Growing discontent of Swiss doctors, 1998-2007.

Background: Work satisfaction of doctors is a useful indicator of the functioning of the health-care system. We documented the work satisfaction of doctors nine years apart, before and after the implementation of several health-care reforms (limitation of working hours for medical trainees, restrictions on new doctors' offices, new reimbursement fee schedule, greater administrative controls).

Methods: Two surveys of all doctors working in the Canton of Geneva, Switzerland (1998: 1146 respondents, 2007: 1546 respondents).

What doctors think about the impact of managed care tools on quality of care, costs, autonomy, and relations with patients.

Background: How doctors perceive managed care tools and incentives is not well known. We assessed doctors' opinions about the expected impact of eight managed care tools on quality of care, control of health care costs, professional autonomy and relations with patients.

Methods: Mail survey of doctors (N = 1546) in Geneva, Switzerland.

Predicted 30-year protection after vaccination with an aluminum-free virosomal hepatitis A vaccine.

Few studies have examined the duration of protection following vaccination against hepatitis A virus (HAV) with currently licensed HAV vaccines. This study explored the long-term immunogenicity in individuals vaccinated with the virosomal hepatitis A virus, Epaxal. Adult volunteers (N = 130) previously enrolled into four different studies between 1992 and 1994 and who had completed a 0/12-month immunization regimen (primary and booster dose) were asked to participate in this follow-up study.

Relationships between work satisfaction, emotional exhaustion and mental health among Swiss primary care physicians.

Background: Work-related satisfaction is an important determinant of quality of care. However, its relationship with doctors' mental health is poorly understood. It could have an independent beneficial effect on mental health (direct association) or simply reduce the impact of work stress on mental health (moderating or 'buffering' role).

Epaxal: a virosomal vaccine to prevent hepatitis A infection.

Over the last few decades, different types of inactivated hepatitis A virus (HAV) vaccines have been developed: several aluminum-adjuvanted vaccines and an aluminum-free, virosome-formulated vaccine. Both types of vaccines are whole-virus preparations that are produced by growth of HAV strains in human diploid cell cultures and are subsequently inactivated with formaldehyde. This review summarizes all published papers on a virosome-formulated vaccine, Epaxal, based on formalin inactivated HAV (strain RG-SB) adsorbed to the surface of special liposomes (virosomes), that replace aluminum hydroxide as the adjuvant principle.

Reliability of doctors' anthropometric measurements to detect obesity.

Objective: To evaluate the reliability of anthropometric measurements (weight, height, Body Mass Index (BMI), waist and hip circumferences (WC; HC) and waist-to-hip ratio (WHR)) performed by doctors to assess obesity.

Method: Repeated anthropometric measurements were performed by 12 primary care physicians on 24 adult volunteers in Geneva, Switzerland, 2006. Volunteers (54% women, mean age 41) had a mean BMI of 28.

Recent advances with a virosomal hepatitis A vaccine.

Background: Epaxal, a virosomal vaccine against hepatitis A virus (HAV) infection, has been in use for nearly 15 years, especially among at-risk adults. Recent studies have shown that it is also a potent vaccine for children.

Objective: To summarise recent advances of Epaxal Junior (0.

[Medical tourism: a new kind of traveler?].

In an era of globalisation, an increasing number of patients are seeking medical care abroad, for a fraction of the price in their home country The reasons are numerous. Some countries face an increasing demand, either because of inappropriate health insurance coverage (e.g.

Prevalence of burnout among Swiss cancer clinicians, paediatricians and general practitioners: who are most at risk?

Goals Of Work: Increasing economical and administrative constraints and changes in health-care systems constitute a risk for burnout, especially for cancer physicians. However, little is known about differences across medical specialties and the importance of work characteristics.

Methods: A postal questionnaire addressing burnout, psychiatric morbidity, sociodemographics and work characteristics was administered to 180 cancer physicians, 184 paediatricians and 197 general practitioners in Switzerland.

Doctor-patient gender concordance and patient satisfaction in interpreter-mediated consultations: an exploratory study.

Background: Research suggests that doctor-patient communication patterns and patient satisfaction are influenced by gender. However, little is known about the effect of gender in consultations with foreign language-speaking patients and in interpreter-mediated consultations.

Methods: The objective of the study was to explore the effect of doctor-patient gender concordance on satisfaction of foreign language-speaking patients in consultations with and without a professional interpreter.

Transcultural validity of a structured diagnostic interview to screen for major depression and posttraumatic stress disorder among refugees.

Refugees and asylum seekers have a high risk of developing mental health problems and appropriate screening in people from diverse origins remains a challenge. The aim of this study was to validate a structured diagnostic interview, adapted from the Major Depressive Episode (MDE) and Posttraumatic Stress Disorder (PTSD) sections of the Mini International Neuropsychiatric Interview, to detect these disorders among newly arrived asylum seekers. The adapted questionnaire was administered by nurses in a primary care context and its performance was judged against the expert opinion of a mental health specialist.

Protection against snake bites by sleeping under a bed net in southeastern Nepal.

Snake bites in persons while they are asleep indoors are associated with a high risk of fatal outcome in southeastern Nepal. The preventive impact of sleeping under a bed net was assessed in four villages in a case-control study. A case was defined as a person with a history of snake bite that occurred indoors while asleep.

Adherence to recommended standards of diabetes care by Swiss primary care physicians.

Objectives: To assess adherence to recommended standards of diabetes care by Swiss primary care physicians.

Methods: Medical files of community-based primary care physician were reviewed to assess adherence to recommended standards of diabetes care. These standards of care were based on a uniform set of definitions addressing medical care processes involved in the detection and follow-up of pre-diabetic and diabetic patients.

Stress from uncertainty from graduation to retirement--a population-based study of Swiss physicians.

Background: Uncertainty shapes many decisions made by physicians everyday. Uncertainty and physicians' inability to handle it may result in substandard care and unexplained variations in patterns of care.

Objective: To describe socio-demographic and professional characteristics of reactions to uncertainty among physicians from all specialties, including physicians in training.

Personal use of medical care and drugs among Swiss primary care physicians.

Objective: To measure medical care and pharmaceutical drug use among Swiss primary care physicians and its determinants.

Design: Cross-sectional mailed survey.

Setting: 1784 randomly selected Swiss primary care physicians, including general practitioners, internists and paediatricians.

Use of tobacco and alcohol by Swiss primary care physicians: a cross-sectional survey.

Background: Health behaviours among doctors has been suggested to be an important marker of how harmful lifestyle behaviours are perceived. In several countries, decrease in smoking among physicians was spectacular, indicating that the hazard was well known. Historical data have shown that because of their higher socio-economical status physicians take up smoking earlier.

Importance of lifestyle counselling by primary care physicians for diabetic patients.

Objective: To identify diabetic patients' characteristics and medical care factors associated with recommended glycaemic control (HbA(1c) < or =7%).

Methods: As part of a cross-sectional assessment of diabetes care involving 204 Swiss primary care physicians, we identified 366 diabetic patients with a recent HbA(1c) value. Cross-tabulations and X(2) tests were used to explore the association of patients' sociodemographic and disease characteristics and medical care characteristics with HbA(1c) < or =7%.

Screening for major depression and posttraumatic stress disorder among asylum seekers: adapting a standardized instrument to the social and cultural context.

Objective: To adapt the PTSD and MDE sections of a validated psychiatric diagnostic instrument, we used the Mini International Neuropsychiatric Interview (MINI) during an initial health assessment into a primary care facility for asylum seekers.

Method: A 3-step process was carried out. First, items of the original version of the MINI were adapted to the specific context of life of asylum seekers in the host country (by a multidisciplinary group that included public health nurses, a primary care physician, a psychologist, a psychiatrist, and an epidemiologist).

Posttraumatic stress disorder and the use of general health services in postwar Kosovo.

Studies conducted in high-income countries have demonstrated that posttraumatic stress symptoms are positively correlated with increased use of general health services; however, comparative data are lacking in postwar settings. This survey was conducted in Kosovo after the end of the conflict; 996 people, age 16 or older, were interviewed. Older age, lower education level, worse physical health, and current diagnosis of posttraumatic stress disorder (PTSD) were associated with higher use of any health services.

Cost-consciousness among Swiss doctors: a cross-sectional survey.

Background: Knowing what influences physicians attitudes toward health care costs is an important matter, because most health care expenditures are the results of doctors' decisions. Many decisions regarding medical tests and treatments are influenced by factors other than the expected benefit to the patient, including the doctor's demographic characteristics and concerns about cost and income.

Methods: Doctors (n = 1184) in Geneva, Switzerland, answered questions about their cost-consciousness, practice patterns (medical specialty, public.

Patient reports of undesirable events during hospitalization.

Background: Thus far, incident reporting in health care has relied on health professionals. However, patients too may be able to signal the occurrence of undesirable events.

Objective: To estimate the frequency of undesirable events reported by recently discharged patients, and to identify correlates of undesirable events.

Eflornithine is safer than melarsoprol for the treatment of second-stage Trypanosoma brucei gambiense human African trypanosomiasis.

Patients with second-stage human African trypanosomiasis treated with eflornithine (n = 251) in 2003 in Kiri, southern Sudan, had an adjusted relative risk of death of 0.2 and experienced significantly fewer cutaneous and neurological adverse effects than did patients who were treated with melarsoprol in 2001 and 2002 (n = 708).

Swiss primary care physicians reporting of utility and use of recommended vaccinations for adults.

Question: To determine how recommended vaccinations in adults are perceived and used by primary care physicians in Switzerland.

Methods: A cross-sectional mail survey of primary care physicians randomly selected from the register of the Swiss medical association was conducted, including specific items measuring perceived utility and reported use for fourteen recommended vaccinations for adults. The answers were standardized to have a minimum of 0 and a maximum of 100.

Nonresponse bias in a survey of patient perceptions of hospital care.

Background: Incomplete participation is of particular concern for surveys of patient perceptions of care because patients who have negative opinions may be least likely to participate.

Objective: We sought to examine indirect evidence of nonresponse bias.

Design: We re-analyzed data from a cross-sectional patient survey.

Interchangeability and tolerability of a virosomal and an aluminum-adsorbed hepatitis A vaccine.

The interchangeability of virosomal (Epaxal) and aluminum-adsorbed (Havrix 1440) hepatitis A virus (HAV) vaccines was studied in 111 healthy adults who were vaccinated in a randomized, single-blind, crossover clinical trial. Anti-HAV antibody titers were measured at days 0 (first dose), 14, and 28, and months 3, 6, 12 (second dose), 13, 24, 36, 48, 60 and 72. Most subjects (>95%) had sero-converted 14 days after the first dose of either vaccine.