[Sexual medicine cases of treatment--developments 1980 - 1990 - 2004]. / Sexualmedizinische Behandlungsfälle - Entwicklungen 1980 - 1990 - 2004.

Sexual dysfunctions can adversely affect men's and women's satisfaction with life over a prolonged period. Besides sexual medicine services in primary medical care, in Switzerland there exist specialized consultation services at University Hospitals. The assessment of the case histories of three years (1980, 1990, and 2004) of the Sexual Medicine Consultation Service at Zurich University Hospital provided the following results: the most common disorders are lack/loss of libido in women and erectile dysfunction in men. Treatment options for sexual disorders have become more differentiated in recent years. The collaboration between the doctors making the referral and the sexual medicine specialists improved markedly between 1980 and 2004. After a diagnostic assessment and a primary treatment in the specialized consultation service, many patients are referred back to the referring doctors for further treatment. Basic and further training in sexual medicine ought to be intensified and improved.

[Attitudes toward older people at the beginning and end of medical students' education]. / Einstellungen zu alten Menschen zu Beginn und am Ende des Medizinstudiums.

In the present study, 188 first year and 120 sixth year students of the University of Zurich were questioned about their attitudes towards older people, their knowledge concerning aging specific developments, their experiences with older people and their own expectations concerning old age. Structured and standardized questionnaires were used. The data were analyzed using univariate and multivariate statistical methods. The results show a positive image of old age independent of gender and point in time of education. Their positive experiences with older people and their positive expectations concern their own aging refer, above all, to their own mental health. For the transfer of gerontological and geriatric knowledge in the education of medical students, these mainly positive attitudes towards older people should be taken into account. Risk factors as well as protective factors concerning the development and treatment of diseases which are characteristic for old age should be pointed out.

[Work stress, health and satisfaction of life in young doctors. Results of a longitudinal study in Switzerland]. / Arbeitsstress, Gesundheit und Lebenszufriedenheit junger Arztinnen und Arzte. Ergebnisse einer Schweizer Longitudinalstudie.

BACKGROUND AND OBJECTIVES: Based on the Effort-Reward-Imbalance Model by Siegrist a study was undertaken to find out (a) in what way young doctors assess effort and reward during their specialist training; (b) whether there are certain job stress patterns over time; and (c) what the correlations are, if any, between perceived job stress, health and satisfaction with life. METHODS: Within the framework of a prospective study (2001 - 2007) 370 doctors who had just qualified and were residents in the German-speaking part of Switzerland were assessed four times by means of anonymized questionnaires. Job stress, measured by the Effort-Reward-Imbalance scale, as well as health and satisfaction with life were assessed in these doctors' 2nd (T2), 4th (T3), and 6th (T4) year of specialist training ("residents"). Stress patterns of the participants were evaluated, based on the effort and reward scale values at T2, T3, and T4, by two-step cluster analysis. Gender differences between the clusters were calculated by the 2 test and differences in the continuous variables by analysis of variance with repeated measurements. RESULTS: During residency the percentage of doctors who experienced an Effort-Reward-Imbalance (ratio between effort and reward ERI > 1) increased from 18% at T2 to 20 % at T3 to 25 % at T4. The cluster analysis revealed two clusters: Type 1 (67%) with effort values below average and reward values above average (ER balance) across the three measurement points, and type 2 (33 %) with effort values above average and reward values below average (ER imbalance). Subjects in cluster 2 showed unfavorable values, when compared with those in cluster 1, in overcommitment, in workload and in the health variables (anxiety, depression, physical and psychological well-being), as well as in their assessed satisfaction with life at all three measurement points. CONCLUSIONS: One third of the doctors experienced stress at work, caused by an effort-reward imbalance. This had a negative impact on their health and satisfaction with life. Regular supervision and goal-oriented career counselling provided by senior physicians could contribute to young doctors not feeling so much stressed at work, feeling well and being more content with their work.

[Young physicians' view on factors that increase the attractiveness of general practice]. / Möglichkeiten zur Attraktivitätssteigerung der Hausarztmedizin aus der Sicht junger Arztinnen und Arzte.

PURPOSE: The objectives of this study are to investigate young physicians' career plans at the end of their residency, and to assess what factors contribute in their view to improve the image of family medicine/general practice and make it an attractive career goal. METHODS: As part of a prospective study on career determinants in young physicians, begun in 2001, 534 residents were asked in 2007 about their aspired to professional career, their planned model of private practice, arguments against or for family medicine/general practice, respectively, and factors to improve the attractiveness of the latter. RESULTS: Of the study sample, 84 participants (42% men, 58% women) decided on family medicine (60% specialise in primary care, 40% in general internal medicine), 450 specialise in other medical specialties. Of the 534 study participants, 208 plan to work in a private practice, mostly in a group practice (88%). Of the future family physicians, 49% want to open their practice in an urban area, of the future specialists the respective number is 77%. Main reasons not to decide on family medicine are the uncertain development in health policy and the low income. The diversity of work, the broad spectrum of patients and the continuity in the doctor-patient relationship are named as factors in favour of family medicine. The possibility to run interdisciplinary group practices and better financial conditions are crucial factors to make family medicine an attractive career goal for young physicians. CONCLUSIONS: Family medicine is still assessed as an interesting field, however, the conditions of work as a family physician/general practitioner have a deterrent effect on young physicians.

[Sexual medicine in primary care--development in the years 1980-1990-2004]. / Sexualmedizin in der ärztlichen Grundversorgung: Entwicklungen 1980-1990-2004.

Sexual disorders are common in community samples. Even so these problems are not often addressed by primary care physicians. In 1980, 1990, and 2004 three cohorts of primary care physicians in the German speaking part of Switzerland were asked to answer a questionnaire on the prevalence of sexual problems and disorders in their patients and their knowledge in sexual medicine. The prevalence of sexual disorders in primary care is underestimated by primary care physicians. Female doctors and female patients address sexual problems more often than male doctors and patients. Lack of sexual interest and erectile dysfunction are the most frequent sexual disorders in primary care. In 2004 the participating doctors assess their knowledge in sexual medicine at a higher level compared to 1980. The training of primary care physicians in primary care should further be improved.

How does psychological processing relate to compliance behaviour after lung transplantation? A content analytical study.

Non-compliance is one of the crucial problems impairing outcome after transplantation. Fourteen lung transplant recipients were interviewed about their thoughts regarding transplant-related topics. Compliance was assessed by doctors. The psychological processing was investigated by content analysis. Highly compliant patients perceived more advantages by transplantation. In contrast, low-compliant patients reported either an emotional distance to the lung or a closer relationship to the donor. Furthermore, they showed a contradictory relationship to the medical staff. There are some indications that perception of advantages by transplantation is crucial to compliance. This experience takes place in the context of a good staff-patient relationship. Emotional distance to the lung or nearness to the donor are further contributing factors of non-compliance.

Waiting for a liver transplant: psychosocial well-being, spirituality, and need for counselling.

UNLABELLED: The number of patients in need of a liver transplant vastly exceeds the number of available organs; the demand worldwide for organs leads to increased waiting times and mortality of patients on the waiting list. The aim of our study was to assess the psychosocial well-being of transplant candidates and their need for psychosocial counselling. METHODS: Sixty-nine liver transplant candidates were asked about their psychosocial well-being, quality of life, spirituality, and need for counselling assessed by interview and questionnaire (HADS-D, FLZ, LOT, SOC, SF-36, SBI-15R) during the initial evaluation procedure for organ transplantation as well as 3 and 6 months after listing. RESULTS: Candidates for a liver transplant exhibited a significant limitation in the levels of their quality of life and psychological well-being, compared with the community normal samples. They showed significantly higher levels of anxiety, but lower levels of spirituality. Almost half of the candidates (47%) expressed a need for counselling during the evaluation procedure. Patients with advanced diseases reported a lower need. Age and the personality-related "Sense of Coherence" correlated negatively with need for counselling. On the waiting list, psychosocial parameters and functions remained largely stable; the need for counselling decreased significantly. CONCLUSIONS: There is a relevant need for psychosocial counselling during the process of liver transplant evaluation. Need for counselling is associated with personality and age, as well as with somatic parameters.

[Bio-psycho-social history--is it still up to date in the time of media communication?]. / Biopsychosoziale Anamnese--noch aktuell im Zeitalter der medialen Kommunikation?

Specialization in medicine changes the kind of communication between doctor and patient. The direct personal communication is quite often complemented by the indirect communication via interactive media. A clinical investigation still demands a broad bio-psycho-social anamnesis which should encompass the history of the illness, the patient, and his/her ailment. The bio-psycho-social anamnesis is subdivided into nine steps: Joining, "map", actual disease, former illnesses, family history, personal development, social anamnesis, overview of the functioning of the systems, finalization of the anamnesis. The different steps are explained, and adequate techniques of exploration are described. How to conduct a professional doctor-patient conversation and exploration can similarly be learnt as the techniques of a physical investigation. These communication skills should be continuously taught during the education of medical students as well as during the further training of physicians.

[Psychosocial aspects of patients with sexual dysfunction]. / Psychosoziale Aspekte bei Patientinnen und Patienten mit sexuellen Funktionsstörungen.

UNLABELLED: Sexual dysfunctions are common among the general population. An essential part of the assignments to specialized sexual medicine care units are from primary care physicians. METHODS: In 2002 to 2004 for a period of 18 months questionnaires were given to all patients, who attended the special sexual medicine care unit at the University Hospital of Zurich for the first time. At the beginning of their treatment, the patients were questioned about different psychosocial characteristics and aspects of their sexuality. RESULTS: We studied 43 women (48.3%) and 46 men (51.7%). Women were with an average age of 33.8 years 10 years younger than men, 43.5 years. The most common sexual dysfunction in women was lack or loss of sexual desire (51.2%), followed by nonorganic vaginism (20.9%) and orgasm disorders (11.6%), in men erectile dysfunction (50.0%), followed by premature ejaculation (26.1%) and lack or loss of sexual desire (15.2%). The studied subjects showed distinctively lower values in their sense of coherence than men and women in the general population. The patients were much more anxious than people in the average population. The questioned men were also much more depressive than men in the general population and than the examined women. The examined men reported sexual wishes, needs and sexual activities significant more frequently than the examined women. CONCLUSIONS: As men and women with sexual dysfunctions are much more anxious than people from the general population, physicians should address sexual themes in the conversations with their patients carefully but actively.

[Neurotoxic encephalopathy caused by neuroleptics and lithium]. / Neurotoxische Enzephalopathie unter Neuroleptika und Lithium.

Treatment of psychiatric patients often necessitates overlapping neuroleptic medication. We report a 60-year-old woman suffering from a schizoaffective disorder who received temporarily three neuroleptics, together with lithium. She developed neurotoxic encephalopathy with symptoms of a malignant neuroleptic syndrome. It is unclear if irreversible brain damage will remain. We recommend frequent electroencephalographic controls for early detection of neurotoxicity.

[Erectile dysfunction in men in their second half of life]. / Erektile Dysfunktion bei Männern in der zweiten Lebenshälfte.

BACKGROUND: Studies to date on the prevalence of erectile dysfunction (ED) report varying results. The present study investigates the frequency and degree of ED, its determining factors as well as the help-seeking behavior of the patients. PATIENTS AND METHODS: A random sample of 628 Swiss men (mean age: 61.5 years) were examined by questionnaire regarding their sexual functioning, comorbidity, and help-seeking behavior. RESULTS: Of the respondents, 9.6% reported complete, 18.0% moderate, and 41.4% minimal ED. All grades of the disorder increased with age and correlated with somatic and psychiatric comorbidity as well as with drug intake. Only 3.2% reported having used drugs for improvement of erectile functioning. CONCLUSION: Only a small number of men suffering from ED seek the help of a doctor. Considering the efficacy of PDE5 inhibitors, objective information and competent medical counseling of ED patients are indicated.

[Effects of hip arthroplasty followed by by inpatient rehabilitation on physical function and quality of life]. / Effekte der Hüftarthroplastik und der nachfolgenden stationären postoperativen Rehabilitation auf körperliche Funktion und Lebensqualität.

The aim of the present study was to investigate the effects of hip arthroplasty followed by an inpatient rehabilitation. Moreover, the relationships among functional status, quality of life and satisfaction with life or health status were examined. Patients were assessed before hip arthroplasty, at the start and at the end of the inpatient rehabilitation. Functional status was measured by using the WOMAC questionnaire and quality of life with the Medical Outcome Survey Short Form 36 (SF-36). Satisfaction was determined with a specific questionnaire (FLZ). Hip arthroplasty followed by an inpatient rehabilitation resulted in significant and clinically highly important improvements of functional status, quality of life and satisfaction with health and life.

Patient well-being after general anaesthesia: a prospective, randomized, controlled multi-centre trial comparing intravenous and inhalation anaesthesia.

BACKGROUND: The aim of this study was to assess postoperative patient well-being after total i.v. anaesthesia compared with inhalation anaesthesia by means of validated psychometric tests. METHODS: With ethics committee approval, 305 patients undergoing minor elective gynaecologic or orthopaedic interventions were assigned randomly to total i.v. anaesthesia using propofol or inhalation anaesthesia using sevoflurane. The primary outcome measurement was the actual mental state 90 min and 24 h after anaesthesia assessed by a blinded observer using the Adjective Mood Scale (AMS) and the State-Trait-Anxiety Inventory (STAI). Incidence of postoperative nausea and vomiting (PONV) and postoperative pain level were determined by Visual Analogue Scale (VAS) 90 min and 24 h after anaesthesia (secondary outcome measurements). Patient satisfaction was evaluated using a VAS 24 h after anaesthesia. RESULTS: The AMS and STAI scores were significantly better 90 min after total i.v. anaesthesia compared with inhalation anaesthesia (P=0.02, P=0.05, respectively), but equal 24 h after both anaesthetic techniques (P=0.90, P=0.78, respectively); patient satisfaction was comparable (P=0.26). Postoperative pain was comparable in both groups 90 min and 24 h after anaesthesia (P=0.11, P=0.12, respectively). The incidence of postoperative nausea was reduced after total i.v. compared with inhalation anaesthesia at 90 min (7 vs 35%, P<0.001), and 24 h (33 vs 52%, P=0.001). CONCLUSION: Total i.v. anaesthesia improves early postoperative patient well-being and reduces the incidence of PONV.

[Determinants in the careers of male and female physicians from the viewpoint of chief physicians]. / Karriereentwicklung von Arztinnen und Arzten aus der Sicht von Chefärzten und Chefärztinnen1.

BACKGROUND AND OBJECTIVE: Chief physicians play an important role for physicians' careers by providing advanced training and allocating time and research resources. This study examined which characteristics will help physicians to achieve a leadership position and how chief physicians conduct career promotion. SAMPLE AND METHODS: All 532 chief physicians in Switzerland's German speaking cantons with medical schools were approached with a questionnaire covering professional motivation and personal attributes of career-oriented physicians career-promoting personal and institutional factors, and type of career promotion. RESULTS: 207 chief physicians (189 men, 18 women; participation rate 38.9 %;) participated. Respondents rated achievement motivation combined with professional interest and job enjoyment (intrinsic), and interest in advancement and social prestige (extrinsic motivation) as beneficial. Extraprofessional concerns such as family obligations and leisure interests were viewed as less important. Instrumental attributes were rated as advantageous. Expressive qualities were also seen as beneficial but less crucial. Ratings were independent of respondents' age, specialty, or type of workplace. The following personal factors were named: professional commitment, professional and social competence, goal orientation, endurance, and strength of character. The institutional factors referred to quality of training and teaching, a good work atmosphere, a transparent and flexible clinic structure. Career promotion was offered predominantly in the form of coaching, career planning, and support in job search. CONCLUSION: Career promotion should be more targeted and structured, e. g. be conducted in mentoring programmes, thus providing the prerequisites for a truly equal career promotion of female and male physicians.

[Suspected fetal malformation in ultrasound examination: The partner's distress and attitudes towards ultrasound. Technology]. / Verdachtsdiagnose einer fetalen Entwicklungsstörung im Ultraschall: Gefühle und Einstellungen zur Ultraschall-Technologie aus Sicht der Partner.

AIM: The involvement of fathers in the preparation for birth was a major progress in modern obstetrics. The present study investigates how fathers evaluate the ultrasound examination during pregnancy and how much they are stressed by the diagnosis of a possible fetal developmental disturbance. METHOD: In a specialized ultrasound center at the University Hospital in Zurich 54 couples who came in with the diagnosis of a possible fetal developmental disturbance were interviewed for their emotional stress and attitudes towards ultrasound examinations during pregnancy. RESULTS: Levels of state anxiety were significantly above the norm for both men and women. However, male partners felt less stressed and experienced less anxiety than the pregnant women. Men were also more optimistic about the health status of the unborn baby. There were no differences in attitudes towards ultrasound examination between women and their male partners, however, men rated their experiences with ultrasound examinations more critical and knew less about it. The support of ultrasound as a routine examination method during pregnancy was high in both sexes. CONCLUSION: The diagnosis of a possible fetal developmental disturbance is a big emotional distress for pregnant women and the fathers of the baby. It does not result in a negative attitude towards ultrasound examination, though.

[Psychosomatic research in primary health care--ideal concept and reality]. / Psychosomatische Forschung in der Grundversorgung--idealvorstellungen und Realität.

UNLABELLED: The cooperation between research institutions and primary care doctors can be seen as a possible model for practical research in psychosomatic medicine. Cooperation experience with a study in the field of sexual medicine are reported as well as recommendations regarding the planning and implementation of similar studies are given. 7455 Swiss physicians specialized in psychiatry, internal or general medicine were asked to fill out a survey on "sexual dysfunction and anti-depressants". They were also asked if they were willing to interview their patients on the same issue. 1100 physicians agreed to answer the doctors survey and 62 were interested in interviewing their patients. However, only 12 physicians actually did. In 55 telephone interviews doctors mentioned as their main reasons for not participating: lack of time and their hesitation to discuss sexual issues with depressive patients. CONCLUSION: The collaboration in research projects means a considerable effort on the side of primary care doctors. Therefore, their cooperation should be rewarded appropriately, e.g. time could be counted as further training.

[Differential diagnosis of chronic pain syndromes of the musculoskeletal system--coding according to ICD-10]. / Differenzielle Diagnostik chronischer Schmerzsyndrome am Bewegungsapparat-Codierung nach der ICD-10.

Primary care for patients suffering from chronic pain is regularly provided by either family physicians or inpatient medical wards. A delay in initiating specific pain treatment is associated with poor outcome in terms of pain intensity, work disability and diminished quality of life. We present a diagnostic classification scheme for chronic pain disorders following the biopsychosocial disease model. This classification may help primary care providers initiate appropriate treatment early in the course of chronic pain, and aid in referral of their patients to services familiar with the treatment of chronic pain. Given increasing requests for quality control in health care and for transparency in disease management by health insurance companies, we propose a coding system of chronic non-malignant pain syndromes with the ICD-10.

[Differential therapy of chronic pain syndromes of the musculoskeletal system in primary health care]. / Differenzielle Therapie chronischer Schmerzsyndrome am Bewegungsapparat in der ärztlichen Grundversorgung.

For treatment of chronic non-malignant musculoskeletal pain syndromes to be successful, simultaneous medical and psychosocial interventions are required. We provide different treatment options for chronic pain disorders for the primary care physician who is not a trained psychotherapist. We stress that the physician must adopt a particular therapeutic attitude towards his patient. We further emphasize the elaboration of a biopsychosocial disease model with the patient, cognitive-behavioral interventions, treatment of associated sleep disorders, the use of a rational drug therapy regimen, physical therapy, relaxation techniques, and involvement of the social environment. Such treatment strategies may help primary care physicians to treat their patients suffering from chronic pain more successfully and with greater patient satisfaction.

[Treatment follow-up of transsexual patients. A catamnestic study]. / Behandlungverläufe transsexueller Patienten. Eine katamnestische Untersuchung.

In a retrospective study, 33 transsexual patients, 22 male-to-female transsexual (MF-TS), and 11 female-to-male transsexuals (FM-TS), were interviewed 53-121 months after their first referral to the psychiatric department of a university hospital. Social integration proved to be satisfactory and relatively stable. Twenty-five patients had gone through surgical sex reassignment, while 29 were currently undergoing hormonal treatment. Regarding the course of treatment, the FM-TS were a more homogeneous group than the MF-TS group. Overall, physical and psychosocial well-being was satisfactory. Psychometric measures yielded remarkably normal values, with some pathological findings regarding personality traits. In the majority of patients, self- and observer-rating appraisals of gender-specific physical appearance were equally positive. The results suggest a three-step procedure for the treatment of transsexual patients, as is practiced in other centers within German speaking continental Europe.

[Ultrasound examinations in the context of suspected fetal malformations: satisfaction of concerned women and their appraisals]. / Die Ultraschall-Untersuchung bei Verdacht auf fetale Entwicklungsstörungen: Zufriedenheit und Bewertungen aus Sicht der betroffenen Frauen.

UNLABELLED: BACKGROUND AND RESEARCH QUESTIONS: Fetal malformations can be detected at an early stage during pregnancy by today's ultrasound technology. This study examined how pregnant women appraise the application of ultrasound technology when a fetal malformation is suspected and how this appraisal is influenced by the confirmation or rejection of the diagnosis and by the subsequent course of the pregnancy. METHOD: In a prospective study 86 pregnant women for whom a fetal malformation had been suspected in an ultrasound examination were assessed at three points in time: before the ultrasound examination at a specialized centre, one to two weeks after the examination, and four weeks after giving birth or after the premature termination of pregnancy. Assessments were conducted by means of questionnaire and semi-structured interviews. RESULTS: 96.4 % of pregnant women advocated routine ultrasound examinations, irrespective of whether the suspected malformation was confirmed or not and irrespective of whether the pregnancy was continued or terminated prematurely. The women rated as being most important the medical goals of the examination (e. g. determination of the child's health status) and less so the subjective and personal goals (e. g. visualization of the child). Communicative competence in the context of the examination (e. g. quality of information) were judged less favourably than technical competence (e. g. performance of the exam). 94.2 % of the women believed that the cost of the ultrasound exam should be carried by health insurances. DISCUSSION: The findings of the study show the strong significance which prenatal ultrasound examinations have for pregnant women. Acceptance of ultrasound technology is high even when the examination results cause psychological stress. However, they also indicate that more attention should be given to aspects of communication and interaction in training and application of ultrasound technology.