associated with memory performance (P=0.0003) in 3,346 young and elderly healthy adults. The genomic location of the contributing methylation sites points to the involvement of specific immune system genes. The decomposition of blood methylome-wide patterns bears considerable potential for the study of brain-related traits

Interseasonal RSV infections in Switzerland - rapid establishment of a clinician-led national reporting system (RSV EpiCH).

In anticipation of an interseasonal respiratory syncytial virus (RSV) epidemic, a clinician-led reporting system was rapidly established to capture RSV infections in Swiss hospitals, starting in January 2021. Here, we present details of the reporting system and first results to June 2021. An unusual epidemiology was observed with an interseasonal surge of RSV infections associated with COVID-19-related non-pharmacological interventions. These data allowed real-time adjustment of RSV prophylaxis guidelines and consequently underscore the need for and continuation of systematic nationwide RSV surveillance

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Qualitätssicherung medizinischer Gutachten - "ideal, aber nicht zwingend?" : Gedanken zu einer juristischen Qualitätslehre aus Anlass von BGE 143 V 124

Ausgehend von BGE 143 V 124, der das Einholen einer Konsensbespre­chung als "ideal, aber nicht zwingend" einstuft, werden im vorliegenden Aufsatz Grundzüge einer juristischen Qualitätslehre skizziert. Eine solche Lehre kann einen wichtigen Beitrag zur Ermöglichung qualitativ hochste­hender medizinischer Gutachten und damit zur «Gleichheit durch Quali­tät» leisten. Plädiert wird zum einen für eine Stärkung der unabhängigen aufsichtsmässigen Qualitätssicherung und zum anderen dafür, dass die Gerichte Gutachten, die gegen anerkannte Qualitätssicherungsmass­nahmen verstossen, vermehrt aus dem Recht weisen