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Aim of This Study: General internal medicine is a crucial element in healthcare systems. Understanding how many people are and will be working in this field is important to maintain and improve quality for patients in healthcare systems. This can provide a basis for political decisions., Methods: We conducted a cross-sectional study to analyse the current and future workforce of generalists (general practitioners and internists in hospitals) in Switzerland. The Swiss Society of General Internal Medicine (SSGIM) distributed a survey to all members. Respondents were asked about their current average workload in 2023 and planned workload in 2033. The responses were used to calculate full-time equivalent (FTE) for the current and future workforce of generalists and to extrapolate FTE for all active SSGIM members. To model the demand by 2033, we derived different scenarios., Results: Of all 6,232 active SSGIM members, 2,030 (33%) participated: 46% female, 25% (largest age group) 56-65 years old, 19% still in postgraduate training. The average workload in 2023 was 78% for female and 87% for male generalists; the FTE extrapolated to all active SSGIM members in 2023 was 5,246. By 2033, 1,935 FTEs (36%) will retire, 502 FTEs (10%) will reduce their workload, 116 FTEs (2%) will increase their workload and 2,800 FTEs (53%) will remain in the workforce with the same workload as in 2023. To maintain the same workforce as in 2023, 2,321 new FTEs (44%) will be needed by 2033. To fill this gap of 232 FTE new generalists per year, we modelled different scenarios with assumptions of interest, workload, migration and dropouts., Conclusions: Within only one decade, 44% of the current workforce of generalists will disappear, mainly due to retirement and decreased workload. To fill this gap, various scenarios need to be incorporated. Politicians are called upon to create the political framework to create attractive training and working conditions for generalists to address the future demand for healthcare services.

Background: The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old., Design/setting: Cross-sectional study among currently active GPs from 29 countries using a case-vignettes survey., Methods: GPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs reporting using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GPs' sex, years of experience, prevalence of oldest-old and location of their practice), we used a mixed-effects regression model accounting for clustering within countries., Results: Overall, 2,543 GPs from 29 countries were included. 59.4% of them reported to use guidelines. Higher guideline use was found in female (p = 0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in self-reported guideline use, ranging from 25% to 90% of the GPs, but there was no difference in hypertension treatment decisions in frail oldest-old patients between GPs that did not use and GPs that used guidelines, irrespective of the guidelines they used., Conclusion: Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users concerning hypertension treatment decisions. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients., Competing Interests: The authors declare that they have no competing interests.

Blood pressure (BP) is expected to have increased over time in children in most countries due to the increasing prevalence of childhood obesity worldwide. The authors conducted a systematic review of studies assessing secular trends in BP in children and adolescents. Of 1739 citations screened, the authors identified 18 studies including 2 042 470 participants examined between 1963 and 2012. Thirteen studies were conducted in high-income countries, five in middle-income countries, and none in low-income countries. The prevalence of overweight or obesity increased in 17 studies and decreased in one study. BP decreased over time in 13 studies, increased in four, and did not change in one. These findings suggest that secular trends in BP do not mirror secular trends in overweight. This implies that other factors mitigate the effect of overweight on BP in children and adolescents., (©2016 Wiley Periodicals, Inc.)

The effect of a newly developed anti-LH-RH vaccine on the performance, sexual development, and incidence of boar taint-related compounds was investigated in young intact male pigs. At 29 kg BW, 40 crossbred intact males and 20 castrates were allocated to three groups. Castrates and half of the intact males were untreated. The remaining intact males were immunized against LH-RH at 29 kg and again at 89 kg BW. All pigs were slaughtered at 105 kg BW. Compared with control intact males, feed efficiency in castrates was decreased by 10%, muscle content was reduced by 5%, and carcass fat content was increased by 26%. Growth performance and carcass traits did not differ significantly between immunized and control intact males. Genital tract weight, measured at slaughter, was decreased (P < or = .002) by immunization. Plasma testosterone concentrations were not significantly affected at 89 kg BW, whereas they were sevenfold lower (P < .001) in immunized than in control intact males at 105 kg BW. Fat androsterone levels, measured at slaughter, were substantially reduced (P < .001) from .66 +/- .07 microgram/g in control to .21 +/- .01 microgram/g in immunized intact males. Rates of testicular steroid biosynthesis, measured in vitro, were decreased by immunocastration. Fat skatole levels were very low and did not differ significantly between the three groups. The present results demonstrate that anti-LHRH immunization was effective in reducing the level of androstenone, a boar taint-related compound, although having a limited effect on the performance of the animals.

A comparative study of the activity of foot-and-mouth disease vaccines, both aqueous- and oil-adjuvanted, was carried out on young bovines from vaccinated mothers. The immunity of these animals against foot-and-mouth disease was controlled after the first vaccination and booster by serology (neutralizing antibody count and immunology virulence testing). After having followed the kinetics of decrease in seroneutralizing antibodies of maternal origin the animals were vaccinated at the age of 11 weeks either with aqueous-adjuvanted or oil-adjuvanted vaccine. A booster dose was given two months later. Blood samples were taken at regular intervals and two virulence tests were made, one 21 days after the first vaccination and the other six months after the booster dose.

Medical and sanitary prevention of a growing number of major infectious diseases of bovines has led IFFA-Mérieux to investigate the association of vaccines and to define methods of utilization. Care has been taken to limit the number of interventions and at the same time to retain in the combined valences the efficacy they had when in a state of single constituent. The work which has been carried out for the last ten years, including the study of adjuvants as well as of incompatibility of associations, has permitted the improvement of formulas, reduced in volume (5 ml for a plurivalent dose), in aqueous excipient (aluminum hydroxide and saponin) or oily excipient (oil in water type). These formulas combine 3 foot-and-mouth disease valences with a rabies valence (fixed strain grown on cell culture) or with a brucellosis valence (strain B. abortus MacEwen 45/20 and B. melitensis H 38). The innocuity of these associations allows them to be used in sanitary compaigns; their efficacy is equal to that of monovalent vaccines. A logical vaccination calendar is proposed.

The characteristics of the viruses produced from cell lines developed in suspension and the vaccines for which they are used should be judged by methods which allow to ensure in all cases their innocuity and efficacity. Innocuity is essentially dependent upon the purity of the viral preparation which should contain a minimum of foreign proteins (due either to the cell or the culture medium) and certain antibiotics. Furthermore, the absence of oncogenic properties of the inactivated viral suspensions should be shown, in addition to their specific innocuity. Efficacity is linked with the concentration of viral particles and with their immunogenic properties after inactivation and incorporation of adjuvants of immunity. Methods of appreciation of the different parameters are proposed.

Combined vaccines are used for many human and animal diseases. However, we have very few examples of combinations containing anti-foot-and-mouth valence which would allow easy immunization against differnet diseases without additional handling. Until now foot-and-mouth vaccination has been applied simultaneously with anti-brucellic vaccination (Baldoni, Renoux), andi-anthrax (Nobili) and vaccination against swine fever and Aujeszky's disease (Lysenko). During the last ten years we have particularly studied the association of anti-foot-and-mouth disease vaccines with anti-brucella and anti-rabies vaccines. We have shown the possiblity of combining these different antigens, either in classical aqueous vaccines in aluminum hydroxide, or in emulsified vaccines containing oily adjuvants. The anti-brucella valences may be agglutinogenic (H 38) or non-agglutinogenic (MacEwen 45/20). The combined vaccines "rabies + foot-and-mouth disease" and "brucellosis + foot-and-mouth disease" can be produced on an industrial scale. For many years millions of animals have been successfully vaccinated in France by means of a combined "rabies + foot-and-mouth disease" vaccine.

Regardless of the duration of the culture period, the amount of both glycoprotein G and sialic acid bound to the rabies virion as not modified. The major proteins of the viral suspension were the same proteins as those of the virion, except one glycoprotein (MW 70,000).

An M mode echocardiographic study was performed, of left ventricular dimensions and wall thickness in two series of normal (N1, N2) and pathological (P1, P2) subjects. In the more recent series (N2 = 40, P2 = 17) data acquisition was facilitated by tests deduced from the technique of ultrasound transit time. The parameters compared were based on: 1) the proportionality between fractional shortening and fractional thickening (N1: not significant; N2: p less than 0.001), 2) the relationship between systolic radius and wall thickness (linear correlation, r = 0.95, between N2 and P2). The slope seemed to be related to the initial condition of contraction, the ratio of end diastolic wall thickness/radius (N1: p less than 0.01). There are several ways of normalising myocardial surface of section in adults and children; the normal surface is related to body surface area (r = 0.87; p less than 0.001 between calculated and predicted values for a N2 mean of 9.3 +/- 0.06 cm2/m2). The end diastolic diameters and wall thicknesses correlated with body surface area but the coefficients were not as statistically significant due to physiological variations in chamber filling. The indexed myocardial surface was increased (p less than 0.001) in the pathological series. The introduction of these tests improves the reliability of echocardiographic data. The use of several measurements simultaneously allows normalisation of body surface area and increases the diagnostic efficacy.

A certain number of parameters involved in the manufacture, control and use of an efficacious vaccine against foot-and-mouth disease have been studied. This report considers the problems raised by the standardization of the raw material constituent to the vaccine as well as the different types of innocuity and activity testing carried out on sows, young pigs and bacon pigs. Special attention is given to virulence testing methods, to the criteria allowing evaluation of the quality of the vaccines and to the transmission of maternal immunity of the sows to their piglets and its incidence on the vaccination schedule.