Creation and testing of the Domiscore-a tool to characterize the impact of housing on health and well-being.

BACKGROUND: Despite evidence of the major impact housing carries on health, many individuals still live in unhealthy dwellings. In France, the Domiscore has been proposed as a tool to assess the quality of dwellings with regard to their health impact, to allow for a better detection of unsafe housing and to improve dwellings. The aim of this paper is to present the method used to construct the Domiscore and test its relevance and usability. METHODS: The Domiscore grid, inspired by the Nutriscore, consists of 46 variables-such as air quality, light or outdoor view. Each variable is scored on a four-point scale using in situ observation, mandatory diagnostics and open access data. The sum of each variable's score results in an overall risk score for the dwelling. The Domiscore was tested in two phases. During the first testing phase, 11 real estate professionals, health professionals and social workers used the Domiscore for on-site visits in different geographic areas of France. They then participated in a semi-structured qualitative interview. The second phase consisted in a public consultation with diverse stakeholders such as public authorities, housing activists and social workers, using an online survey to collect their opinions on the Domiscore's relevance, understandability and usability. RESULTS: The Domiscore was tested on 28 homes. Variables completion rates were high irrespective of tester profile for all home visits (91%, SD = 4.7%). The mean time needed to fill in the grid was 1.5 h. The public consultation returned 151 responses. The Domiscore was deemed easy to understand, relevant, and rather easy to fill out. Most participants found the Domiscore useful for information gathering, awareness raising, detecting at-risk situations and agreed that it could contribute to enhance housing conditions. Its length was noted, although the inclusion of additional variables was also suggested. CONCLUSIONS: The results of this study suggest that the Domiscore is accessible to housing specialists and other professionals for the evaluation of a dwelling's health impacts and the standardized detection of dangerous situations. The testing process allowed for improvements in the grid and training materials for future users.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies, risk factors for infection and associated symptoms in Geneva, Switzerland: a population-based study.

Aims: To assess SARS-CoV-2 seroprevalence over the first epidemic wave in the canton of Geneva, Switzerland, as well as risk factors for infection and symptoms associated with IgG seropositivity. Methods: Between April and June 2020, former participants of a representative survey of the 20-74-year-old population of canton Geneva were invited to participate in the study, along with household members aged over 5 years. Blood samples were tested for anti-SARS-CoV-2 immunoglobulin G. Questionnaires were self-administered. We estimated seroprevalence with a Bayesian model accounting for test performance and sampling design. Results: We included 8344 participants, with an overall adjusted seroprevalence of 7.8% (95% credible interval 6.8-8.9). Seroprevalence was highest among 18-49 year-olds (9.5%), and lowest in 5-9-year-old children (4.3%) and individuals >65 years (4.7-5.4%). Odds of seropositivity were significantly reduced for female retirees and unemployed men compared to employed individuals, and smokers compared to non-smokers. We found no significant association between occupation, level of education, neighborhood income and the risk of being seropositive. The symptom most strongly associated with seropositivity was anosmia/dysgeusia. Conclusions: Anti-SARS-CoV-2 population seroprevalence remained low after the first wave in Geneva. Socioeconomic factors were not associated with seropositivity in this sample. The elderly, young children and smokers were less frequently seropositive, although it is not clear how biology and behaviours shape these differences.

Associations between Depression and Self-Reported COVID-19 Symptoms among Adults: Results from Two Population-Based Seroprevalence Studies in Switzerland.

(1) Mental health may modulate the perceived risk of SARS-CoV-2 infection. However, it is unclear how psychological symptoms may distort symptom perception of COVID-19 and SARS-CoV-2 infection. We assessed whether depressive symptoms predicted self-reported COVID-19 symptoms, independently of serologically confirmed SARS-CoV-2 infection. (2) Participants (aged 20-64) in the Geneva (N = 576) and Ticino (N = 581) Swiss regions completed the Patient Health Questionnaire before being tested for anti-SARS-CoV-2 IgG antibodies and recalled COVID-19-compatible symptoms on two occasions: April-July 2020 (baseline), and January-February 2021 (follow-up). We estimated prevalence ratios for COVID-19 symptoms by depression scores in interaction with serological status. (3) At baseline, in Geneva, higher depression predicted higher probability of reporting systemic, upper airways, and gastro-intestinal symptoms, and fever and/or cough; in Ticino, higher depression predicted systemic, upper airways, and gastro-intestinal symptoms, fever and/or cough, dyspnea, and headache. At follow-up, in Geneva, higher depression predicted higher probability of reporting systemic symptoms and dyspnea; in Ticino, higher depression predicted higher probability of reporting systemic and upper airways symptoms, dyspnea and headache (all p values < 0.05). (4) We found positive associations between depressive symptoms and COVID-19-compatible symptoms, independently of seropositivity. Mental wellbeing has relevant public health implications because it modulates self-reported infection symptoms that inform testing, self-medication, and containment measures, including quarantine and isolation.

Satisfaction survey of general practitioners calling upon an external mobile geriatric team.

The external mobile geriatric team (équipe mobile de gériatrie extrahospitalière [EMGEH]) at the University Hospital of Grenoble-Alps intervenes with elderly subjects in complex medical and social situations at home at the request of general practitioners (GPs). To evaluate the satisfaction of GPs after EMGEH intervention. The secondary outcomes were the follow-up of recommendations and training requests from community care partners. Retrospective monocentric satisfaction survey of the 124 GPs who used the EMGEH between January 2015 and December 2018. Participation rate of 44%, representative of independent GPs in urban or semi-rural practices. Participants were "satisfied" or "very satisfied" (84.2%) with the responsiveness of the EMGEH, and 85.5% responded favourably to the content of the evaluation. The EMGEH was described as playing an expert and supportive role for GPs. The recommendations were followed by more than 89% of respondents. As many as 83.6% of participants wanted the EMGEH to conduct training sessions, mainly for the management of "behavioural disorders". Following this survey, five recommendations were formulated: decrease the response time by recruiting trained staff, systematically send an e-mail following the report to the requesting doctor, use a platform to exchange information, develop partnerships with the psychiatry team, and create an online resource space. This study contributed towards improving the relationship between the community and the hospital by strengthening links between the GPs within the CHUGA health region and the EMGEH.

[Satisfaction survey about general practitioners who used an External Mobile Geriatric Team]. / Enquête de satisfaction auprès des médecins généralistes ayant eu recours à une équipe mobile de gériatrie extrahospitalière.

CONTEXT: The External Mobile Geriatric Team (EMGT) of the University Hospital of Grenoble-Alps (UHGA) intervenes with elderly subjects in a complex medicosocial situation at home at the request of the general practitioner (GPs). OBJECTIVE: To evaluate the satisfaction of GPs after EMGT intervention. The secondary outcomes were the follow-up of recommendations and the training request of community partners. METHOD: Retrospective monocentric satisfaction survey of the 124 GPs who used EMGT from January 2015 to December 2018. RESULTS: Participation rate of 44 %, representative of GPs liberal urban or semi-rural. Participants were "satisfied" or "very satisfied" with the responsiveness of EMGT to 84,2 % and 85,5 % respond favorably to the content of the evaluation. EMGT was described as having an expert and supportive role for GPs. The recommendations were followed more than 89 %. The participants wanted to 83,6 % that the EMGT conducts training sessions, mainly for "behavioral disorders management". Following this survey, five improvement proposals were formulated: decrease the response time by recruiting trained staff, systematically send an e-mail post-analysis of the report to the doctor-applicant, use a platform of exchange, develop the partnership with the psychiatry team, and create a dematerialized resource space. CONCLUSION: This study contributed to the improvement of the city-hospital relationship by strengthening the links between the GPs of the CHUGA sanitary territory and the EMGT.

Grippenet: A New Tool for the Monitoring, Risk-Factor and Vaccination Coverage Analysis of Influenza-Like Illness in Switzerland.

Implemented in Switzerland in November 2016, Grippenet provides Internet-based participatory surveillance of influenza-like illness (ILI). The aim of this research is to test the feasibility of such a system and its ability to detect risk factors and to assess ILI-related behaviors. Participants filled in a web-based socio-demographic and behavioral questionnaire upon registration, and a weekly symptoms survey during the influenza season. ILI incidence was calculated weekly, and risk factors associated to ILI were analyzed at the end of each season. From November 2016 to May 2019, 1247 participants were included. The crossing of the Sentinel System (Sentinella) epidemic threshold was associated with an increase or decrease of Grippenet ILI incidence, within the same week or earlier. The number of active users varied according to ILI incidence. Factors associated with ILI were: ages 0-4 compared with 5-14 (adjusted odds ratio (AOR) 0.6, 95% confidence interval (CI) 0.19-0.99), 15-29 (AOR 0.29, 95% CI 0.15-0.60), and 65+ (AOR 0.38, 95% CI 0.16-0.93); female sex (male AOR 0.81, 95% CI 0.7-0.95); respiratory allergies (AOR 1.58, 95% CI 1.38-1.96), not being vaccinated (AOR 2.4, 95% CI 1.9-3.04); and self-employment (AOR 1.97, 95% CI 1.33-3.03). Vaccination rates were higher than those of the general population but not high enough to meet the Swiss recommendations. Approximately, 36.2% to 42.5% of users who reported one or more ILIs did not seek medical attention. These results illustrate the potential of Grippenet in complementing Sentinella for ILI monitoring in Switzerland.

User Expectations and Willingness to Share Self-Collected Health Data.

The rapid improvement in mobile health technologies revolutionized what and how people can self-record and manage data. This massive amount of information accumulated by these technologies has potentially many applications beyond personal need, i.e. for public health. A challenge with collecting this data is to motivate people to share this data for the benefit of all. The purpose of this study is to survey and examine factors that may motivate sharing this data. We asked 447 participants four questions related to health data sharing and motivation. Participants with a chronic disease were concerned about data sharing but also willing to share health data if personalized feedback is provided. Functionality, ease of use, and privacy are regarded as crucial features of health apps.

Corona Immunitas: study protocol of a nationwide program of SARS-CoV-2 seroprevalence and seroepidemiologic studies in Switzerland.

OBJECTIVES: Seroprevalence studies to assess the spread of SARS-CoV-2 infection in the general population and subgroups are key for evaluating mitigation and vaccination policies and for understanding the spread of the disease both on the national level and for comparison with the international community. METHODS: Corona Immunitas is a research program of coordinated, population-based, seroprevalence studies implemented by Swiss School of Public Health (SSPH+). Over 28,340 participants, randomly selected and age-stratified, with some regional specificities will be included. Additional studies in vulnerable and highly exposed subpopulations are also planned. The studies will assess population immunological status during the pandemic. RESULTS: Phase one (first wave of pandemic) estimates from Geneva showed a steady increase in seroprevalence up to 10.8% (95% CI 8.2-13.9, n = 775) by May 9, 2020. Since June, Zurich, Lausanne, Basel City/Land, Ticino, and Fribourg recruited a total of 5973 participants for phase two thus far. CONCLUSIONS: Corona Immunitas will generate reliable, comparable, and high-quality serological and epidemiological data with extensive coverage of Switzerland and of several subpopulations, informing health policies and decision making in both economic and societal sectors. ISRCTN Registry: https://www.isrctn.com/ISRCTN18181860 .

Cost-effectiveness of precision medicine: a scoping review.

OBJECTIVES: Precision medicine (PM) aims to improve patient outcomes by stratifying or individualizing diagnosis and treatment decisions. Previous reviews found inconclusive evidence as to the cost-effectiveness of PM. The purpose of this scoping review was to describe current research findings on the cost-effectiveness of PM and to identify characteristics of cost-effective interventions. METHODS: We searched PubMed with a combination of terms related to PM and economic evaluations and included studies published between 2014 and 2017. RESULTS: A total of 83 articles were included, of which two-thirds were published in Europe and the USA. The majority of studies concluded that the PM intervention was at least cost-effective compared to usual care. However, the willingness-to-pay thresholds varied widely. Key factors influencing cost-effectiveness included the prevalence of the genetic condition in the target population, costs of genetic testing and companion treatment and the probability of complications or mortality. CONCLUSIONS: This review may help inform decisions about reimbursement, research and development of PM interventions.