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The great majority of suicides and suicide attempts are related to mental illness. Special risk has been attributed to depression, psychosis, substance use, personality, and trauma-related disorders. Many affected persons seek medical attention prior to taking action. Primary care therefor plays an outstanding role in suicide prevention. Doctors should pay attention to potential risk constellations and actively address the issue. This paper presents possibly helpful models and instruments for everyday use. Most importantly, however, professionals’ empathy and time are required as well as appropriate decisions concerning a referral to a psychiatrist or psychiatric inpatient treatment.

This paper discusses the phenomenon of suicidality with regard to patient autonomy on the one hand and the obligation of medical professionals to provide support and treatment on the other hand. The continuation of a broad debate on these issues within the whole of society is mandatory also in the future. Suicide and assisted suicide are topics with high relevance for medicine in general and for psychiatry in particular. They can, however, not be handled by medical specialists alone.

Telemedicine aims to create new forms of health care delivery by the use of information and communication technologies (ICT),for example, to improve the access to health care for patients in rural regions. There is a need for assistive technologies and innovative technological solutions due to the demographic change. Population trends of western societies show concurrently an ageing population and the wish of elderly people to live at home as long as possible while there is a tendency that older people live in greater distances to their kin nowadays. More complex diseases and multimorbidity urge improved interconnectedness between different health care professionals. Hence, different health systems pursue e-health strategies with the aim to implement electronic patient records (EPR) and similar technological solutions as a first approach to tackle those challenges. Telemedicine represents an open and evolving concept which is subject to a regular process of further development as a consequence of accelerated technological progress. The increased articulated demand for patient centered health care is one driver for the use of telemedicine. In the context of the trend of shorter hospital stays technological solutions can provide an opportunity for better support and care at home to reduce health risks and improve caregiving quality after hospital discharges. Despite the still prevalent reservations of elderly people about the use of ICT research shows that acceptance and the willingness to use technical devices is increasing. The article describes different aspects of telemedicine in the context of the aging population: definitions, an overview of trends and various fields of use with specific practical examples. A synoptic view of research results of evaluations of telemedicine applications regarding their effectiveness and cost-benefit analysis complement the paper.

Ambient Assisted Living (AAL) summarizes various connected digital networked assisting technologies with the aim to support elderly and chronically ill people and to improve their quality of life. This paper defines the term AAL and shows different fields of application for AAL technologies. It illustrates the role of AAL against the background of the societal and demographic changes, of the expected growth of older people in need of care, and of the ongoing trend of singularisation of elderly. We describe medical application areas with new opportunities for the use of AAL technologies. The article highlights further the importance of the technical acceptance of these technologies by the end users, which we deem to be the most critical factor for the diffusion and use of AAL technologies in the forthcoming years.

The issue of the capacity of judgement or the lack thereof and the validity of legal actions performed in such conditions will become more and more important considering the longer life expectancy and the increasing number of people with diseases like dementia. This paper will discuss the capacity of judgement from a legal point of view. According to article 16 of the swiss civil code a person is capable of judgement within the meaning of the law if he or she does not lack the capacity to act rationally by virtue of being under age or because of a mental disability, mental disorder, intoxication or similar circumstances. Therefore, the incapacity of judgement requires the existence of one of the aforementioned conditions (objective aspect) which have to result in the lack of capacity to act rationally (subjective aspect). The capacity of judgement is relative and must always be evaluated within a given context, i. e. the capacity of judgement has to be confirmed or refuted for a specific transaction at a specific time. By law, the capacity of judgement is assumed (statutory presumption) and the opposite has to be proven. As part of a notarial procedure the capacity of judgement has to be verified by the notary public, although only in a brief and limited manner. If the capacity of judgement is disputed, only the competent civil judge has the power to render a legally binding judgement.

Hundreds scores and dozens staging systems exist in Oncology. They provide for example information on the spread and prognosis of a disease or are included in treatment decisions. Because of the existing diversity a description of all oncological codes would exceed the scope of this paper, the following articles focuses in the first part on some exemplary and lesser-known scores and in the second part on main staging systems in Oncology. Internet sites such as Wikipedia or Onkopedia provide answers to many other questions regarding ongologic scores and stages. As an example of a tumor graduation the Gleason score in prostate cancer is described. It provides not only information about the prognosis of the disease, but influences the primary treatment. In metastasic disease, the general condition of the patient is decisive on the question of whether a (further) systemic therapy should be applied. The general condition is classified with the Karnofsky index and in Oncology more frequently with the ECOG- or WHO-performance status. In solid tumors the response to treatment is assessed with RECIST criteria. The spread of solid malignancies is documented according to the TNM classification. This classification is regularly updated according to latest prognostic and therapeutic results. In contrast the Ann Arbor criterias - the staging system of lymphomas - have little changed since their initial description.

Surveillance programs have been recommended for colorectal and breast cancer patients in several countries, and appropriate surveillance guidelines have been issued by various societies. The Swiss Society of Gastroenterology consensus paper recommends a surveillance program for patients after curative resection of colorectal cancer (CRC), and the respective guidelines are updated regularly. Early detection of recurrent disease from CRC allows treatment with intention to cure. Five year survival rates after treatment for recurrent CRC can reach up to 50 % or more. Therefore tumor surveillance in CRC is important, and there is compelling evidence that patients benefit from intensive surveillance. In addition to clinical controls, measurements of carcinoembryonal antigen, colonoscopies and thoraco-abdominal CT scans should be performed on a regular basis. For surveillance of breast cancer (BC) patients, a regular schedule is recommended as well. However, this surveillance program is more focussing on the detection of possible loco-regional tumor relapse, as curative therapy of BC metastases is much less frequently possible than in CRC patients. Irrespective of the underlying tumor entity, surveillance is an important and challenging process that should be coordinated by one single physician. It is crucial that all involved physicians are aware of their responsibility and that they are informed about the respective surveillance program and its benefit to the patient.

Many consequences of an illness or an accident that are treated in the form of basic medical practice consequences concerned can either be directly caused by the illness or accident, or result from the ensuing treatment. A physician providing basic medical care is therefore often confronted with traffic medicine issues. Moreover, most Swiss cantons have charged general practitioners with carrying out the legally prescribed regular check-ups for motorists aged over 70. General practitioners thus assume the role of medical examiner for these bi-annual check-ups. This paper discusses basic aspects in connection with general practitioners' evaluation of a person's aptitude for driving and with frequent traffic medicine issues dealt with in basic medical practice. Special emphasis is placed on best practice in the regular check-ups for over 70-year-old motorists.

Child abuse may result in dramatic short and longtime damage of children's physical and emotional well being. This underscores the clinician's special responsibility to contribute a sound professional and scientific approach to the multiprofessional diagnosis and intervention in suspected child abuse cases. The approach is to correlate the probability of a given finding with the history and comparing it to biomechanical principles. Of concern are especially all serious injuries with an alleged trivial or inadequate for age mechanism, missing, vague or changing patterns of explanation, injuries of different age, delay of medical care and allegations by independent observers or even the child. Exact documentation of all medical examinations is the basis of any forensic expertise if child abuse is to be considered. This paper ist dealing with morhological findings following various kinds of violence which can often be observed in connection with child abuse, as well as the interpretation of characteristic patterns of findings. Furthermore, practicable procedures after diagnosing child abuse ar being discussed on the basis of legal terms.

Disasters can have a severe impact on whole communities, but the impact can be especially difficult for the more vulnerable in our societies: women and children. This paper identifies a number of ways that women and children can be impacted, and explores some practical approaches that can serve to effectively address the special needs of women and children after a disaster. Specific community-based psychosocial practices are identified that can enhance the healthy psychological processes in children and women. This can be accomplished through the fostering of protective factors that strengthen what is known as "resilience processes". This is a new approach how to care to those who experienced disaster-related trauma or stress. It offers psychosocial methods that can be useful, practical and effective in post-emergency circumstances alternatively or integrated into standard medico-psychotherapy approaches where large populations of women and children are affected, particularly where people from cultures unfamiliar with western therapeutic concepts or interventions are affected. Possible applications and considerations for encouraging resilience processes in women and children who have experienced disasters are explored, along with a commentary about implications for applications in Switzerland.

Migrants from Turkey face several barriers to a successful integration in Switzerland including equal access to the health care system; most important are language problems, cultural and economic barriers. According to the scientific report of the Federal Bureau of Health "Migration and Health " current forms of therapy do not fulfil the needs of this patient population. Ambulatory and in-hospital services are devoted to the acute phase of a pain disorder; they are not imbedded into the circumstances of daily living. Re-Adjusting to daily life however, is crucial for patients' attempt to return to normality. Therefore therapeutic offers are needed to close the gap between high intensity treatment in hospitals and almost no treatment in the ambulatory setting. We developed an integrative post acute model of patient care, consisting of assisted self-help groups that is presented in the current paper.

Burn injuries are very frequent, most being trifle cases. Nevertheless every year about 200 patients need to be treated in one of the two specialised Swiss burns centres. Admission criteria are burns > 15% body surface or burns to critical areas (face neck, hands, genitalia, joints) and electrical injuries. The paper reviews the physiophathology of the burn wound which differs depending on the thermal or electrical aetiology. The airway may be threatened due to true inhalation, but also to burns to the face or neck. In major burns >20% body surface in adults, or > 10% in children, fluid resuscitation will be required; oral hydration is generally sufficient by smaller burns. Surgical treatment of 2nd and 3rd degree burns starts within the first 24 days after injury. While complex treatment is generally available in peace time, a major accident such as a disco-fire that can generate hundreds casualties in a few minutes, can threaten our system and force the adoption of triage rules, and simplified treatments. Attitudes to adopt in such conditions are discussed.

To learn from errors is not always easy, especially if they happened to others! This paper describes the organization and management of a critical incident reporting system for primary care physicians in Switzerland and reports about the difficulties and experiences during the first 18 months since the start of the program. It seems to be particularly difficult to enhance the attentiveness of physicians for apparently harmless daily critical incidents and to motivate them to report it even in an anonymous reporting system. As incentives for more intensive participation there are the hope for comments on reported cases by other participants and the expectation that reported errors will be avoided by the readers.

The first reliable diagnostic tools for the diagnosis of HIV infection, Western blot and ELISA, were created 20 years ago in the U.S., using initially sera from AIDS patients diagnosed clinically in Switzerland. In Swiss laboratories the diagnosis of HIV infection today is established by using 4th generation screening tests which detect both antibodies and p24 antigen while in the doctor's surgery a rapid antibody assay is used. Confirmation in authorized confirmatory labs relies on a set of different minimal combinations of positive test results derived from both the first and second blood specimen. In patients with a confirmed diagnosis of HIV infection, two further principal questions arise concerning, on the one hand, the virus load and, on the other hand, some clinically relevant properties of the infecting virus (type or subtype, resistance against antiretroviral drugs). The paper starts with a personal flashback to the first days of HIV diagnostics and describes the sensible use of tests available today for answering the above-mentioned principal questions. Alternative methods which can be used when standard tests fail or appear unreliable are mentioned also.

Anxiety is a normal and ubiquitous emotion with adaptive value, in that is acts as a warning system alerting a person of impending danger. This system can be considered maladaptive, however, when anxiety becomes unjustifiably excessive and, thus, morbid. Both forms of anxiety, situational anxiety and pathological anxiety are common in the elderly. Also anxiety disorders in elderly persons are among the most frequently encountered psychiatric conditions. In this paper I begin with the epidemiology of anxiety in the elderly, discuss the clinical characteristics of late life anxiety with special attention to difficulties in the differential diagnostic evaluation and describe treatment strategies for managing elderly patients with anxiety disorders. In conclusion I try to discuss the question: "Anxiety in the elderly--Condition sine qua non?"

In this paper the basic knowledge about the morphology of gunshot wounds is presented, which should help the physician to answer the most important questions imposed on a criminal case. The paramount measures to be taken are the documentation of the gunshot wounds, the excision of the injury and separate debridement of each lip of the wound, the careful observation of the projectile, the cataloging of the victim's clothes and the omission of cleaning the hands of the victim. Some forensic aspects are demonstrated, particularly the professional discretion respectively the obligation to notify the authorities.

While immunization programs for children are well accepted in Switzerland, vaccinations of adults are still a problem. This paper deals with indications for vaccinations in adults. While the whole adults population should be immunized (boostered) against diphtheria, poliomyelitis and tetanus, other vaccinations (CEE, hepatitis A, hepatitis B, influenza, measles, mumps, rubella, rabies, varicella) should be administered according to risks at the workplace. Guidelines for vaccination programs in occupational medicine are presented and discussed.

In this paper the most isolated endemic and imported pathogens of diarrhea in Central Europe are demonstrated. Clinical symptoms, diagnosis and therapy and additional hygiene measures are described.

The statistics about work-related diseases influence greatly the setting of prevention priorities. It is consequently of prime importance that these statistics correctly mirror the reality. This paper summarizes the results of studies which show that the real prevalence of work-related diseases is probably two to three times greater than generally admitted; therefore, it seems very important to improve the quality of diagnosis and of data collection.

This paper evaluates production and consumption of alcohol from an economic point of view. The economic rationale for public policies towards alcohol in a market system is discussed at the outset. Economic costs and benefits of alcohol consumption are then assessed. Three alternatives for taxing alcohol with a special excise tax are presented. The main results of a cost-benefit study of the treatment of chronic alcoholics in Switzerland are reported. Finally, some conclusions are drawn regarding public policy in this field.