RESUMO
BACKGROUND: The association of physical activity (PA) and lung function (LF) varies from no measurable effect to delayed LF decline. We assessed the association between accelerometery-assessed PA and LF in a sample of apparently healthy, community-dwelling subjects. METHODS: We included two cross-sectional studies using data from the PneumoLaus study (2014-17 and 2018-21), conducted in Lausanne, Switzerland. PA was assessed by accelerometry and categorised as inactivity, light, moderate or vigorous. Forced expiratory volume in 1 second (FEV1), forced volume capacity (FVC) and maximal mid-expiratory flow (MMEF) were measured by spirometry and expressed in percentage of predicted value (PV). RESULTS: Overall, 1'910 (54.7% women, 62.0 ± 9.7 years) and 1'174 (53.4% women, 65.8 ± 9.5 years) participants were included in the first and the second surveys, respectively. In both surveys, moderate and vigorous PA showed a weak but significant correlation with FEV1 in percentage (PV) (R = 0.106 and 0.132 for the first and 0.111 and 0.125 for the second surveys, p < 0.001). Similar correlations with FVC (p < 0.001) were found. Associations held irrespective of smoking status and remained after multivariable adjustment. Fewer associations were detected between LF and light PA or between MMEF and PA. CONCLUSION: Moderate and vigorous intensity PA are associated with increased LF regardless of smoking status in apparently healthy community-dwelling European population. These associations are statistically but not clinically significant due to the small correlation coefficients (R < 0.30), corresponding to a weak association.
Assuntos
Vida Independente , Pulmão , Humanos , Feminino , Masculino , Capacidade Vital , Estudos Transversais , Volume Expiratório Forçado , Espirometria , Exercício FísicoRESUMO
Imposture syndrome is widespread among physicians and medical students. It is defined as a psychological experience in which people doubt their own skills and achievements despite proven successes and thus have an unfounded fear of being found out. This can have serious consequences, such as anxiety and/or depressive disorders, and can lead to burn-out. The Clance scale is a self-assessment tool used to measure the level of imposture experienced and, when appropriate, to assess the suffering caused. The aim of this article is to help recognise this syndrome, which is one way of preventing it.
Le syndrome d'imposture est largement répandu chez les médecins et les étudiant-e-s en médecine. Il est défini comme une expérience psychologique où l'individu, malgré des succès démontrés, doute de ses compétences et réussites et, ainsi, éprouve une crainte infondée d'être démasqué. D'importantes conséquences comme des troubles anxieux et/ou dépressifs associés à un burnout peuvent en découler. L'échelle de Clance est un outil d'autoévaluation permettant de mesurer le niveau d'imposture ressenti et, le cas échéant, d'en évaluer la souffrance engendrée. Le but de cet article est d'aider à reconnaître ce syndrome, ce qui constitue l'un des axes de sa prévention.
Assuntos
Transtornos de Ansiedade , Autoimagem , Humanos , Ansiedade/etiologia , MedoRESUMO
In hospitals, many different professions work together with the same goal: optimal patient care. This challenge requires effective coordination and communication as well as good knowledge of each other's work. Due to an ever-increasing administrative workload and a large patient flow, time dedicated to this interprofessional collaboration is dwindling. Some hospitals, particularly in North America, have been using lean management concepts for some years, as an organizational aid and aiming at continuous improvement. A cockpit is a tool that aims at dedicating a space and a period of time to interprofessional communication and collaboration.
Au sein d'un hôpital, de nombreux corps de métiers travaillent ensemble dans un même but : la prise en charge optimale des patients. Ce défi nécessite une coordination et une communication performantes ainsi qu'une bonne connaissance du travail de chacun. En raison d'un travail administratif en constante augmentation et d'un flux de patients important, le temps dédié à cette collaboration interprofessionnelle s'amenuise. Certains hôpitaux, notamment en Amérique du Nord, utilisent depuis quelques années des concepts issus du « lean management ¼, comme aide organisationnelle et dans une perspective d'amélioration continue. Un « cockpit ¼ ou « salle de pilotage ¼ est un outil qui a pour but de consacrer un espace et une période de temps à la communication et à la collaboration interprofessionnelle.
Assuntos
Comportamento Cooperativo , Relações Interprofissionais , Humanos , ComunicaçãoRESUMO
Efficient management of hospitalized patients requires carefully planning each stay by taking into account patients' pathologies and hospital constraints. Therefore, the ability to accurately estimate length of stays allows for better interprofessional tasks coordination, improved patient flow management, and anticipated discharge preparation. This article presents how we built and evaluated a predictive model of length of stay based on clinical data available upon admission to a division of internal medicine. We show that Machine Learning-based approaches can predict lengths of stay with a similar level of accuracy as field experts.
Une prise en charge efficiente des patients nécessite une planification minutieuse des soins en fonction de la pathologie et des contraintes hospitalières. Dans ce contexte, une estimation de la durée de séjour permet de mieux coordonner les tâches interprofessionnelles, de gérer le flux des patients et d'anticiper la préparation à la sortie. Cet article présente la construction et l'évaluation d'un modèle prédictif de la durée de séjour à l'aide de données cliniques présentes à l'admission dans un service de médecine interne universitaire. Nous démontrons que les approches basées sur le Machine Learning sont capables de prédire des durées de séjour avec une performance similaire à celle des professionnels.
Assuntos
Inteligência Artificial , Hospitalização , Humanos , Medicina Interna , Tempo de Internação , Alta do PacienteRESUMO
BACKGROUND: In a hospital setting and among older patients, inactivity and bedrest are associated with a wide range of negative outcomes such as functional decline, increased risk of falls, longer hospitalization and institutionalization. Our aim was to assess the distribution, determinants and predictors of physical activity (PA) levels using wrist-worn accelerometers in older patients hospitalized with acute medical illness. METHODS: Observational study conducted from February to November 2018 at an acute internal medicine unit in the University hospital of Lausanne, Switzerland. We enrolled 177 patients aged ≥65 years, able to walk prior to admission. PA during acute hospital stay was continuously recorded via a 3D wrist accelerometer. Clinical data was collected from medical records or by interview. Autonomy level prior to inclusion was assessed using Barthel Index score. PA levels were defined as < 30 mg for inactivity, 30-99 mg for light and ≥ 100 for moderate PA. Physically active patients were defined as 1) being in the highest quartile of time spent in light and moderate PA or 2) spending ≥20 min/day in moderate PA. RESULTS: Median [interquartile range - IQR] age was 83 [74-87] years and 60% of participants were male. The median [IQR] time spent inactive and in light PA was 613 [518-663] and 63 [30-97] minutes/day, respectively. PA peaked between 8 and 10 am, at 12 am and at 6 pm. Less than 10% of patients were considered physically active according to definition 2. For both definitions, active patients had a lower prevalence of walking aids and a lower dependency level according to Barthel Index score. For definition 1, use of medical equipment was associated with a 70% reduction in the likelihood of being active: odds ratio (OR) 0.30 [0.10-0.92] p = 0.034; for definition 2, use of walking aids was associated with a 75% reduction in the likelihood of being active: OR = 0.24 [0.06-0.89], p = 0.032. CONCLUSION: Older hospitalized patients are physically active only 10% of daily time and concentrate their PA around eating periods. Whether a Barthel Index below 95 prior to admission may be used to identify patients at risk of inactivity during hospital stay remains to be proven.
Assuntos
Acelerometria/métodos , Exercício Físico/fisiologia , Hospitalização/estatística & dados numéricos , Pacientes Internados , Idoso , Feminino , Humanos , Masculino , Monitorização Fisiológica , Suíça , Fatores de Tempo , Caminhada , Dispositivos Eletrônicos Vestíveis , PunhoRESUMO
Immune checkpoint inhibitors have radically changed oncology by significantly improving prognosis and survival of many patients, even at an advanced or metastatic stage. Some patients undergoing immunotherapy develop adverse immune-related events, presenting a toxicity spectrum that can affect any organ, separately or simultaneously, with different intensities depending on the treatment used and patient characteristics. We hereby suggest a diagnostic and therapeutic approach that any internist, general practitioner or emergency doctor should have facing digestive, cardiac and pulmonary toxicities.
Les inhibiteurs de points de contrôle immunitaire (IPCI) ont radicalement changé la prise en charge oncologique en améliorant significativement le pronostic ainsi que la survie de nombreux patients, même à un stade avancé ou métastatique. Une partie des patients traités peuvent développer des effets indésirables immunomédiés avec un spectre de toxicités pouvant atteindre tous les organes, de façon isolée ou simultanée, avec une sévérité et une chronologie variables en fonction du traitement utilisé et des caractéristiques de chaque patient. Nous proposons ici la conduite à tenir du médecin interniste, généraliste ou urgentiste devant les toxicités digestives, cardiaques et pulmonaires.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Clínicos Gerais , Imunoterapia/efeitos adversos , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Humanos , Fatores Imunológicos , Neoplasias/patologia , PrognósticoRESUMO
The SARS-CoV-2 pandemic is putting our healthcare system under exceptional pressure, given the number of affected patients. In a context of limited human healthcare resources, senior medical students represent a valuable workforce that can quickly be mobilized for patient care. This is the approach followed in Switzerland and other countries, in several outpatient structures or inpatient services, including the Department of Internal Medicine, of the Lausanne University Hospital (CHUV). In this article, we first give the floor to students who responded to our call. We conclude with important considerations in terms of students' clinical supervision. It is reminded that the involvement of students in the care of COVID-19 patients should only occur on a vo luntary basis.
La pandémie de COVID-19 met notre système de santé sous une pression exceptionnelle, au vu du nombre de patient·e·s atteint·e·s. Dans un contexte de ressources humaines médico-soignantes limitées, les étudiant·e·s en médecine avancé·e·s dans leur cursus représentent un renfort très précieux, rapidement mobilisable auprès des patient·e·s. C'est la démarche suivie en Suisse et ailleurs dans le monde par diverses structures ambulatoires ou services hospitaliers, dont le Service de médecine interne du Centre hospitalier universitaire vaudois (CHUV). Dans cet article, nous donnons tout d'abord la parole aux étudiant·e·s qui ont répondu à notre appel. Nous terminons par des considérations importantes quant à l'accueil et l'accompagnement de ces étudiant·e·s. Il est rappelé que l'engagement d'étudiant·e·s auprès de patient·e·s souffrant de COVID-19 devrait se faire sur une base volontaire uniquement.
Assuntos
Infecções por Coronavirus , Mão de Obra em Saúde , Pandemias , Pneumonia Viral , Estudantes de Medicina , Betacoronavirus , COVID-19 , Competência Clínica , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Motivação , Assistência ao Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , SARS-CoV-2 , SuíçaRESUMO
The rapid progression of COVID-19 is an organizational challenge for all hospitals. To secure the patient overflow, the Department internal medicine of the University Hospital of Lausanne increased nurse and medical workforces as well as bed capacity by 65â %, with extraordinary help from other departments. The implemented crisis management stood upon three pillarsâ : a crisis management team, steering documents and internal communication. In this new form, the Department had already taken care of 442 COVID-19 admissions by April 16, 2020. Alongside organizational challenges, clinical issues such as rapid respiratory distress, clinical suspicions with negative PCR and treatment uncertainties in the absence of sufficient evidence were overcome. Despite the peak of the pandemic appearing to have passed, the next phase could be just as complicated.
La progression rapide du COVID-19 constitue un défi organisationnel pour tous les hôpitaux. Pour anticiper un afflux important de patients, le service de médecine interne du CHUV a ainsi augmenté ses forces de travail médico-soignantes et son nombre de lits de 65â % avec un soutien extraordinaire de toute l'institution. Pour opérer ces changements majeurs, l'organisation de crise mise en place s'est appuyée sur trois piliersâ : une cellule de conduite, des documents de pilotage et une communication interne. Sous cette nouvelle forme, le service a pris en charge 442 hospitalisations COVID-19 jusqu'au 16 avril 2020. Si les enjeux organisationnels ont été majeurs, la gestion des situations complexes, comme les manifestations respiratoires et les multiples incertitudes cliniques diagnostiques et thérapeutiques, ont été également une gageure. Le pic de la pandémie semble passé, mais la prochaine phase pourrait constituer un nouveau défi organisationnel.
Assuntos
Betacoronavirus , Infecções por Coronavirus , Gestão de Recursos da Equipe de Assistência à Saúde , Pandemias , Pneumonia Viral , Centros de Atenção Terciária/organização & administração , COVID-19 , Infecções por Coronavirus/epidemiologia , França , Humanos , Pneumonia Viral/epidemiologia , SARS-CoV-2RESUMO
Many diseases affect the oral cavity. Therefore, the mouth is an organ that internists should observe carefully. Hereafter we present five illustrations of oral semiology that reflect a systemic condition: a strawberry tongue, an ulceration, a labial lesion, a gingival hyperplasia and a gingival hyperpigmentation. Each time, a differential diagnosis is to be considered, potentially allowing the identification of severe diseases.
Un grand nombre de pathologies ont une répercussion sur la sphère buccale. Pour l'interniste, la bouche est par conséquent un organe à observer soigneusement. Nous présentons cinq illustrations de sémiologie buccale qui traduisent une affection systémiqueâ : une langue framboisée, une ulcération, une lésion labiale, une hyperplasie gingivale et une hyperpigmentation gingivale. À chaque fois, un diagnostic différentiel doit être évoqué, permettant potentiellement l'identification de maladies sévères.
Assuntos
Medicina Interna/métodos , Doenças da Boca/complicações , Doenças da Boca/diagnóstico , Boca/patologia , Diagnóstico Diferencial , Humanos , Doenças da Boca/patologia , Mucosa Bucal/patologiaRESUMO
2018 has continued to bring important progress in all areas of internal medicine, impacting our daily practice. From bezafibrate in primary biliary cholangitis to the new Clostridioides difficile guidelines, passing by use of procalcitonine, cristalloids, copeptin and how to administer furosemide, internal medicine journals are full of novelties. Every year, the chief residents of the CHUV internal medicine ward meet up to share their readings : here is their selection of 12 articles, chosen, summarized and commented for you.
L'année 2018 a vu d'importants progrès dans tous les domaines de la médecine interne, avec un impact important sur notre pratique quotidienne. Du bézafibrate dans la cholangite biliaire primitive aux nouvelles recommandations pour le traitement du Clostridioides difficile en passant par l'utilisation de la procalcitonine, des cristalloïdes, de la copeptine et du mode d'administration du furosémide, les nouveautés abondent dans la littérature. Chaque année, les chefs de clinique du Service de médecine interne du Centre hospitalier universitaire vaudois (CHUV) se réunissent pour partager leurs lectures : voici une sélection de 12 articles choisis, revus et commentés pour vous.
Assuntos
Medicina Interna , Medicina Interna/tendências , EditoraçãoRESUMO
The hospital discharge letter is an important tool for transmitting medical information during the transition from inpatient to outpatient care. It promotes continuity of care, as well as quality and safety of medical care. Nevertheless, several challenges exist within a university hospital department that may make it difficult to transmit these documents in a timely manner. In this article we describe a project to improve the quality and rapidity of the transmission of discharge letters in our internal medicine department, composed of organizational and formative measures.
La lettre de sortie d'hospitalisation est un important outil de transmission d'informations médicales lors de la transition entre les soins hospitaliers et ambulatoires. Elle favorise la continuité des soins, ainsi que la qualité et la sécurité de la prise en charge médicale. Néanmoins, au sein d'un service hospitalier universitaire existent plusieurs défis pouvant empêcher la transmission de ces documents dans les délais adéquats. Dans cet article, nous décrivons un projet d'amélioration de la qualité et de la temporalité de la transmission des lettres de sortie dans notre service de médecine interne, composé de mesures organisationnelles et formatives.
Assuntos
Assistência Ambulatorial , Continuidade da Assistência ao Paciente , Alta do Paciente , Departamentos Hospitalares , Hospitais , HumanosRESUMO
2017 has continued to bring important progress in all areas of internal medicine, impacting our daily practice. From bedside screening for beta-lactam allergies, to statins as primary prevention in the elderly, SGLT2 inhibitors in heart failure, azithromycin in severe asthmatics and tofacitinib in ulcero-haemorrhagic recto-colitis, internal medicine journals are full of novelties. Every year, the chief residents of the CHUV internal medicine ward meet up to share their readings: here is their selection of eleven articles, chosen, summarized and commented for you.
L'année 2017 a vu d'importants progrès dans tous les domaines de la médecine interne, avec un impact important sur notre pratique quotidienne. Du dépistage au lit du patient des allergies aux bêta-lactames, aux statines en prévention primaire chez les personnes âgées, en passant par l'utilisation des inhibiteurs SGLT2 dans l'insuffisance cardiaque, de l'azithromycine chez les asthmatiques sévères et du tofacitinib en cas de rectocolite ulcéro-hémorragique (RCUH), les nouveautés abondent dans la littérature. Chaque année, les chefs de clinique du Service de médecine interne du Centre hospitalier universitaire vaudois (CHUV) se réunissent pour partager leurs lectures : voici une sélection de onze articles choisis, revus et commentés pour vous.
Assuntos
Medicina Interna , BibliometriaRESUMO
The year 2016 was rich in significant advances in all areas of internal medicine. Many of them have an impact on our daily practice in general internal medicine. From the treatment of NSTEMI in population older than 80, to new sepsis and septic shock criteria to antidotes of new oral anticoagulants, this selection offers to the readers a brief overview of the major advances. The chief residents in the Service of internal medicine of the Lausanne University hospital are pleased to share their readings.
L'année 2016 a été riche en avancées importantes dans tous les domaines de la médecine. L'impact de ces avancées sera palpable dans notre pratique en médecine interne générale. De la prise en charge du NSTEMI (infarctus myocardique sans élévation ST) dans la population des plus de 80 ans, aux nouveaux critères du sepsis et du choc septique, aux antidotes des nouveaux anticoagulants oraux en passant par la déprescription médicamenteuse, les nouveautés dans la littérature ont été abondantes. Chaque année, les chefs de clinique du Service de médecine interne du Centre hospitalier universitaire vaudois (CHUV) se réunissent pour partager leurs lectures. Onze de leurs choix sont ici revus et commentés.
Assuntos
Hospitais Universitários/tendências , Medicina Interna/tendências , Internato e Residência/tendências , Medicina Geral/métodos , Medicina Geral/tendências , Humanos , Medicina Interna/métodos , Internato e Residência/métodosRESUMO
In 2015 a computer-based system of incident reporting was implemented in our hospital. Since then our department has successfully managed this reporting process with a constant interest shown by our staff (1 report / 100 days of hospitalization which equals nearly 2 reports a day). All incidents are analyzed. Some are then chosen for their impact and improvement potential and presented to hospital staff at monthly morbidity and mortality (M&M) conferences or published as clinical cases. This puts emphasis on the reporting process and on suggested practical changes. The current challenge is to transform these ideas into daily improvements and to find the necessary resources to report and analyze the more complex incidents.
Introduite en 2015, la gestion des événements critiques et indésirables recueillis par un système informatisé (application informatique RECI) se poursuit dans notre service, avec un intérêt constant des collaborateurs (1 événement / 100 jours d'hospitalisation, soit presque 2 événements / jour). Tous les événements sont analysés. Quelques-uns, choisis selon leur impact et leur potentiel d'amélioration pratique, sont transmis aux collaborateurs sous forme de colloques morbidité-mortalité (M&M) ou de vignettes cliniques. Ceci permet de valoriser les signalements et de proposer des modifications pratiques. Le défi actuel consiste à transformer ces propositions en actions concrètes et à trouver les ressources nécessaires pour la déclaration et l'analyse des situations les plus compliquées.
Assuntos
Sistemas de Informação Hospitalar , Erros Médicos/estatística & dados numéricos , Gestão de Riscos/métodos , Hospitais , Humanos , Erros Médicos/prevenção & controle , Recursos Humanos em HospitalRESUMO
Background: Moderate-intensity physical activity (PA) is recommended for health benefits, but optimal PA timing regarding cardiovascular disease (CVD) is debated. Objectives: The authors assessed the impact of differing PA patterns on CVD risk factors and outcomes. Methods: Data from 2 surveys (S1 and S2) of the CoLaus-PsyCoLaus study (2,465 and 1,692 participants, respectively; 55.3% [54.3%] females; mean age 61.2 ± 9.7 years [64.4 ± 9.5]), conducted in Lausanne, Switzerland. PA was assessed using a wrist-worn accelerometer, and PA patterns were assessed using K-means clustering. Results: Morning PA was positively associated with hypertension (multivariable-adjusted OR: 1.36 [95% CI: 1.00-1.84]) in S1, similar trend in S2. No significant association was found between PA clusters and total, HDL-, and LDL-cholesterol or triglycerides. Morning PA was positively associated with hypolipidemic drug treatment: 1.88 (1.07-3.30) in S2. Evenly distributed daily PA was positively associated with diabetes: 1.82 (95% CI: 1.06-3.12) in S2, with a similar trend in S1. In the outcome analysis, the early morning PA cluster (7 am-12 am) and the evenly distributed daily PA cluster led to a higher risk of CVD events (HR: 3.33 [95% CI: 1.08-10.3] and 3.16 [95% CI: 1.04-9.57], respectively). Conclusions: In a population-based study, we observed a higher risk for cardiovascular events in participants whose daily PA occurred predominantly in the early morning (7 am-12 am) or was evenly distributed throughout the day. No PA pattern was consistently associated with hypertension, blood lipids, or diabetes markers.
RESUMO
BACKGROUND & AIMS: Vitamins are essential nutrients, taken in very small amounts (0.01-100 mg a day). Associations between vitamin supplement intake or status and the immune system are far from consensual. Our aim was to understand the association between vitamin supplements and the immune system, namely regarding lymphocyte count and immunoglobulin levels against infectious pathogens. METHODS: Cross-sectional study using data from the first follow-up of the CoLaus|PsyCoLaus study (April 2009 to September 2012). Participants were categorized as vitamin users and non-users. Serostatus for 15 viruses, six bacteria, and one parasite was assessed. Data for inflammatory markers (hs-CRP, IL-1ß, IL-6, and TNF-α) and blood elements were also collected. RESULTS: Of the initial 5064 participants, 3769 (74.5 %, mean age 58.3 ± 10.5 years, 53.6 % women) were retained for serostatus. On bivariate analysis, participants taking vitamins presented with higher positivity levels in three markers and lower positivity levels in two, but those differences were no longer statistically significant after multivariable analysis. 4489 participants (88.6 %, mean age 57.7 ± 10.5 years, 53.2 % women) had data for inflammatory markers; no association was found between vitamin supplement use and inflammatory markers both on bivariate and multivariable analysis. Finally, 3349 participants (66.1 %, mean age 57.3 ± 10.3 years, 53.1 % women) had data for blood elements; on bivariate analysis, vitamin supplement users had lower levels of haemoglobin and lymphocytes, but those differences were no longer significant after multivariable adjustment. CONCLUSION: In this cross-sectional, population-based study, we found no association between vitamin supplement use and markers of immune status.
Assuntos
Suplementos Nutricionais , Vitaminas , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Estudos Transversais , Vitamina A , Proteína C-ReativaRESUMO
We thank the authors of the commentary [...].
Assuntos
Dieta Mediterrânea , Lipídeos , Humanos , Lipídeos/sangueRESUMO
INTRODUCTION: The first COVID-19 wave (2020), W1, will remain extraordinary due to its novelty and the uncertainty on how to handle the pandemic. To understand what physicians went through, we collected narratives of frontline physicians working in a Swiss university hospital during W1. METHODS: Physicians in the Division of Internal Medicine of Lausanne University Hospital (CHUV) were invited to send anonymous narratives to an online platform, between 28 April and 30 June 2020. The analysed material consisted of 13 written texts and one audio record. They were examined by means of a narrative analysis based on a holistic content approach, attempting to identify narrative highlights, referred to as foci, in the texts. RESULTS: Five main foci were identified: danger and threats, acquisition of knowledge and practices, adaptation to a changing context, commitment to the profession, and sense of belonging to the medical staff. In physicians' narratives, danger designated a variety of rather negative feelings and emotions, whereas threats were experienced as being dangerous for others, but also for oneself. The acquisition of knowledge and practices focus referred to the different types of acquisition that took place during W1. The narratives that focused on adaptation reflected how physicians coped with W1 and private or professional upheavals. COVID-19 W1 contributed to revealing a natural commitment (or not) of physicians towards the profession and patients, accompanied by the concern of offering the best possible care to all. Lastly, sense of belonging referred to the team and its reconfiguration during W1. CONCLUSIONS: Our study deepens the understanding of how physicians experienced the pandemic both in their professional and personal settings. It offers insights into how they prepared and reacted to a pandemic. The foci reflect topics that are inherent to a physician's profession, whatever the context. During a pandemic, these foundational elements are particularly challenged. Strikingly, these topics are not studied in medical school, thus raising the general question of how students are prepared for the medical profession.
Assuntos
COVID-19 , Médicos , Humanos , Suíça , Médicos/psicologia , Medicina Interna , Hospitais UniversitáriosRESUMO
High adherence to the Mediterranean diet (MD) has been associated with lower incidence of cardiovascular disease, increased HDL-cholesterol levels, and decreased triglycerides (TG), and total and LDL cholesterol levels. We aimed to assess the association of MD adherence at baseline with the lipid profile both cross-sectionally and prospectively in a sample of apparently healthy community-dwelling subjects. We conducted three cross-sectional studies using data from follow-ups 1 (FU1, 2009-2012), 2 (FU2, 2014-2017), and 3 (FU3, 2018-2021) of CoLaus|PsyCoLaus, a population-based sample from Lausanne, Switzerland. Dietary intake was assessed with a food frequency questionnaire. Two MD scores (Trichopoulou and Vormund) were computed, ranging from 0 (low) to 9 (high). In total, LDL and HDL cholesterol and TG were assessed. Incident dyslipidemia was defined as hypolipidemic treatment at FU2 or FU3. Overall, 4249 participants from FU1 (53.7% women, 57.6 ± 10.5 years, Trichopoulou 4.0 ± 1.5, Vormund 4.7 ± 1.9) were included. Neither MD score correlated significantly with the lipid markers and similar results were obtained according to the hypolipidemic status. Among the 3092 untreated FU1 participants with FU2 and FU3 data, 349 (11.3%) developed dyslipidemia by FU2 or FU3. No difference in MD scores was found between participants who developed dyslipidemia and those who did not (4.1 ± 1.5 vs. 4.0 ± 1.5 and 4.8 ± 1.8 vs. 4.8 ± 1.9 for Trichopoulou and Vormund, respectively, p > 0.05). Finally, no associations were found between MD score and lipid changes at 5 or 10 years. Contrary to other studies, adherence to MD at baseline did not show any significant effects on lipid composition/incident dyslipidemia in Colaus|PsyCoLaus participants.