[Evaluation of a prostate cancer E­health tutorial : Development and testing of the website prostata-information.ch]. / Evaluation eines Online-Tutorials zum Prostatakarzinom : Entwicklung und Überprüfung der Seite prostata-information.ch.

BACKGROUND: Due to the multitude of therapy options, the treatment decision after diagnosis of localized prostate cancer is challenging. Compared to printed booklets, web-based information technology offers more possibilities to tailor information to patients' individual needs. OBJECTIVES: To support the decision-making process as well as the communication with patients, we developed an online tutorial in a systematic process in the German-speaking part of Switzerland and then tested it in a pilot study. The study investigated users' satisfaction, the coverage of information needs, the preparation for decision making, and the subjective quality of the decision. MATERIALS AND METHODS: Based on already existing information material, the online tutorial was developed in an iterative process using focus groups with patients and urologists. For the following evaluation in eight clinics a total of 87 patients were invited to access the platform and participate in the study. Of these patients, 56 used the tutorial and 48 answered both surveys (the first one 4 weeks after the first login and the second one 3 months after treatment decision). The surveys used the Preparation for Decision Making Scale (PDMS), the Decisional Conflict Scale (DCS), and the Decisional Regret Scale (DRS). RESULTS AND CONCLUSION: Satisfaction with the tutorial is very high among patients with newly diagnosed localized prostate cancer. Users find their information needs sufficiently covered. Three months after the decision they felt that they were well prepared for the decision making (mean PDMS 75, standard deviation [SD] 23), they had low decisional conflict (mean DCS 9.6, SD 11), and almost no decisional regret (mean DRS 6.4, SD 9.6). Based on these findings, further use of the tutorial can be recommended.

Temporal change to self-rated health in the Swiss population from 1997 to 2012: the roles of age, gender, and education.

OBJECTIVES: Our study aimed to describe the temporal changes in self-rated health status (SRH) from 1997 to 2012 in adults aged 25 to 84 residing in Switzerland, with a view to identifying groups at risk for declining health. STUDY DESIGN: Secondary analysis of population-based cross-sectional health surveys. METHODS: Data were collected from the cross-sectional, population-based, five-year Swiss Health Survey, from 1997, 2002, 2007 and 2012. A total of 63,861 individuals' data were included. Multilevel mixed-effect logistic regression analysis was employed to estimate the probability of very good and good health within the framework of a hierarchical cross-classified age-period-cohort model (HAPC), adjusting for education level, gender, civil status, smoking status and body mass index. RESULTS: Individuals with higher education were substantially more likely than those with primary education to report good SRH (OR = 2.12; 95% CI = 1.93-2.33 for secondary education and OR = 3.79; 95% CI = 3.39-4.23 for tertiary education). The education effect depended on birth cohort and age: higher proportions of good SRH were reported by secondary (8%-17%) and tertiary (10%-22%) compared with primary educated individuals from the 1940 birth cohort onward; the proportion of secondary/tertiary (compared to primary) educated people reporting good SRH increased with age (by 10/11% at 45-50 years and 25/36% at 80-84 years). Gender health equality was achieved by the 1955 (primary educated) and 1960 (secondary educated) birth cohorts, while these women overtook men in reporting good SRH from the 1975 birth cohort onward. Tertiary educated younger women were significantly less likely to report good SRH than men but parity was achieved at around pension age. Similarly, gender inequality in those with primary and secondary education reduced in the younger ages to not be significant at around age 55, with women overtaking men from age 65. CONCLUSIONS: Younger birth cohorts with lower education levels appear most vulnerable in terms of their SRH. The education effect cumulatively increases when attaining incrementally higher education levels. While women report lower health than men, gender inequality in SRH has declined and even reversed over time and is substantially linked to differences in educational status. Swiss public health strategies should particularly target the younger adults with only primary school education of both genders; for women, to combat health burdens in their early life, and men, to mitigate issues in their later life.

[Information needs of patients with prostate cancer. Pronounced differences between individuals after diagnosis of localised prostate carcinoma]. / Informationsbedürfnisse von Prostatakrebspatienten. Große individuelle Unterschiede nach Diagnose eines lokalisierten Prostatakarzinoms.

BACKGROUND: In the context of shared decision-making it is important to know more about information needs of prostate cancer patients. Therefore, this study investigates content and extent of these information needs. MATERIAL AND METHODS: We surveyed 330 patients of 4 urological Clinics in Switzerland with a well-established written questionnaire between 3 and 24 months after their diagnosis of an early-stage prostate cancer. A total of 179 patients responded and 128 (39%) questionnaires were entered into final statistical analysis. RESULTS: Patients expressed broad information needs and pronounced differences between individuals were observed. Each of the 92 questions presented was rated as "essential" by at least 18% of the patients. On average 50 questions were rated as 'essential'. One patient rated only four questions as 'essential' whereas another participant reported all 92 questions as being 'essential' to him. CONCLUSIONS: Concerning patient education it is important to identify the individual information needs of each prostate cancer patient separately.

[Developing and testing quality indicators of home care in Switzerland]. / Entwicklung und Erprobung von Qualitätsindikatoren für die ambulante Pflege in der Schweiz.

PURPOSE: The aim of this study was to develop and examine quality indicators of home care in Switzerland using the Swiss version of the RAI-HC (Resident Assessment Instrument Home Care). The quality indicators are part of the quality management strategy of the 'Spitex Verband Schweiz', the organisation of Swiss home care institutions. METHODS: The study consisted of four steps. First, a set of potential quality indicators was operationalised. For this purpose, already defined indicators of the North American version of RAI-HC were adopted, also additional indicators based on the Swiss RAI-HC were developed. In a second step, the changeability, practicability and relevance of these quality indicators were judged by home care professionals using a group consensus method (nominal group technique). Third, based on a sample of 1808 clients from a total of 45 Swiss home care organisations, the quality indicators were empirically tested with regard to sample frequencies (incidences and prevalences) and between-group variance. Fourth, the interrater reliability of the quality indicators was assessed. RESULTS: A total of 29 potential home care quality indicators was developed. Based on the results of the three sub-studies (rating by experts, frequencies/variation and interrater reliability), a core-set of 19 quality indicators was defined which can be recommended for quality measurement in home care settings of Switzerland. CONCLUSIONS: The Swiss version of RAI-HC provides a viable instrument for measuring quality of home care. The application of consistent assessment rules should be improved.

Occupation, social support and quality of life in persons with schizophrenic or affective disorders.

BACKGROUND: Most people suffering from severe mental illness (SMI) lack paid employment. This study investigates the relationship between work status and objective as well as subjective quality of life (QoL) in people with SMI. METHODS: The sample consists of 261 subjects (102 women, 159 men) aged 35 (men) and 38 (women) years on average, of whom 158 suffer from a schizophrenic disorder (ICD-10: F2) and 103 were diagnosed as having an affective disorder (ICD-10: F3). Subjective QoL was assessed with the WHOQOL-BREF scale. RESULTS: Subjects with an occupation in general have a larger social network at their disposal and receive more social support. With regard to income, few (12%) of the subjects with a job on the open labour market live below the poverty level, but many (28-38%) of those engaged in sheltered or other work-like activities do. Occupation ameliorates satisfaction with life domains referring to social integration (social relationships, environment), whereas the individual's well-being (psychological, physical) is hardly affected. Social support is an important mediator of the relationship between occupation and subjective QoL. Income is weakly and negatively related to subjective QoL. CONCLUSIONS: Supportive relationships to colleagues at the workplace mainly explain the better subjective QoL of SMI people with an occupation. When designing specific employment possibilities for people with SMI, we should take notice of the social support dimension at the workplace. Mentally ill people have a substantial poverty risk, even when they are working. In particular, payment for sheltered work should be ameliorated.

[A risk profile of the aggressive psychiatric inpatient: can it be identified?]. / Gibt es ein Täterprofil des aggressiven Psychiatrie-Patienten?

Violent behavior of psychiatric inpatients has grown in interest. Within the scope of a prospective study,patient assaults in six psychiatric hospitals of the Swiss Canton of Zurich were assessed during a period of 6 months, from November 1999 until May 2000. Three hundred eighty-eight of 5,251 inpatients (7.4%) were reported to act aggressively. The following risk factors for aggressive behavior were identified: male gender, younger age, unemployment, severity of mental illness, and rehospitalization. Psychiatric diagnosis was not related to aggressiveness. In spite of the detection of risk factors, a characteristic profile of aggressive psychiatric inpatients cannot be stated. Research should pay more attention to situation-specific cues for the aggressive behavior of such individuals.

Comparison of four groups of substance-abusing in-patients with different psychiatric comorbidity.

OBJECTIVE: Comparisons of different groups of dual patients are rare, yet potential differences could have therapeutic implications. In this study, four groups of psychiatric in-patients with substance use disorder were compared to each other: patients with no psychiatric comorbidity, patients with comorbid schizophrenia and patients with affective and personality disorder. METHOD: Apart from sociodemographic, therapy-related variables and a detailed survey of their substance use, all subjects were assessed with BPRS and SCL-90-R. RESULTS: No differences were found in the patients' demography, psychosocial adjustment and substance consumption career. Significant differences were found in regard to some therapy variables reflecting adherence to treatment and global outcome and to the level of psychopathology. CONCLUSION: Both substance use and comorbid psychiatric disorder have a variable impact on distinct areas of patients' general condition and functioning. The group with comorbid affective disorder appeared to be the most difficult to treat and the therapeutic approach to this disorder deserves reconsideration.

Effectiveness of inpatient drug detoxification: links between process and outcome variables.

The Psychiatric University Hospital of Zürich offers a 2-week residential detoxification treatment program for patients abusing illegal drugs. 96 out of 160 patients were interviewed at three intervals: upon admission, on the 10th day of treatment, and about 1 month after leaving the clinic. Approximately 17% of the patients were completely abstinent 1 month after treatment. About 50% of the patients could give up the consumption of particular drugs. For around one third of the dependents, the drug consumption remained the same or had increased. The analysis of the predictors of drug consumption after treatment stresses the importance of the social integration of the dependents before detoxification as well as of characteristics of the treatment process (relapse, dropping out of treatment, and referral to a follow-up program).

[Who is rehospitalized in a psychiatric hospital? Psychiatric hospitalization rates and social indicators in the Zurich canton (Switzerland)]. / Wer wird psychiatrisch rehospitalisiert? Psychiatrische Hospitalisierungsraten und soziale Indikatoren im Kanton Zürich (Schweiz).

There are two approaches in the research on the relation between social conditions and mental disorder: The ecological approach is concerned with characteristics of the social composition of a certain geographical area and their relation to the frequency of disorders, whereas for the individualistic view variables of the psychosocial background of the individual are of interest. This study is on the risk for psychiatric admission (first and re-admission). While considering variables of the social context of the community as well as of the background of the individual, it tries to take into account both the ecological and the individualistic view of the relationship between social conditions and (treated) mental disorder. The sample of the study includes data of 4021 psychiatric inpatients treated in 1997 in one of the seven psychiatric hospitals of the Swiss canton of Zurich as well as data of social context of the 171 communities of the canton of Zurich. The psychiatric first and re-admission rates of the community can be predicted by the following variables of its social context: 1. pro portion of foreigners, 2. urban character of the living area, 3. population density. Two other variables are of relevance only for the prediction of first admissions: 4. proportion of one-person households and 5. local tax rate. However, further results of the study show that correlations between variables of the social context and psychiatric admission rate of the community cannot be interpreted as risks for the individual.

Effect of intra-abdominally induced pressure on the urethral pressure profiles of healthy and incontinent bitches.

OBJECTIVE: To determine whether reduced pressure transmission is of importance in the pathophysiologic mechanism of urinary incontinence in bitches. ANIMALS: 20 sexually intact, continent bitches and 21 spayed, incontinent bitches. PROCEDURE: Urethral pressure profiles before (resting) and after (stressed) insufflation of gas in the abdominal cavity were recorded in bitches under general anesthesia. Differences (stressed minus resting) were calculated for all variables. On the basis of these values, the pressure transmission ratio was determined. RESULTS: Resting pressure profiles of incontinent bitches indicated significantly (P < 0.05) lower maximal closure pressure (4.5 +/- 3.0 cm of H2O) than did those of continent bitches (11.2 +/- 7.2 cm of H2O). The intra-abdominal pressure increase lead to a shortening of total profile length, which was equal in both groups and caused an increase in maximal urethral pressure. The change in maximal urethral pressure was significantly (P < 0.05) greater in incontinent bitches (12.4 +/- 4.1 cm of H2O) than in continent bitches (8.8 +/- 4.5 cm of H2O). The profile areas and the pressure transmission ratios did not differ significantly (P < 0.05) between the 2 groups. CONCLUSION: The effect of decreased pressure transmission on the urethra is not a factor in the pathophysiologic mechanism of urinary incontinence attributable to urethral incompetence in bitches.

A prospective study of surgically treated acetabular fractures.

Between November 1988 and March 1993, 101 patients with 102 fractures of the acetabulum were referred to the authors' institution. They included 31 both column; 25 transverse associated posterior wall; 16 anterior column associated posterior hemitransverse; 9 posterior wall; 7 posterior column associated posterior wall; 7 anterior column; 5 T shaped; and 2 transverse fractures. Thirteen fractures were excluded, leaving 89 patients with 89 operatively treated fractures available for followup. Postoperative radiographs were evaluated for adequacy of reduction and scored on a scale of 1-9 with 9 being perfect. Perfect or near perfect reduction was achieved in 82% of patients. A minimum of 1 year followup was available for 53 patients. Clinical results were assessed in terms of the patients' activities and included their ability to walk, range of motion and pain. Excellent results were achieved in 27 patients and an additional 16 had satisfactory results, for an overall 81% acceptable outcome. Radiographic evidence of posttraumatic osteoarthrosis was present in 40% of patients: mild in 10, moderate in 5, and severe in 5. Heterotopic ossification was Brooker Grade III and Grade IV in 1 patient each. These results indicate that operative treatment of acetabular fractures provides results that are superior to those achieved with nonoperative treatment.

Reproducibility of urethral pressure profiles in clinically normal sexually intact female dogs by use of microtransducer catheters.

Urethral pressures profiles (UPP) obtained by use of microtransducer catheters were determined in 8 anestrous sexually intact female Beagles during general anesthesia. A UPP study consisted of 3 consecutive recordings, and 4 UPP studies were repeated at an interval of 5 days in each dog. Maximal urethral pressure (cm of H2O), bladder pressure (cm of H2O), and anatomic urethral length (cm) were recorded. Maximal urethral closure pressure (cm of H2O) was calculated. Mean +/- SD (for all measurements) maximal urethral closure pressure was 12.8 +/- 5.6 cm of H2O (range, 2.4 to 25.2 cm of H2O). Maximal urethral closure pressure was significantly (P < 0.05) decreased during the first recording period (11.4 +/- 5.8 cm of H2O), compared with the second (13.0 +/- 5.2 cm of H2O) or third (14.1 +/- 5.7 cm of H2O) recording periods within a UPP study (3 consecutive recordings). Mean maximal difference in urethral closure pressure during a single UPP study was 4.8 +/- 2.4 cm of H2O. Significant difference in maximal urethral closure pressure was not observed between studies. Mean (for all measurements) anatomic urethral length was 6.2 +/- 0.9 cm (4.1 to 7.8 cm). Anatomic urethral length was significantly (P < 0.05) less during the first recording period (6.1 +/- 0.9 cm), compared with values for the second and third periods (6.3 +/- 0.9 cm, 6.4 +/- 0.9 cm respectively). Anatomic urethral length for time 3 was significantly (P < 0.05) less than the value for time 1 (5.8 +/- 0.7 cm vs 6.6 +/- 0.8 cm).(ABSTRACT TRUNCATED AT 250 WORDS)