[Ukrainians Refugees: how to address their health needs in times of migration crisis?] / Réfugiés d'Ukraine : comment répondre à leurs besoins de santé en période de crise migratoire ?

February 2022: Russia attacks Ukraine. Anticipating the wave of refugees generated by this war, the Geneva University Hospitals create a Ukraine Task Force. In this context, the Programme Santé Migrants (PSM), a reference consultation for refugees, realises that it will not be able to cope with the number of those coming from Ukraine in addition to the others, and creates a parallel structure: the PSM bis. The article describes how it was set up and the challenges that were faced, in particular: express training of staff in ambulatory medicine in a context of migratory crisis, focus on early identification of mental health problems and their management. This experience highlights the importance of a coordinated, interdisciplinary, and culturally adapted approach to responding to a crisis situation.

Février 2022 : la Russie attaque l'Ukraine. Anticipant la vague de réfugiés générée par cette guerre, les Hôpitaux universitaires de Genève créent une Task Force Ukraine. Dans ce contexte, le Programme santé migrants (PSM), consultation de référence pour les réfugiés, réalise qu'il ne pourra pas faire face au nombre de ceux venant d'Ukraine en plus des autres et créé une structure parallèle : le PSM bis. L'article relate comment elle s'est mise en place et les défis qui ont été affrontés, notamment : formation express du personnel à la médecine ambulatoire dans un contexte de crise migratoire et focus sur l'identification précoce des problèmes de santé mentale et leur prise en charge. Cette expérience souligne l'importance d'une approche coordonnée, interprofessionnelle et culturellement adaptée, pour répondre à une situation de crise.

[New reimbursement criteria for vitamin D measurements: what about our migrant patients?] / Nouveaux critères de remboursement du dosage de la vitamine D : et nos patients migrants ?

Vitamin D deficiency is a global health burden, which has been subject to debate in recent years. Although its consequences on patients' general health are debatable, the association between severe vitamin D deficiency and osteomalacia are clearly established. Since the 1st of July 2022, blood testing in individuals who do not meet the recognized risk factors for deficiency is no longer reimbursed in Switzerland. Being a migrant (or refugee) does not constitute a risk factor even though it has repeated been shown that this population is at high risk of deficiency, in particular sever deficiency. This article aims to establish new recommendations for vitamin D deficiency diagnosis and substitution for this population. It is sometimes necessary to adapt our national recommendations to take into account our cultural diversity.

Le déficit en vitamine D est un problème de santé publique au cœur de l'actualité. Si les répercussions sur la santé générale des patients sont débattues, l'association entre déficit sévère et ostéomalacie est clairement établie. En Suisse, depuis le 1er juillet 2022, l'assurance obligatoire de soins ne rembourse plus son dosage sanguin, sauf si le patient présente des facteurs de risque avérés. Le fait d'être migrant (ou réfugié) n'est pas considéré comme l'un d'eux. Pourtant, plusieurs études attestent que cette population est à haut risque de déficit, notamment sévère. Cet article a pour but d'établir de nouvelles recommandations de dépistage et de substitution qui s'adaptent à cette population. Il est parfois nécessaire d'adapter les recommandations nationales pour prendre en compte la diversité culturelle populationnelle.

[Latest developments in the non-pharmacological treatment of depression - A more integrative approach]. / Nouveautés dans les traitements non pharmacologiques de la dépression - Place à une approche plus intégrative.

Non-pharmacological treatments of depression have become more widespread recently, especially for mild to moderate forms of depression. These complementary approaches are particularly interesting for patients who are reluctant to start an antidepressant. Novel approaches are found in psychotherapy, alternative treatments, plant-based treatments as well as the prevention of relapse through the use of digital tools. Some are even reimbursed by health insurance. However, these approaches are currently only applicable in combination with usual treatment, pharmacological or psychotherapy, as studies have shown that their efficiency in monotherapy is still limited.

L'intérêt pour les approches non pharmacologiques a augmenté ces dernières années dans la prise en charge des dépressions légères à modérées. Ces nouvelles approches sont intéressantes, notamment pour les patients qui peuvent être réticents à la prise d'un antidépresseur seul. Les nouveautés se trouvent dans les méthodes de psychothérapie, les traitements alternatifs, la phytothérapie ainsi que dans la prévention des rechutes par des outils digitaux. Certaines de ces approches sont remboursées par l'assurance-maladie obligatoire ou complémentaire. Néanmoins, elles restent des traitements complémentaires aux thérapies usuelles, soit pharmacologique et psychothérapeutique, car les preuves de leur efficacité en monothérapie sont encore limitées dans les études.

[Migrants in a vulnerable situation†: does their access to healthcare match their health needs†?] / Migrants en situation vulnérable†: leur accès aux soins correspond-il à leurs besoins de santé†?

At the beginning of the twenty-first century, migratory movements have never been so large and complex. After describing the risk factors influencing the health of migrants in vulnerable situations (asylum seekers, undocumented migrants), this article attempts to describe a holistic model of access to care for this type of population. It also develops a plea for equitable treatment of migrants in their host country, while respecting basic human rights and the independence of the medical profession.

En ce début de XXIe siècle, les mouvements migratoires n'ont jamais été aussi nombreux et complexes. Après avoir décrits les facteurs de risque influençant la santé des migrants en situation de vulnérabilité (demandeurs d'asile, sans-papiers), cet article s'attache à décrire un modèle holistique d'accès aux soins pour ce type de population. Il développe également un plaidoyer pour une prise en charge équitable des migrants dans leur pays d'accueil, dans le respect des droits humains fondamentaux et de l'indépendance de la profession médicale.

[Level of knowledge and behavior regarding HIV prevention in a population of migrants]. / Niveau de connaissances et comportement en matière de prévention du VIH au sein d'une population de migrants.

In Geneva an HIV voluntary counselling and testing (VCT) consultation for migrants exists in a primary care center. A semi-structured questionnaire, was filled out during the VCT consultations. 650 questionnaires were analyzed. 82 % were asylum seekers. 30 % said they did not really understand how HIV is transmitted and 27 % cited erroneous modes of contamination. 78 % of women who did not use condoms regularly gave having a stable partner as the reason compared to 49 % for men. VCT is a great prevention tool : the counseling accompanying the test provides an opportunity to openly raise various risk practices and to personalize the information. However, this requires a suitable and affordable structure.

A Genève, une consultation de conseil et test volontaire du VIH (VCT, Voluntary Counselling and Testing) pour migrants existe dans une structure de médecine de premier recours. Un questionnaire semi-structuré, servant aussi de guide d'entretien, est rempli durant ces consultations VCT. 650 questionnaires ont été analysés. 82 % sont demandeurs d'asile. 30 % déclarent ne pas vraiment comprendre les modes de transmission du VIH et 27 % citent des modes de contamination erronés. 78 % des femmes n'utilisent pas le préservatif systématiquement, et mentionnent pour motif le partenaire stable contre 49 % pour les hommes. Le VCT constitue un outil de prévention idéal : l'entretien accompagnant le test permet de discuter ouvertement sur les différentes pratiques à risque et individualiser l'information. Cependant, cela nécessite une structure adaptée, accessible financièrement.

Multi-year linkage and association mapping confirm the high number of genomic regions involved in oilseed rape quantitative resistance to blackleg.

KEY MESSAGE: A repertoire of the genomic regions involved in quantitative resistance to Leptosphaeria maculans in winter oilseed rape was established from combined linkage-based QTL and genome-wide association (GWA) mapping. Linkage-based mapping of quantitative trait loci (QTL) and genome-wide association studies are complementary approaches for deciphering the genomic architecture of complex agronomical traits. In oilseed rape, quantitative resistance to blackleg disease, caused by L. maculans, is highly polygenic and is greatly influenced by the environment. In this study, we took advantage of multi-year data available on three segregating populations derived from the resistant cv Darmor and multi-year data available on oilseed rape panels to obtain a wide overview of the genomic regions involved in quantitative resistance to this pathogen in oilseed rape. Sixteen QTL regions were common to at least two biparental populations, of which nine were the same as previously detected regions in a multi-parental design derived from different resistant parents. Eight regions were significantly associated with quantitative resistance, of which five on A06, A08, A09, C01 and C04 were located within QTL support intervals. Homoeologous Brassica napus genes were found in eight homoeologous QTL regions, which corresponded to 657 pairs of homoeologous genes. Potential candidate genes underlying this quantitative resistance were identified. Genomic predictions and breeding are also discussed, taking into account the highly polygenic nature of this resistance.

[Health risks linked to recent migratory patterns: myth or reality?]. / Risques sanitaires liés aux récents phénomènes migratoires: mythe ou réalité?

The migratory crisis currently faced by Europe is of exceptional magnitude since the Second World War. It is mainly related to the conflict in Syria, as well as recurring violations of human rights in other regions of the world. Widely relayed by the media, the unusual number of refugee applicants and the precariousness of their migration routes raise the question of the health risk. From the old concept of quarantine to the new paradigm of migrants' health, it is important to contextualize the screening measures, taking into account the epidemiology of communicable diseases in the countries of origin and of the regions crossed, the ruptures of access to treatments for chronic diseases, but also the impact of multiple trauma (war, violence) on the mental health of refugees.

Fleshing out vulnerability.

In the literature on medical ethics, it is generally admitted that vulnerable persons or groups deserve special attention, care or protection. One can define vulnerable persons as those having a greater likelihood of being wronged - that is, of being denied adequate satisfaction of certain legitimate claims. The conjunction of these two points entails what we call the Special Protection Thesis. It asserts that persons with a greater likelihood of being denied adequate satisfaction of their legitimate claims deserve special attention, care or protection. Such a thesis remains vague, however, as long as we do not know what legitimate claims are. This article aims at dispelling this vagueness by exploring what claims we have in relation to health care - thus fleshing out a claim-based conception of vulnerability. We argue that the Special Protection Thesis must be enriched as follows: If individual or group X has a greater likelihood of being denied adequate satisfaction of some of their legitimate claims to (i) physical integrity, (ii) autonomy, (iii) freedom, (iv) social provision, (v) impartial quality of government, (vi) social bases of self-respect or (vii) communal belonging, then X deserves special attention, care or protection. With this improved understanding of vulnerability, vulnerability talk in healthcare ethics can escape vagueness and serve as an adequate basis for practice.

Crossover rate between homologous chromosomes and interference are regulated by the addition of specific unpaired chromosomes in Brassica.

Recombination is a major mechanism generating genetic diversity, but the control of the crossover rate remains a key question. In Brassica napus (AACC, 2n = 38), we can increase the homologous recombination between A genomes in AAC hybrids. Hypotheses for this effect include the number of C univalent chromosomes, the ratio between univalents and bivalents and, finally, which of the chromosomes are univalents. To test these hypotheses, we produced AA hybrids with zero, one, three, six or nine additional C chromosomes and four different hybrids carrying 2n = 32 and 2n = 35 chromosomes. The genetic map lengths for each hybrid were established to compare their recombination rates. The rates were 1.4 and 2.7 times higher in the hybrids having C6 or C9 alone than in the control (0C). This enhancement reached 3.1 and 4.1 times in hybrids carrying six and nine C chromosomes, and it was also higher for each pair of hybrids carrying 2n = 32 or 2n = 35 chromosomes, with a dependence on which chromosomes remained as univalents. We have shown, for the first time, that the presence of one chromosome, C9 , affects significantly the recombination rate and reduces crossover interference. This result will have fundamental implications on the regulation of crossover frequency.

["I am a little out of breath". When a commonplace symptom hides a rare disease: cardiac amyloidosis]. / "Je suis un peu essoufflé". Ouand un symptôme banal cache une maladie rare: l'amylöidose cardiaque.

Based on a case report, this article reviews the different forms of cardiac involvement in amyloidosis. This affection refers to the extracellular tissue deposition of protein fibrils (the amyloid substance), which gradually invades a variety of organs, disrupting their function. The clinical presentation depends on the type of the amyloidogenic protein and on its main distribution. The most severe cardiac impairment and with the worse prognosis is seen in its primary form (or AL), while it is less frequent, with a slower course and a better prognosis in its other forms: secondary (AA), familial (ATTR) or senile (SSA).

The role of mind-body interventions in traumatised refugees' primary care: A qualitative exploration of professionals' experiences in a dedicated programme in Geneva.

Post-traumatic physical and psychological symptoms are pervasive among refugees. Primary care staff face numerous challenges and often seek innovative ways of addressing their refugee patients' physical and mental health needs. A nascent body of literature suggests that mind-body interventions (MBIs1) have a positive effect on post-traumatic symptoms in this population. But the quality of evidence is still poor, and little is known about the role MBI could play in the primary care of refugees. Following the implementation of two different kinds of MBI in a dedicated primary care unit, this study aimed to explore staff members' perceptions and prescribing habits for MBI. Given the paucity of information about this topic, we used a qualitative design combining ethnography and discourse analysis providing in-depth insight into professionals' experiences of MBI. Data collected over five-months of non-participative observation and the transcription of twelve interviews were analysed following the Interpretative Phenomenological Analysis method (IPA) yielding four main results: (1) Generally poor initial understanding of MBI; (2) A variety of conditions and situations where MBIs appeared acceptable and helpful; (3) A persistent lack of experience and knowledge about the indications for MBI, hindering prescription; (4) The importance of articulating MBIs with mental health services. These results, in the light of the existing literature, suggest that stronger evidence for MBI efficacy for refugees is required, a key to improving professionals' understanding of MBI, providing them with explicit prescription criteria, and encouraging stakeholders to implement these innovative interventions.

Quantitative plant resistance in cultivar mixtures: wheat yellow rust as a modeling case study.

Unlike qualitative plant resistance, which confers immunity to disease, quantitative resistance confers only a reduction in disease severity and this can be nonspecific. Consequently, the outcome of its deployment in cultivar mixtures is not easy to predict, as on the one hand it may reduce the heterogeneity of the mixture, but on the other it may induce competition between nonspecialized strains of the pathogen. To clarify the principles for the successful use of quantitative plant resistance in disease management, we built a parsimonious model describing the dynamics of competing pathogen strains spreading through a mixture of cultivars carrying nonspecific quantitative resistance. Using the parameterized model for a wheat-yellow rust system, we demonstrate that a more effective use of quantitative resistance in mixtures involves reinforcing the effect of the highly resistant cultivars rather than replacing them. We highlight the fact that the judicious deployment of the quantitative resistance in two- or three-component mixtures makes it possible to reduce disease severity using only small proportions of the highly resistant cultivar. Our results provide insights into the effects on pathogen dynamics of deploying quantitative plant resistance, and can provide guidance for choosing appropriate associations of cultivars and optimizing diversification strategies.

The grapevine genome sequence suggests ancestral hexaploidization in major angiosperm phyla.

The analysis of the first plant genomes provided unexpected evidence for genome duplication events in species that had previously been considered as true diploids on the basis of their genetics. These polyploidization events may have had important consequences in plant evolution, in particular for species radiation and adaptation and for the modulation of functional capacities. Here we report a high-quality draft of the genome sequence of grapevine (Vitis vinifera) obtained from a highly homozygous genotype. The draft sequence of the grapevine genome is the fourth one produced so far for flowering plants, the second for a woody species and the first for a fruit crop (cultivated for both fruit and beverage). Grapevine was selected because of its important place in the cultural heritage of humanity beginning during the Neolithic period. Several large expansions of gene families with roles in aromatic features are observed. The grapevine genome has not undergone recent genome duplication, thus enabling the discovery of ancestral traits and features of the genetic organization of flowering plants. This analysis reveals the contribution of three ancestral genomes to the grapevine haploid content. This ancestral arrangement is common to many dicotyledonous plants but is absent from the genome of rice, which is a monocotyledon. Furthermore, we explain the chronology of previously described whole-genome duplication events in the evolution of flowering plants.

Suboptimal access to primary healthcare among street-based sex workers in southwest Switzerland.

OBJECTIVES: Street-based sex workers (SSWs) in Lausanne, Switzerland, are poorly characterised. We set out to quantify potential vulnerability factors in this population and to examine SSW healthcare use and unmet healthcare requirements. METHODS: We conducted a cross-sectional questionnaire-based survey among SSWs working in Lausanne's red light district between 1 February and 31 July 2010, examining SSW socio-demographic characteristics and factors related to their healthcare. RESULTS: We interviewed 50 SSWs (76% of those approached). A fifth conducted their interviews in French, the official language in Lausanne. 48 participants (96%) were migrants, of whom 33/48 (69%) held no residence permit. 22/50 (44%) had been educated beyond obligatory schooling. 28/50 (56%) had no health insurance. 18/50 (36%) had been victims of physical violence. While 36/50 (72%) had seen a doctor during the preceding 12 months, only 15/50 (30%) were aware of a free clinic for individuals without health insurance. Those unaware of free services consulted emergency departments or doctors outside Switzerland. Gynaecology, primary healthcare and dental services were most often listed as needed. Two individuals (of 50, 4%) disclosed positive HIV status; of the others, 24/48 (50%) had never had an HIV test. CONCLUSIONS: This vulnerable population comprises SSWs who, whether through mobility, insufficient education or language barriers, are unaware of services they are entitled to. With half the participants reporting no HIV testing, there is a need to enhance awareness of available facilities as well as to increase provision and uptake of HIV testing.

Quality in practice: integrating routine collection of patient language data into hospital practice.

QUALITY PROBLEM: Timely identification of patients' language needs can facilitate the provision of language-appropriate services and contribute to quality of care, clinical outcomes and patient satisfaction. INITIAL ASSESSMENT: At the University Hospitals of Geneva, Switzerland, timely organization of interpreter services was hindered by the lack of systematic patient language data collection. CHOICE OF SOLUTION: We explored the feasibility and acceptability of a procedure for collecting patient language data at the first point of contact, prior to its hospital-wide implementation. IMPLEMENTATION: During a one-week period, receptionists and triage nurses in eight clinical services tested a new procedure for collecting patient language data. Patients were asked to identify their primary language and other languages they would be comfortable speaking with their doctor. Staff noted patients' answers on a paper form and provided informal feedback on their experience with the procedure. EVALUATION: Registration staff encountered few difficulties collecting patient language data and thought that the two questions could easily be incorporated into existing administrative routines. Following the pilot test, two language fields with scroll-down language menus were added to the electronic patient file, and the subsequent filling-in of these fields has been rapid and hospital wide. LESSONS LEARNED: Our experience suggests that routine collection of patient language data at first point of contact is both feasible and acceptable and that involving staff in a pilot project may facilitate hospital-wide implementation. Future efforts should focus on exploring the sensitivity and specificity of the proposed questions, as well as the impact of data collection on interpreter use.

Mental and physical health of Kosovar Albanians in their place of origin: a post-war 6-year follow-up study.

PURPOSE: Long-term outcome of traumatic experiences among war-exposed civilians living in their home country has been seldom documented. The present study examined change in posttraumatic stress disorder (PTSD) frequency and perceived physical and mental health in a cohort of Kosovar Albanians over 6 years (2001-2007). METHODS: Of 996 Albanian Kosovar civilians included in the 2001 survey, 551 subjects (55.3%) were recalled and interviewed in 2007. Diagnoses of PTSD and major depressive episode were assessed using the Mini International Neuropsychiatric Interview. Subjective physical and mental health were investigated using the Medical Outcomes Study 36-Item Short-Form (SF-36). A list of traumatic events adapted from the Harvard Trauma Questionnaire and other stressful life events was also considered. RESULTS: Posttraumatic stress disorder was significantly less frequent in 2007 than in 2001 (14.5% vs. 23.2%, p < 0.001). For 18.0, 5.3 and 9.3% of participants, PTSD remitted, persisted and developed over the 6-year follow-up period, respectively. Ill health without having access to medical care and major changes in responsibilities at work were associated with both persistence and new occurrence of PTSD. While the SF-36 mental component summary score significantly improved (mean change +4.5, p < 0.001), the physical component summary score did not change between 2001 and 2007, after adjustment for age (mean change -0.8, p = 0.14). CONCLUSIONS: Results point at the importance of economic and health system reconstruction programs with respect to public health in post-conflict countries.