ABSTRACT
Except in the United Kingdom, there are no epidemiological data on permanent vegetative state in Europe over the last 12 years. Transposing the British (and Japanese) data to Switzerland with a population of 7 million, an annual incidence of some 70 cases can be expected and a prevalence of about 200-350 cases. The ethics committees of a number of Anglo-American societies specialized in the field postulate the ending of life-sustaining measures if the diagnosis of permanent vegetative state is definitely established. The medical, legal and ethical grounds for such a postulate are summarized.
Subject(s)
Ethics, Medical , Jurisprudence , Persistent Vegetative State/therapy , Adult , Aged , Brain Death/diagnosis , Child , Diagnosis, Differential , Euthanasia, Passive/legislation & jurisprudence , Humans , Incidence , Life Support Care , Persistent Vegetative State/diagnosis , Persistent Vegetative State/epidemiology , Switzerland/epidemiologyABSTRACT
From (1) the Swiss population census 1980, (2) the calculations of the Swiss Federal Office of Statistics, referring to the probable age composition of the stable Swiss population from 1990 to 2025 (scenario 2A-86), (3) the meta-analysis of Jorm et al. [8] on the prevalence of dementia, and (4) a study of the Swiss Federal Office of Statistics on the nursing personnel employed by inpatient institutions for the care of the aged, it is concluded that the number of elderly patients suffering from moderate to severe dementia will increase in Switzerland from 48,000 to 92,000 during the years 1980-2020. In 1990 the nursing staff for the ambulatory and inpatient care of 62,900 patients with dementia numbered 17,100 full-time positions. The calculated need for such positions was 37,700 in 1990 and will be 55,200 in 2020. This major shortfall in nursing capacities, now and in the near future, can probably not be covered by an extension of extrahospital services and certainly not by increased training of nursing personnel. By analogy with the obligatory military service for young men in Switzerland, an obligatory civilian service for men and women, for the care of the aged, is therefore proposed.
Subject(s)
Health Services for the Aged/supply & distribution , Nurses/supply & distribution , Aged , Ambulatory Care Facilities/supply & distribution , Dementia/nursing , Health Services Needs and Demand , Humans , Population Dynamics , Switzerland , WorkforceABSTRACT
Experimental and clinical data concerning placebo effects on pain states and other subjective symptoms are summarized, and show that placebo treatment and psychotherapy are identical. The drugs used by anthroposophical physicians, homeopaths, phytotherapists and therapists attempting to "normalize" the intestinal bacterial flora are in fact pure or impure placebos. Since official medicine is well aware of the scientific basis and favourable results of placebo treatment in psychosomatic and self-limiting diseases, it does not appear necessary to integrate varieties of alternative medicine into graduate and postgraduate medical training.
Subject(s)
Complementary Therapies , Pain Management , Placebos/therapeutic use , Anthroposophy , Homeopathy , Humans , Plants, Medicinal , Psychophysiologic Disorders/therapy , TherapeuticsABSTRACT
Chronic inflammatory bowel diseases are probably due to stimulation of the intestinal immune system by multiple, so far unknown antigens. Chronic inflammatory bowel diseases can be contained but not healed by corticosteroids, sulfasalazine (SASP), azathioprin and metronidazol. Healing may be expected by direct pharmacological intervention in the intestinal immune system, but these are not yet available. -5-aminosalicylic acid may replace SASP in the treatment of ulcerative colitis. When administered locally 5-ASA may be effective in cases of corticosteroid-resistant distal colitis. Controlled studies are needed before the perspectives for 5-ASA in the treatment of Crohn's disease can be assessed.
Subject(s)
Aminosalicylic Acids/therapeutic use , Colitis, Ulcerative/drug therapy , Crohn Disease/drug therapy , Salicylates/therapeutic use , Administration, Oral , Aminosalicylic Acids/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Humans , Mesalamine , Pharmaceutical Vehicles , Salicylates/administration & dosageABSTRACT
To evaluate the quality of Swiss postgraduate gastroenterological training, a questionnaire was circulated to 100 practising gastroenterologists. The results show that knowledge of psychosomatic problems, proctology and nutrition should be improved. The majority of practising Swiss gastroenterologists favoured formal education in ultrasound techniques. Radiological and laparoscopic techniques are no longer needed. The question whether postgraduate training standards should be raised, and a board examination introduced, is discussed.
Subject(s)
Education, Medical, Graduate/standards , Gastroenterology/education , Gastrointestinal Diseases/diagnosis , Health Policy , Humans , Specialty Boards , Surveys and Questionnaires , SwitzerlandABSTRACT
In Crohn's disease epidemiological data show a 5-fold increase in incidence between 1950 and 1970. The incidence in towns is higher than in rural areas. The significance of environmental factors such as sugar, fat and nicotine has not been established. L-forms of mycobacteria may be the cause of the disease. Intestinal immunoregulation is not impaired. The natural history is poorly influenced by drugs and "curative" resection. Male, but not female, fertility may be impaired. There is only a slightly increased risk of cancer.
