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Volume 155, No. 8

Published August 1, 2025

Viewpoint

  1. Rubén Fuentes Artiles, Vera Regitz-Zagrosek , Thorsten Buch (Author)

    Sex- and gender-specific medicine: why it's a man's business too

    Sex- and gender-specific medicine must expand to include the health disparities affecting men, who face distinct and under-researched health disparities just as women do in some medical fields. Despite its broad relevance, the field is still primarily led by women, which may inadvertently limit male engagement and distort its scope. Men should join women in actively shaping healthcare into a more inclusive and intersectional system that benefits all.

Review article: Medical guidelines

  1. Roger Lehmann, Sandrina Bervini, Vojtech Pavlicek, Regula Wick, Barbara Lucchini, Ulrike Iten, Lia Bally (Author)

    Swiss recommendations on driving ability in patients with diabetes mellitus

    Most people with diabetes mellitus operate motor vehicles safely without creating any meaningful risk on the road for themselves or others. A diagnosis of diabetes is, in itself, inadequate for determining a person’s driving capability or safety. Diabetes-related traffic accidents are rare for most drivers with diabetes mellitus and occur less frequently than for many other diseases that can impair driving performance and that are tolerated by society. The incidence of hypoglycaemia, which impairs the ability to drive, severe retinopathy (including macular oedema) or cataract formation affecting visual acuity required to drive a motor vehicle, and peripheral neuropathy, which can severely impair sensation in the feet, is not so common as to justify restricting driving privileges for all drivers with diabetes mellitus.

    In recent years, several pharmacological and technological innovations have revolutionised diabetes care. Continuous glucose monitoring system (CGMS) technology has only recently become increasingly integrated into diabetes therapy. Today, except for insulin, none of the treatments recommended for type 2 diabetes mellitus causes hypoglycaemia, and the risk of hypoglycaemia with ultra-long-acting insulins is lower. As a result, recommendations for driving motor vehicles have had to be adjusted. Since hypoglycaemia is the greatest risk factor for impaired driving ability, the latest technology (CGMS coupled with hybrid closed-loop insulin pumps) can reduce the number of hypoglycaemic events and blood glucose fluctuations. In addition, HbA1c and time in target range can be improved. Patients with type 1 diabetes mellitus are now, in exceptional cases, allowed to be licensed in higher vehicle categories. With the analysis of CGMS data, an objective assessment of the frequency of hypoglycaemia is now possible; this was previously only partially possible with blood glucose logs. Patients who are treated with insulin should use a CGMS. This also applies to gestational diabetes and diabetes during pregnancy. Since these systems warn of impending hypoglycaemia, they will also improve road safety, and the safety margin for blood glucose, previously set at 5 mmol/l, can be lowered to 4 mmol/l. For CGMS users, blood glucose measurements every 2 hours while driving are no longer necessary.

Original article

  1. Irina Höhn, Anett Hernadi, Reto Zihlmann, Christina Coelius, Katharina Walter, Amr Hamza, Nicole Ochsenbein-Kölble, Leonhard Schäffer (Author)

    Impact of COVID-19 lockdown-associated visitor restrictions on mother-child interaction and emotional state of women in the puerperium – a retrospective cohort study

    INTRODUCTION: The aim of this study was to analyse the impact of maternal isolation during the COVID-19 lockdown. Two main aspects were examined: (1) What impact do these social restrictions have on maternal depressive symptoms? and (2) Is there an influence on mother-child interaction? As secondary endpoints, we defined the influence of the restrictions on breastfeeding, the length of hospital stay, patient satisfaction during the inpatient stay due to the reduced number of visitors, and postpartum complications after discharge.

    MATERIALS AND METHODS:The study was conducted at a university-affiliated teaching hospital in Switzerland. Women who delivered in the first phase of the COVID-19 pandemic and who were not allowed to have any visitors including the child’s father (group “total ban”, n = 53; 20 March 2020 to 10 May 2020) and women who were only allowed to have a visit from the child’s father (group “partial ban”, n = 49; 11 May 2020 to 20 June 2020) were compared to a reference group of women who delivered prior to the restrictions (n = 61; 1 January 2020 to 16 February 2020). Participants completed a questionnaire one year after delivery to assess their situation one week and one year after giving birth. The primary outcomes were the state of mental health (measured by the Edinburgh Postnatal Depression Scale) and maternal bonding (measured by the Mother-to-Infant-Bonding Scale). Secondary outcome measures were breastfeeding status, postpartum complications and length of hospital stay.

    RESULTS: Of 404 women eligible for participation, 241 declined to participate or could not be reached. Obstetric baseline characteristics were similar across all three groups. Analysis of signs of depression showed a 2-fold higher risk of postpartum depression after one week and one year in both isolation groups compared to the reference group (23% and 20% vs 9% at one week; 11% and 11% vs 5% at one year). However, this did not reach statistical significance (p = 0.158; p = 0.471). Analysis of the Mother-to-Infant-Bonding Scale revealed similar scores in all groups in the first week and after 12 months. There were no significant differences in the rates of breastfeeding and postpartum complications. Hospital stays were clearly shorter during the partial and total visitor bans (3.06 days and 2.55 days vs 3.51 days in the reference group [p <0.001]). 45% of patients in the reference group would have been dissatisfied with a limitation to the number of visitors as compared to only 18% in the total and 9% in the partial visitor ban groups (p <0.001).

    CONCLUSIONS: We found an increased albeit non-statistically significant risk of postpartum depression one week and one year after delivery under different forms of isolation on the postpartum ward. We hypothesise that this is unlikely caused solely by isolation, as both groups were equally affected independently of the possibility of partner support. Maternal bonding and breastfeeding rates were unaffected. Hospital stays were significantly shorter during the partial and total visitor ban, but postpartum complications were unaffected. Only a minority of women in the isolation groups were dissatisfied with the visiting restrictions. The SARS-CoV-2-associated protective isolation measures applied in maternity wards appear not to have had a major negative impact on maternal wellbeing in this population.

  2. Enrica Pittaluga, Alexis Arnoux, Sophie Merckaert (Author)

    Sensitivity of clinical screening for detecting developmental dysplasia of the hip: a retrospective study

    BACKGROUND: Detecting developmental dysplasia of the hip in infants is crucial. This study aimed to estimate the sensitivity of clinical screening for developmental dysplasia of the hip in a tertiary care setting. We compared clinical findings with ultrasound results to determine diagnostic accuracy.

    METHODS: This retrospective study evaluated newborns aged 0–4 months treated for developmental dysplasia of the hip from May 2017 to June 2023 at a tertiary care centre in Switzerland. All patients underwent clinical examinations and a hip ultrasound scan (Graf method). The sensitivity of clinical findings was calculated, along with 95% confidence intervals (CI), and stratified by developmental dysplasia of the hip severity.

    RESULTS: Among 122 newborns, clinical screening demonstrated an overall sensitivity of 66% (95% CI: 58–74%). Sensitivity was higher for unstable hips (91%, 95% CI: 82–99%) than for stable hips (50%, 95% CI: 38–62%). Differences in diagnostic timing were observed between groups.

    CONCLUSION: Clinical screening for developmental dysplasia of the hip showed limited sensitivity, particularly for stable cases. Universal ultrasound screening could improve early detection rates.

  3. Barbara Jarmila Germann, Julia Frey, Alain Soltermann, Janna Küllenberg (Author)

    “A good physician works full-time?” – a mixed-methods study on (mis)conceptions about part-time work in hospitals

    STUDY AIMS: While part-time employment is commonly discussed as a way to recruit and retain physicians, the average workload of hospital physicians has barely decreased in the past decade, and hospitals face persistent difficulties in adopting part-time work. This study aims to examine the attitudes of hospital physicians across various specialties and positions towards part-time employment, and to identify factors that hinder or facilitate the successful implementation of part-time arrangements in hospital settings.

    METHODS: We conducted an exploratory mixed-method study, combining a qualitative interview study with reflexive thematic analysis of 19 participants, and an online quantitative survey of 553 physicians. Data were collected between August and November 2023 in seven public hospital organisations in Switzerland.

    RESULTS: The quantitative data revealed a widespread desire for workload reduction across all roles, specialties, age groups and sexes, with an average ideal workload of 81%. Contrary to some statements in the qualitative interviews, the youngest cohort of physicians reported the highest ideal workload (88%). Most respondents (60%) believed they would be granted a workload reduction, yet an equal percentage at least partially agreed that working part-time would negatively impact advancement opportunities within the hospital. Other concerns about part-time work included the additional workload it might place on colleagues (76.5%) and a potential decline in medical quality (17.5%). These concerns varied across specialties and positions. The qualitative interviews identified both organisational and cultural barriers to the implementation of part-time work for hospital physicians, such as complex scheduling, additional effort and the prevailing “ideal physician norm” that prioritises physical presence and professional obligations over personal life. Conversely, factors facilitating part-time work included a supportive culture for part-time models and flexible organisational structures and processes.

    CONCLUSION: Addressing current perceptions of physicians’ part-time work may be an essential first step towards establishing sustainable part-time solutions in hospitals. This includes the assumption that a physician’s competence depends solely on his or her availability. Furthermore, the redesign of workplace structures, including shift schedules and training programmes, may be necessary to accommodate varying workloads. When accommodating part-time solutions for hospital physicians, implementing one-size-fits-all solutions may not be expedient, given the varying circumstances of different specialties and positions. Therefore, we recommend that solutions be tailored to the specific needs of each clinic and developed through a participatory process.

  4. Luzius Mader, Lea Wildisen, Dominik Menges, Flurina Suter, Gautier Defossez, Jean-Luc Bulliard, Sabine Rohrmann, Katharina Staehelin (Author)

    The impact of the COVID-19 pandemic on cancer incidence, stage distribution and survival in Switzerland: a register-based cohort study

    BACKGROUND: The COVID-19 pandemic disrupted healthcare systems worldwide. This raised concerns about delays in cancer diagnosis and treatment, with potentially worse patient outcomes. The aim of this nationwide, population-based cohort study was to investigate the impact of the COVID-19 pandemic on cancer incidence, stage distribution and one-year survival in Switzerland.

    METHODS: We used national cancer registry data for the period 2017–2021 from the National Agency for Cancer Registration in Switzerland, covering all except three cantons. We estimated national cancer incidence counts and calculated age-standardised incidence rates for all cancers and separately for female breast cancer, colorectal cancer, lung cancer, melanoma and prostate cancer. We calculated proportional stage distributions for cancer types and estimated observed and relative one-year survival for all cancers and cancer types based on Swiss population life tables. Results were analysed descriptively.

    RESULTS: We included 218,736 cancer cases diagnosed between 2017 and 2021. Annual incidence counts of all cancer cases increased in 2020 (2.1%) and 2021 (7.3%) compared to the mean of 2017–2019. When evaluating monthly incidence counts, we observed a substantial decrease during the COVID-19 lockdown period, which was largest in April 2020 (−19.9% for all cancers). This decrease was most pronounced for female breast cancer (−39.9%), followed by prostate cancer (−29.0%), colorectal cancer (−28.7%) and melanoma (−26.9%). An increase in incidence counts for all cancers was observed in March 2021 (18.8%). We observed no clear shift in stage distributions across 2017–2021. The observed and relative one-year survival for all cancers and individual cancer types was similar in 2020 and slightly higher in 2021 compared to 2017–2019.

    CONCLUSIONS: This nationwide study suggests that the pandemic had no major effect on short-term cancer patient outcomes. These findings are of importance for policymakers and the public health system regarding future pandemics.

  5. Fahim Ebrahimi, Simone Hubacher, Emanuel Christ, Stefan Zechmann (Author)

    Pitstop approach: diabetologist referral and quality of care in patients with type 2 diabetes – a Swiss longitudinal study

    STUDY AIMS: Patients with type 2 diabetes mellitus are typically managed in primary care settings, but management has become more complex in recent years due to modern therapeutic options. There is a paucity of data on the role of a one-off referral to an outpatient diabetes centre (a “pitstop” approach) in improving the quality of diabetes care.

    METHODS: This was a retrospective study of patients with type 2 diabetes mellitus who were referred to an outpatient diabetes centre at a regional hospital in Switzerland between 1 January 2019 and 31 December 2020. The primary outcome was the change in glycated haemoglobin (HbA1c) between the first and last consultation. Secondary endpoints included changes in body weight, blood pressure, low-density lipoprotein cholesterol and use of antidiabetic medications.

    RESULTS: At a median follow-up of 5.1 months (interquartile range [IQR] 3.0–9.1) after referral to an outpatient diabetes centre, haemoglobin A1c improved from 8.6% / 70.5 mmol/mol to 7.3% / 56.3 mmol/l (difference −1.28% / −14.2 mmol/l; 95% confidence interval [CI] −1.50 to −1.05), body weight decreased from 91.0 kg to 88.0 kg (difference −3.93; 95% CI −4.9 to −3.0) and systolic blood pressure values decreased by 1.6 mm Hg (95% CI −2.7 to −0.5), while low-density lipoprotein cholesterol levels remained unchanged. Compared to baseline, the pitstop approach resulted in decreased prescriptions for sulfonylureas (11.0% vs 2.8%) and dipeptidyl peptidase-4 inhibitors (31.4% vs 20.0%), but increased prescriptions for sodium-glucose cotransporter 2 (SGLT2) inhibitors (15.3% vs 27.5%) and glucagon-like peptide-1 (GLP1) receptor agonists (13.7% vs 46.3%).

    CONCLUSION: A short-term intervention by an outpatient diabetes clinic was associated with significant improvements in glycaemic control and body weight in patient with type 2 diabetes. It promoted a shift towards modern antidiabetic medications with proven cardiorenal protective effects.

  6. Elisa Canini, Lorenza Pacchin, Ann Kristine Blackham, Johannes Lorscheider, Jakob Passweg, Alfred Zippelius, Heinz Läubli, Markus R. Mutke, David König (Author)

    Exacerbation of demyelinating polyneuropathy after adoptive cell therapy with tumour-infiltrating lymphocytes by metastatic melanoma

    Adoptive cell therapy (ACT) with tumour-infiltrating lymphocytes (TIL) is an effective personalised immunotherapy for patients with advanced pretreated melanoma. For TIL-ACT, tumour-specific T cells are expanded from excised tumour samples and stimulated in cell culture with interleukin-2 (IL-2). The resulting autologous tumour-infiltrating lymphocytes are reinfused to the patient after a non-myeloablative lymphodepleting chemotherapy with cyclophosphamide and fludarabine. Thereafter, activation of tumour-infiltrating lymphocytes in the patient is supported by the administration of high-dose IL-2. Although effective, there is a need for enhancement of TIL-ACT in terms of effectiveness and toxicity. Most of the toxicity in this multistep, complex treatment regimen is due to the preparative chemotherapy and high-dose IL-2 treatment. At University Hospital Basel, we are currently evaluating an experimental approach of TIL-ACT in which we replace high-dose IL-2 by in vivo tumour-infiltrating lymphocyte activation with ANV419, a novel antibody-cytokine fusion protein consisting of IL-2 fused to an anti-IL-2 monoclonal antibody, in an ongoing phase I trial (BaseTIL-03M). The primary endpoint of the study is safety.

    We herein describe the case of a patient included in the BaseTIL-03M trial with chronic inflammatory demyelinating polyneuropathy who received TIL-ACT with ANV419 and developed an acute polyneuropathy of Guillain-Barré syndrome.

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