[The spirit of community medicine: students learning from students]. / Penser la médecine communautaire s'apprend avec les pairs.

At the University of Lausanne third-year medical students are given the task of spending a month investigating a question of community medicine. In 2009, four students evaluated the legitimacy of health insurers intervening in the management of depression. They found that health insurers put pressure on public authorities during the development of legislation governing the health system and reimbursement for treatment. This fact emerged during the scientific investigation led jointly by the team in the course of the "module of immersion in community medicine." This paper presents each step of their study. The example chosen illustrates the learning objectives covered by the module.

Prevalence of victims of violence admitted to an emergency department.

OBJECTIVE: To collect data on the consultation frequency and demographic profile of victims of violence attending an emergency department (ED) in Switzerland. METHODS: We undertook screening of all admitted adult patients (>16 years) in the ED of the CHUV, Lausanne, Switzerland, over a 1 month period, using a modified version of the Partner Violence Screen questionnaire. Exclusionary criteria were: life threatening injury (National Advisory Committee on Aeronautics score > or =4), or inability to understand or speak French, to give oral informed consent, or to be questioned without a family member or accompanying person being present. Data were collected on history of physical and/or psychological violence during the previous 12 months, the type of violence experienced by the patient, and if violence was the reason for the current consultation. Sociodemographic data were obtained from the registration documents. RESULTS: The final sample consisted of 1602 patients (participation rate of 77.2%), with a refusal rate of 1.1%. Violence during the past 12 months was reported by 11.4% of patients. Of the total sample, 25% stated that violence was the reason for the current consultation; of these, 95% of patients were confirmed as victims of violence by the ED physicians. Patients reporting violence were more likely to be young and separated from their partner. Men were more likely to be victims of public violence and women more commonly victims of domestic violence. CONCLUSIONS: Based on this monthly prevalence rate, we estimate that over 3000 adults affected by violence consult our ED per annum. This underlines the importance of the problem and the need to address it. Health services organisations should establish measures to improve quality of care for victims. Guidelines and educational programmes for nurses and physicians should be developed in order to enhance providers' skills and basic knowledge of all types of violence, how to recognise and interact appropriately with victims, and where to refer these patients for follow up care in their local networks.

[Training of field professionals in Switzerland health prevention projects]. / Formation des acteurs de terrain à la gestion de projets de prévention en Suisse.

Following various difficulties during prevention programs, an interdisciplinary training course in project management was set up for professionals working in the field. Sessions devoted to theoretical aspects alternated with workshops aimed at problem-solving strategies. The intention of the course was to equip the participants with relevant operational tools. The twenty-seven participants came from twelve different professional backgrounds. Fourty-two hours of training were given over a period of nine months. Two physicians specialized in public health accompanied the course throughout, seven invited speakers joined the group for occasional sessions. The evaluation was positive for the teaching methods used and the variety of subjects covered. The analysis of practical experiences has proved to be a powerful learning tool and a vehicle for interdisciplinary exchanges. The course has highlighted the isolation of the professionals in the field, the absence of common points of reference and the resulting difficulties in communication and collaboration. This experience has clearly shown the need for a well-defined standard model in project management and for intensive training of the professionals in the field.

Comparison of a radioactive and non-radioactive method for sequencing foot and mouth disease virus isolates.

The authors compare the radioactive method of detecting foot and mouth disease virus sequence products with a non-radioactive, silver stain sequencing method. The latter was found to compare favourably to the radioactive technique for detecting such products. The silver stain sequencing method was simple and did not require expensive specialised equipment. This new approach will be particularly useful in developing countries, since the method does not depend on the availability of fresh radioactive isotopes and is also safer and considerably cheaper.

A hemi-nested PCR assay for the detection and identification of vesicular stomatitis virus nucleic acid.

This paper is the first to describe the development of a hemi-nested PCR assay for the detection of vesicular stomatitis virus (VSV) nucleic acid. This assay was developed as it combines high sensitivity for virus genome detection with the identification of the external amplification product in the reamplification step, thus confirming the specificity of the reaction. The assay did not depend on the presence of infectious virus in samples, as demonstrated by its detection of VSV in blood samples which were non-infectious in tissue culture. One further advantage was that the VSV-New Jersey and VSV-Indiana serotypes could be differentiated through the selective use of the appropriate hemi-nested primer. This assay is ideal for the study of VSV pathogenesis and persistence.

Haptoglobin response of cattle infected with foot-and-mouth disease virus.

Haptoglobin, a major bovine acute phase protein, was evaluated as a marker of the primary replication of foot-and-mouth disease virus in 12 naturally infected cattle from which blood was collected daily. An acute phase response, as measured by an increase in serum haptoglobin concentration and the presence of fever, was not detected during the previraemic stage of disease, but there was a significant increase in serum haptoglobin after the onset of viraemia. It occurred on the same day as the first appearance of clinical signs in three of the cattle, one day later in four and two days later in the other five cattle.

Detection of foot-and-mouth disease virus RNA in clinical samples and cell culture isolates by amplification of the capsid coding region.

Foot-and-mouth disease is one of the most economically important virus diseases of livestock. Two important requirements for the control of this disease are rapid laboratory diagnosis and epidemiological investigation. The use of the polymerase chain reaction method (PCR) to amplify specific nucleic acid regions offers the unique possibility of combining swift viral detection with the production of genetic material suitable for sequencing and other methods of molecular epidemiological analysis. The sequencing of the region of foot-and-mouth disease virus (FMDV) genome encoding the capsid proteins of the virus (approximately 2260 bps), provides valuable information that adds to the molecular characterisation of an isolate. This paper describes the use of the PCR for the amplification of this region of the FMDV genome from bovine clinical samples and cell culture isolates. Suitable pairs of oligonucleotide primers were selected from the published sequence of FMDV type O1, Kaufbeuren. One primer set amplified 2091 bps of the capsid coding region of all seven serotypes of FMDV. The other primer set amplified 216 bp from this region of FMDV type O1, BFS 1860, in nucleic acid extracts from several clinical samples. Nucleic acid extracts from the picornaviruses, bovine enterovirus and swine vesicular disease virus, which affect the same animals, were not amplified. Direct sequencing was carried out on the amplified fragments and showed that the PCR products were > 98% homologous to published FMDV sequences.

An indirect sandwich ELISA for the identification of bovine enteroviruses.

An indirect sandwich ELISA is described for the detection of bovine enteroviruses. The assay was developed as an alternative to the complement fixation test and proved to be more sensitive and convenient. Ten bovine enterovirus prototype strains were easily discriminated. No cross-reactions were observed with other picornaviruses including foot-and-mouth disease viruses, swine vesicular disease virus, porcine enteroviruses and bovine rhinovirus.

Subacute effects of thiazide administration on renal hemodynamics and calcium metabolism.

To elucidate the renal effects of thiazides as a function of sodium intake, 8 healthy volunteers without renal disease were studied at baseline and 1 day as well as 4 days after the administration of 100 mg hydrochlorothiazide/day. The subjects were compared on two different dietary sodium intakes (120 mmol/day and 220 mmol/day). Measurements comprised inulin clearance (Cin) and paraaminohippurate clearance (Cpah) by infusion clearance technique, total and ionised calcium, immunoreactive parathyroid hormone (1.84 iPTH), 1.25 (OH)2 vitamin D3, and indices of hemoconcentration. Acute administration of hydrochlorothiazide (HCTZ) caused no change in Cin (before 111 +/- 3 ml/min 1.73 m2; 24 h after, 107 +/- 2 ml/min 1.73 m2) or Cpah (before, 579 +/- 9 ml/min 1.73 m2; after, 584 +/- 12 ml/min 1.73 m2), while a significant (P less than 0.01) decrease was noted on the 4th day after 100 mg HCTZ/day and normal sodium intake. No significant change of creatinine clearance (Ccr) was seen with either manouever. Renal hemodynamic changes after HCTZ administration were marginal when hemoconcentration was prevented by a high salt intake. Acute administration (1 h) of HCTZ caused suppression of 1.84 iPTH (before, 2.3 +/- 0.5 pmol/l; after, 1.9 +/- 0.2 pmol/l; P less than 0.01), but after 4 days a lower ionised calcium (baseline, 1.25 +/- 0.01 mmol/l; day 5, 1.20 +/- 0.02 mmol/l; P less than 0.01) was noticed in parallel with hemoconcentration, metabolic alkalosis, and reduced 1.25 (OH)2 vitamin D3 concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Data on the community health education of social workers at the Ecole d'études sociales et pédagogiques]. / Quelques données sur la formation en santé communautaire des travailleurs sociaux à l'Ecole d'études sociales et pédagogiques.

Social workers may be an essential link between health professionals and patients. Their possibilities of action in health education and prevention could be used more systematically. From this viewpoint, the various functions they carry out are an absolute advantage. They are confronted with countless relevant matters of social and preventive medicine and often resort to "original" intervention models. This article presents a programme of training in social and preventive health developed in the Social and Educational School of Lausanne for future social workers and health promoters. The critical analysis of this programme shows the numerous difficulties which are linked to this training, but also the necessity of such a training for the social workers who are more and more involved in interventions where health problems are in the front rank.