[Clinical experience of an offloading orthosis to prevent and heal diabetic foot ulcers of the digits]. / Expérience clinique d'une orthèse de décharge pour prévenir et guérir les ulcères digitaux du pied diabétique.

Globally, every 30 seconds a lower limb amputation is carried out due to diabetes, in 85 % of cases preceded by a foot ulcer. One of the main causes of foot ulcer formation is abnormal mechanical pressure and shear, the alleviation of which is therefore a key element in the management of diabetic foot ulcers. The toes, often neglected in routine clinical examinations, are particularly vulnerable because of the thin soft tissue between the bones and the skin and because of trauma due to ill-fitting shoes. The orthosis described in this article provides effective protection of protruding and injured areas while being comfortable to wear with everyday shoes and compatible with an active lifestyle. When correctly designed, worn and monitored, it has the potential to prevent and heal diabetic ulcers of the Hallux and the lesser toes.

Toutes les 30 secondes, une personne dans le monde subit une amputation du membre inférieur due au diabète, précédée dans 85 % des cas d'un ulcère au pied. L'allègement d'une pression mécanique néfaste est un élément clé dans la prise en charge du pied diabétique. Les orteils, souvent négligés dans l'examen clinique, sont particulièrement vulnérables en raison de la minceur des tissus mous entre les os et la peau et à cause des chaussures potentiellement nuisibles car inadaptées à la forme et au volume de l'avant-pied. L'orthèse de décharge décrite dans cet article assure une protection efficace des zones saillantes et lésées tout en étant confortable à porter et compatible avec une vie active. Conçue et portée correctement, elle a le potentiel de prévenir et guérir les ulcères digitaux du pied diabétique.

Flood resilience, amenity and biodiversity benefits of an historic urban pond.

The main pond within the historic Royal Botanic Garden Edinburgh is an important component of urban blue-green infrastructure. This paper reports on flood resilience provided by the pond (simulated using the CityCAT hydrodynamic model), its water residence times (obtained using the Shetran hydrological model), and the ecology and biodiversity (vascular plants, bryophytes, aquatic invertebrates, phyto- and zooplankton, birds) of the pond and the adjacent area. The results show that the pond improves the flood resilience with at least a 27% reduction in the peak discharge during a 1 h, one in 100-year event. The area represents a biodiversity hot spot with a range of native taxa occurring among introduced plant species. The plankton community is dominated by diatoms, reflecting elevated levels of turbulence and a relatively short residence time, with an average value of 10 days. Analysis of macroinvertebrate community indicates a potential for water quality improvement. The results are discussed in relation to multiple societal benefits related to flood resilience, recreation, education, water quality, amenity and biodiversity value. The conclusions may prove particularly valuable for introducing practical measures in the water catchment, preventing waterlogging of the soil and ensuring an uninterrupted supply of public services. This article is part of the theme issue 'Urban flood resilience'.

HIA in Switzerland: strategies for achieving Health in All Policies.

Summary: The purpose of this article is to review the status of Health Impact Assessment (HIA) in Switzerland and assess whether HIA can be used to implement Health in All Policies (HiAP) in this highly decentralized country. The methods include expert opinion and an extensive literature review, as well as targeted interviews with key informers in the cantons of Geneva, Jura and Ticino. HIA has been implemented successfully since the early 2000s in Switzerland. However, integration has been heterogeneous with only a few cantons taking the lead. Integration of HIA at the federal level was attempted in 2012 but failed due to resistance from a pro-business lobby. HIA in Switzerland has the potential to contribute to HiAP, but success depends on a wider dissemination of HIA and on some form of integration at the national level. In this respect, a 'bottom-up' approach based on inter-cantonal collaborations appears more promising than the 'top-down' federal level approach.

The role of health impact assessment in Phase V of the Healthy Cities European Network.

Health impact assessment (HIA) is a prospective decision-making aid tool that aims to improve the quality of policies, programmes or projects through recommendations that promote health. It identifies how and through which pathways a decision can impact a wide range of health determinants and seeks to define the distribution of effects within populations, thereby raising the issue of equity. HIA was introduced to the WHO European Healthy Cities Network as one of its four core themes during the Phase IV (2004-08). Here we present an evaluation of the use of HIA during Phase V (2009-13), where HIA was linked with the overarching theme of health and health equity in all local policies and a requirement regarding capacity building. The evaluation was based on 10 case studies contributed by 9 Healthy Cities in five countries (France, Hungary, Italy, Spain and the UK). A Realist Evaluation framework was used to collect and aggregate data obtained through three methods: an HIA factors analysis, a case-study template analysis using Nvivo software and a detailed questionnaire. The main conclusion is that HIA significantly helps promote Health in All Policies (HiAP) and sustainability in Healthy Cities. It is recommended that all Healthy City candidates to Phase VI (2014-18) of the WHO Healthy Cities European Network effectively adopt HIA and HiAP.

Implementation and impact of anti-smoking interventions in three prisons in the absence of appropriate legislation.

OBJECTIVE: To assess the acceptability and impact of anti-smoking policies in three prisons in Switzerland. METHODS: A before-after intervention study in A) an open prison for sentenced prisoners, B) a closed prison for sentenced prisoners, and C) a prison for pretrial detainees. Prisoners and staff were surveyed before (2009, n=417) and after (2010-2011, n=228) the interventions. Medical staff were trained to address tobacco dependence systematically in prisoners. In prison A, a partial smoking ban was extended. No additional protection against second-hand smoke was feasible in prisons B and C. RESULTS: In prison A, more prisoners reported receiving medical help to quit smoking in 2011 (20%) than in 2009 (4%, p=0.012). In prison A, prisoners and staff reported less exposure to second-hand smoke in 2011 than in 2009: 31% of prisoners were exposed to smoke at workplaces in 2009 vs 8% in 2011 (p=0.001); in common rooms: 43% vs 8%, (p<0.001). No changes were observed in prisons B and C. CONCLUSIONS: Reinforcement of non-smoking rules was possible in only one of the three prisons but had an impact on exposure to tobacco smoke and medical help to quit. Implementing anti-smoking policies in prisons is difficult in the absence of appropriate legislation.

Integrating Self-Management Education and Support in Routine Care of People With Type 2 Diabetes Mellitus: A Conceptional Model Based on Critical Interpretive Synthesis and A Consensus-Building Participatory Consultation.

The integration of self-management education and support into the routine diabetes care is essential in preventing complications. Currently, however, there is no consensus on how to conceptualise integration in relation to self-management education and support. Therefore, this synthesis presents a framework conceptualising integration and self-management. Methods: Seven electronic databases (Medline, HMIC, PsycINFO, CINAHL, ERIC, Scopus and Web of Science) were searched. Twenty-one articles met the inclusion criteria. Data were synthesised using principles of critical interpretive synthesis to build the conceptual framework. The framework was presented to 49 diabetes specialist nurses working at different levels of care during a multilingual workshop. Results: A conceptual framework is proposed in which integration is influenced by five interacting components: the programme ethos of the diabetes self-management education and support intervention (content and delivery), care system organisation (the framework in which such interventions are delivered), adapting to context (the aspects of the people receiving and delivering the interventions), interpersonal relationship (the interactions between the deliverer and receiver of the intervention), and shared learning (what deliverer and receiver gain from the interactions). The critical inputs from the workshop participants related to the different priorities given to the components according to their sociolinguistic and educational experiences, Overall, they agreed with the conceptualisation of the components and their content specific to diabetes self-management education and support. Discussion: Integration was conceptualised in terms of the relational, ethical, learning, contextual adapting, and systemic organisational aspects of the intervention. It remains uncertain which prioritised interactions of components and to what extent these may moderate the integration of self-management education and support into routine care; in turn, the level of integration observed in each of the components may moderate the impact of these interventions, which may also apply to the impact of the professional training. Conclusion: This synthesis provides a theoretical framework that conceptualises integration in the context of diabetes self-management education and support in routine care. More research is required to evaluate how the components identified in the framework can be addressed in clinical practice to assess whether improvements in self-management education and support can be effectively realised in this population.

Psychological Responses and Strategies Towards the COVID-19 Pandemic Among Higher Education Students in Portugal and Switzerland: A Mixed-Methods Study.

Background: The COVID-19 pandemic has caused overwhelming changes in individual and community daily-life, resulting from the public health measures implemented to contain it, and also from its psychological and socio-economic consequences. These shifts and consequences impacted the entire population, but some groups are more likely to be affected by these changes, including higher education students. Objectives: a) to investigate mental health status and its determinants among higher-education students in Portugal and Switzerland; and b) to explore adjustment patterns used by these students to overcome the impact of the COVID-19 pandemic. Methods: A cross-sectional study with a mixed-methods sequential explanatory design was conducted in two phases. First, an online survey was conducted among higher education students in Portugal and Switzerland, in Portuguese and French respectively. A convenience sampling method was used. Second, some participants from the first phase were invited to participate in four online focus group discussions (two in each country) using a maximum variation sampling method. Results: The survey was answered by 1,880 students. Portuguese students revealed higher levels of stress and anxiety, but lower depression symptoms and less resilient coping compared to Swiss respondents. Hope was identified as an explanatory variable for mental health symptoms in students from both countries. In the focus groups (n = 27), 13 adjustment strategies were found, which were subdivided into three spheres: personal, social, and contextual. Conclusions: The results suggest that the COVID-19 pandemic had a mild to moderate impact on most of the evaluated mental health variables. Nevertheless, the students reacted and mobilized positive short-term strategies, which need to be reinforced in order to prevent long-term psychological harm. In addition, our results can inform psychosocial interventions to minimize psychological impact, anxiety, depression, and stress due to sanitary crises or other population-wide problems or disasters.

Migrant and refugee populations: a public health and policy perspective on a continuing global crisis.

The 2015-2017 global migratory crisis saw unprecedented numbers of people on the move and tremendous diversity in terms of age, gender and medical requirements. This article focuses on key emerging public health issues around migrant populations and their interactions with host populations. Basic needs and rights of migrants and refugees are not always respected in regard to article 25 of the Universal Declaration of Human Rights and article 23 of the Refugee Convention. These are populations with varying degrees of vulnerability and needs in terms of protection, security, rights, and access to healthcare. Their health status, initially conditioned by the situation at the point of origin, is often jeopardised by adverse conditions along migratory paths and in intermediate and final destination countries. Due to their condition, forcibly displaced migrants and refugees face a triple burden of non-communicable diseases, infectious diseases, and mental health issues. There are specific challenges regarding chronic infectious and neglected tropical diseases, for which awareness in host countries is imperative. Health risks in terms of susceptibility to, and dissemination of, infectious diseases are not unidirectional. The response, including the humanitarian effort, whose aim is to guarantee access to basic needs (food, water and sanitation, healthcare), is gripped with numerous challenges. Evaluation of current policy shows insufficiency regarding the provision of basic needs to migrant populations, even in the countries that do the most. Governments around the world need to rise to the occasion and adopt policies that guarantee universal health coverage, for migrants and refugees, as well as host populations, in accordance with the UN Sustainable Development Goals. An expert consultation was carried out in the form of a pre-conference workshop during the 4th International Conference on Prevention and Infection Control (ICPIC) in Geneva, Switzerland, on 20 June 2017, the United Nations World Refugee Day.

Is HIA the most effective tool to assess the impact on health of climate change mitigation policies at the local level? A case study in Geneva, Switzerland.

This study aims to understand how the health dimension is integrated into four impact assessment tools used in Geneva, Switzerland: environmental impact assessment (EIA), strategic environmental assessment (SEA), sustainability assessment (SA) and health impact assessment (HIA). We have chosen as a case study greenhouse gas (GHG) emissions reduction policies chosen by the city of Geneva. The methodological approach consists in analysing EIA, SEA, SA and HIA conducted on three projects in three topic areas: urban planning, heating and transportation. These projects are: a complex urbanisation plan in an urban neighbourhood in Geneva (the Gare des Eaux-Vives project), a sustainable transportation plan for a central district in Geneva (the St-Gervais transportation project) and a strategy to encourage the City's employees to use sustainable transport for local business travel. The results show some shortcomings in the consideration of health in SEA, EIA and SA. This work highlights a narrow vision of health in SEA and EIA, limiting itself to a review of the effects of projects on the determinants of the physical environment as required by the legislation relating to these tools. EIA does not require the integration of the health dimension. As for SA, our research found that health is treated much more superficially than in HIA and primarily through the analysis of 'health and safety' criteria. It appears from this work that HIA is the tool which provides the most elaborate assessment, compared to SA, SEA or EIA, of the consequences for health of the GHG reduction policies chosen by the local decision-makers of a city. However, our study suggests that the HIA community should identify the situations in which HIA should be carried out and in which cases it is better to include health issues within an integrated analysis.

Mercury toxicity presenting as chronic fatigue, memory impairment and depression: diagnosis, treatment, susceptibility, and outcomes in a New Zealand general practice setting (1994-2006).

In a group of 465 patients diagnosed as having chronic mercury toxicity (CMT), 32.3% had severe fatigue, 88.8% had memory loss, and 27.5% had depression. A significant correlation was found between CMT and the Apo-lipoprotein E4 genotype (p=0.001). An investigation into an additional 864 consecutively seen general practice patients, resulted in 30.3% having evidence consistent with CMT, and once again a significant correlation was found with the APO-E4 genotype (p=0.001). Removal of amalgam mercury fillings when combined with appropriate treatment resulted in a significant symptom reduction (p<0.001) to levels reported by healthy subjects.

Validation of English-language versions of three scales measuring attitudes towards smoking, smoking-related self-efficacy and the use of smoking cessation strategies.

AIMS: To assess the validity of English translations of three scales initially developed in French, measuring perception of the adverse effects of smoking, self-efficacy and the use of smoking cessation strategies. METHODS: Between 1999 and 2001, 5667 people from 97 countries (4724 smokers and 943 ex-smokers) answered the scales on the internet, of which 997 (18%) took part in a follow-up 86 days later. FINDINGS: The factor structures of the scales were generally maintained after translation. Internal consistency coefficients were 0.5-0.9. Test-retest reliability was >0.7 for the "Adverse effects" and self-efficacy scales, but was low (0.2-0.4) for self-change strategies, which probably reflects active use of these strategies in this sample. The translated scales performed adequately in most tests of construct validity. In particular, higher self-efficacy ratings predicted smoking cessation at follow-up, and a lower self-efficacy predicted relapse in baseline ex-smokers. CONCLUSION: The validity of the scales was maintained after translation in English.

Utilization and impact of cigarette pack covers illustrated with antismoking messages.

The authors tested whether smokers would use cigarette pack covers illustrated with antismoking messages. In 2001, visitors to a smoking cessation Web site ordered cigarette pack covers and answered a follow-up questionnaire 52 days later. Participants received by mail cardboard boxes designed to contain cigarette packs and illustrated with antismoking messages. Participants were 393 smokers living in France, Belgium, and Switzerland. Participants used their boxes for 21 days out of a possible 28 days, and 31% were still using them at follow-up. Almost one third (32%) said that the boxes often prompted discussions about smoking. The boxes that were submitted to pretests were preferred to the boxes that were not pretested. The authors concluded that the boxes were welcomed by smokers and enabled the display of antismoking messages for 3 weeks in their immediate environments. The intervention had no impact on smoking cessation, but this was not its primary objective.

Survey of the WHO-REMPAN network's capability for strengthening preparedness for radiological and nuclear emergencies.

This paper investigates the capacity of the World Health Organization (WHO)-REMPAN network in responding to radiological incidents and nuclear emergencies. A survey developed by the WHO Secretariat and Nagasaki University was sent to all 40 WHO-REMPAN collaborating centres and liaison institutes in order to verify the current situation of the network, identify needs and collect suggestions for future improvements. Most of the responding institutions said they were satisfied with the current status of the network. However, several responses to the survey indicate that better internal communication is needed, as well as a position document to specify the roles, rights and responsibilities of the network members.

A novel three-dimensional endoscopic ultrasound technique for the freehand examination of the oesophagus.

This study details the development and evaluation of a freehand radial three-dimensional endoscopic ultrasound (3D-EUS) technique for use in the upper gastro-intestinal tract. It comprised of a commercial EUS system, a custom acquisition system to simultaneous acquire radial B-mode images and corresponding incremental changes in position of the scope as it was withdrawn and a custom 3D-EUS package written in Matlab™, to reconstruct and analyse the volume. This technique was evaluated using an EUS phantom with embedded objects of known dimensions and volumes and with clinical images acquired during routine cancer staging. For the phantom measurements, average Z-dimensional error was <1% and volume errors were 1.4% (volume(1) = 48930 mm(3)) and 4.5% (volume(2) = 5100 mm(3)). Application of this technique to EUS acquired clinical images produced excellent characterisation of oesophageal structures and accurate dimension and volume measurements. It also enabled the endoscopist to review "off-line" the EUS examination in case important information was missed.

Global networking for biodosimetry laboratory capacity surge in radiation emergencies.

For the public health management of radiation emergencies, one of the essential components of integrated risk assessment is to quickly and accurately assess and categorize the exposure. In addition to other methods, biodosimetry is instrumental to support decision-making for: 1) efficient secondary triage in a hospital response phase; 2) multi-parameter approach for defining best-treatment strategies for those severely exposed; 3) clinical prognosis and assessment of risk; and 4) reassurance and psychological support for those potentially exposed, or "worried-well." In large-scale events, the number of victims, and especially those worried-well, is likely to overwhelm hospital and laboratory capacities in the accident area. This is already being addressed through the networking approach within several countries and/or regions of the world. The paper reports about WHO's activity toward coordination of these regional efforts and the international collaborative network of biodosimetry laboratory services, WHO BioDoseNet. The network includes more than 30 laboratories around the world and supports the implementation of the revised International Health Regulations, the scope of which since 2007 also covers the field of radionuclear incidents.