[Sex workers: when taboos get in the way of care in the emergency department]. / Travailleuses* du sexe aux urgences : quand le tabou entrave les soins.

In Switzerland, sex work has been legal under certain conditions since 1942, and the number of sex workers in 2011 was estimated at between 14'000 and 20'000 throughout the country, 96% of whom were migrants. These people are exposed to a wide range of vulnerabilities, both because of their profession and because of structural and institutional shortcomings. The complexity of their care has led over time to the creation of specialised structures and units, which are often unknown to healthcare professionals. The aim of this article is to shed light on these facilities and to offer healthcare professionals appropriate advice on how to improve the care provided to patients in the emergency department.

En Suisse, le travail du sexe est légal sous certaines conditions depuis 1942 et le nombre de travailleuses du sexe (TS) en 2011 était estimé entre 14 000 et 20 000 sur l'entier du territoire, dont 96 % de migrantes. Ces personnes sont exposées à de nombreuses vulnérabilités, de par leur métier mais également en raison de lacunes structurelles et institutionnelles. La complexité de leur prise en charge a mené au fil du temps à la création de structures et d'unités spécialisées, qui sont souvent méconnues des professionnels de la santé. L'objectif de cet article est de mettre en lumière ces lieux et de proposer aux soignants des conseils adaptés afin d'améliorer la prise en charge des TS au service d'urgences.

[Health equity: an often misused concept]. / Équité en santé : un concept souvent galvaudé.

The use of the concept "health equity" is more and more widespread. It is often considered as a major objective in health policies aimed at improving healthcare for populations in a vulnerable situation. However, the understanding of "health equity" is often subject to confusion and it can be misinterpreted with the concept of "health equality". Although it may seem trivial at first sight, such confusion may lead to serious consequences for health policies and their implementation with the target populations. This article aims to provide a clarification of the concept of "health equity", while proposing definitions that are more suitable to the needs of professionals and their audience.

L'usage du concept « équité en santé ¼ est de plus en plus répandu. Il est souvent intégré dans les politiques de santé en tant qu'objectif majeur dans les processus visant à améliorer la qualité des soins, en particulier auprès des populations en situation de grande vulnérabilité. Néanmoins, la compréhension de ce terme est souvent confuse et sa définition peut être confondue avec celle de l'« égalité ¼. Bien que pouvant paraître anodine au premier abord, une telle confusion peut avoir de lourdes conséquences sur les politiques de santé et leur mise en œuvre auprès des publics cibles. Cet article vise à proposer une clarification du concept d'« équité en santé ¼, tout en fournissant des définitions adaptables aux besoins des professionnels et de leur audience.

[Teaching health equity in the French-speaking part of Switzerland : inventory in 2023]. / Enseignements sur l'équité en santé en Suisse romande : état des lieux en 2023.

The theme of health equity was for a long time absent or little addressed in the pre- and postgraduate teaching programs of universities and training university hospitals in Switzerland. This gap has gradually been filled by the development and provision of structured teaching on health equity, adapted to the needs of their target audiences. This article aims to highlight a selection of teachings that have emerged in recent years in the French-speaking part of Switzerland.

La thématique de l'équité en santé a été pendant longtemps absente ou peu abordée dans les programmes d'enseignement pré et post-gradué des universités et établissements hospitaliers de formation en Suisse. Cette lacune a été progressivement comblée par le développement et la mise à disposition de formations structurées portant sur l'équité en santé, adaptées aux besoins de leurs publics cibles. Cet article vise à mettre en avant une sélection d'enseignements qui ont vu le jour ces dernières années en Suisse romande.

[Management of human papillomavirus at the doctor's office : what to do for men ?] / Prise en charge du papillomavirus humain au cabinet médical : que faire pour les hommes ?

In primary care medicine, doctors may be facing with human papillomavirus (HPV)-related questions regarding prevention, screening or treatment, more so with women than with men. Through three clinical vignettes, this article aims to offer some clinical management recommendations in a primary care setting when HPV-related questions are raised by the male population.

En médecine de premier recours, le médecin peut être confronté à des questions de prévention, de dépistage ou de traitement en lien avec le papillomavirus (HPV), situations généralement ­rencontrées chez la femme mais parfois aussi chez l'homme. Au travers de trois vignettes cliniques, cet article vise à proposer quelques recommandations de prise en charge au cabinet dans le but de répondre aux questions liées au HPV susceptibles d'être soulevées par la population masculine.

Qualitative evaluation of primary care providers' experiences caring for frequent users of the emergency department.

OBJECTIVES: Many interventions have been developed over the years to offer frequent users of the emergency department (FUEDs) better access to quality coordinated healthcare. Despite recognising the role primary care physicians (PCPs) play in FUEDs' care, to date their perceptions of case management, the most studied intervention, have rarely been assessed. Furthermore, a gap regarding PCPs' experience of caring for FUEDs persists. Thus, this study aimed to explore PCPs' perceptions of the care provided to FUEDs in emergency and primary care settings, their views on the local case management team (CMT), and their suggestions to improve FUEDs' care. DESIGN: Qualitative study using in-depth semistructured interviews and inductive thematic analysis. SETTING: Canton of Vaud, Switzerland. PARTICIPANTS: Thirty PCPs participated, 16 in private practice (PP-PCPs) and 14 based at the Lausanne University Centre of General Medicine and Public Health (Unisanté-U-PCPs). RESULTS: U-PCPs and PP-PCPs thought that most FUEDs' emergency department (ED) visits were legitimate, but questioned ED adequacy to meet FUEDs' needs. Yet, both PCP groups reported encountering many challenges in FUEDs' care themselves. In this context, PP-PCPs seemed more satisfied of the care they provided to FUEDs than U-PCPs. Generally, U-PCPs seemed to find more value in the CMT to help them care for FUEDs than PP-PCPs. To enhance FUEDs' care, U-PCPs and PP-PCPs suggested enhancing collaboration with other healthcare providers. U-PCPs also wished to increase their availability, and some PP-PCPs considered outpatient clinics, larger group practices or medical centres most appropriate to handle FUEDs' needs. CONCLUSIONS: This study highlights the many challenges PCPs face in caring for FUEDs, that a CM intervention has the potential to mitigate, and provides ways forward in improving FUEDs' care, including reinforced communication with the CMT and ED physicians, and structural changes to their own way of delivering care to FUEDs.

[Compassion fatigue: an inevitable reality in the context of a pandemic crisis†?] / Fatigue compassionnelle†: une réalité inéluctable dans le contexte d'une crise pandémique†?

The pandemic attributed to the SARS-CoV-2 virus has been responsible since 2019 for the extreme strains put on health and social assistance services across the globe. While factors such as the contagiousness of the virus, the lack of immunity in the general population and the uncertain trajectory of the pandemic contribute to the rise of general anxiety among these professionals, the morbidity and mortality attributed to the virus, the scarcity of material and personnel resources are at high risk of leading to their exhaustion, both physically and mentally. The admirable surge of solidarity, resilience and self-sacrifice shown on a daily basis by these professionals and many others should not obscure the awareness of the mental «cost¼ of caring.

La pandémie liée au virus SARS-CoV-2 est responsable depuis 2019 de la mise sous tension globale et extrême des systèmes de santé et d'assistance sociale. Dans ce contexte, des facteurs tels que la contagiosité du virus, l'absence d'immunité dans la population générale et la trajectoire incertaine de la pandémie contribuent à l'élévation du niveau d'anxiété générale de professionnels de la santé et du social. La morbidité et la mortalité liées au virus, les ressources insuffisantes en matériel et en personnel sont, quant à elles, à risque élevé de conduire à un épuisement, tant sur le plan physique que psychique, du personnel soignant. L'élan de solidarité, la résilience et l'abnégation admirables dont font preuve au quotidien ces corps professionnels et bien d'autres ne devraient pas occulter la prise de conscience des «â€…coûts ¼ psychiques liés aux soins prodigués à autrui.

Epidemiology of sexually transmitted infections among female sex workers in Switzerland: a local, exploratory, cross-sectional study.

Female sex workers are often considered highly vulnerable to sexually transmitted infections (STIs). However, data on STI epidemiology in female sex workers are lacking in Switzerland. Our main goal was to evaluate the prevalence of six STIs (human immunodeficiency virus [HIV], hepatitis B, hepatitis C, Chlamydia trachomatis, Neisseria gonorrhoeae and syphilis) among local female sex workers in Lausanne. A local, exploratory, cross-sectional study was conducted on a convenience sample of adult (≥18 years) Female sex workers in Lausanne, Switzerland, from 1 April 2015 to 31 December 2016. female sex workers who worked in street sex venues, massage parlours and brothels were approached for recruitment by a local non-governmental organisation. They were then invited to present at the Lausanne University Hospital, where they were offered a free STI screening and hepatitis A and B vaccination. We enrolled 96 female sex workers. They were predominantly undocumented immigrants (60%) from Africa and Eastern Europe with no health insurance; only one participant (1%) was Swiss born. During the study, 15 (16%; 95% confidence interval [CI] 9–23%) participants were newly confirmed to have an STI: six (6%; 95% CI 1–11%) had C. trachomatis, five (5%; 95% CI 0.6-9%) latent syphilis and four (4%; 95% CI 0.1–8%) hepatitis B (three with chronic active infection and one with past exposure). No human immunodeficiency virus (HIV) infections were newly diagnosed among the participants. Nineteen (20%) of the female sex workers were already vaccinated against hepatitis B, and 73 (76%) initiated vaccination against hepatitis A and hepatitis B during the study. Forty-four (46%) of the female sex workers required translation and assistance from social services.

[Management of emergency department frequent users]. / Prise en charge des grands consommateurs des services d'urgences.

For decades, emergency departments of hospitals in industrialized countries have been dealing with the challenges of a group of patients responsible for a disproportionate number of emergency room visits : the emergency department frequent users. Although they represent only a minority of all emergency department patients, their healthcare can often be complex if not difficult due to their health vulnerability (e. g., psychiatric disorders associated with substance addictions), often aggravated by a precarious psycho-social context (e. g., homelessness, illegal status, poverty, etc.). Taking care of these patients by using a case management approach can promote the development of an interprofessional and coordinated healthcare plan that includes their empowerment.

Depuis plusieurs décennies, les services d'urgences des centres hospitaliers des pays industrialisés doivent faire face aux défis que représente un groupe de patients responsables d'un nombre disproportionné de consultations aux urgences : les «â€…grands consommateurs des services d'urgences ¼. Bien que ne représentant qu'une minorité de l'ensemble des patients des services d'urgences, leur prise en charge peut s'avérer être souvent complexe, voire difficile, en lien avec leur vulnérabilité sur le plan de la santé, souvent aggravée par un contexte psychosocial précaire. La prise en charge de ces patients, selon une approche de type case management, peut favoriser le développement d'une prise en charge pluridisciplinaire et coordonnée, tout en intégrant ces derniers dans le processus d'aide et de soutien (empowerment).

Implementing a case management intervention for frequent users of the emergency department (I-CaM): an effectiveness-implementation hybrid trial study protocol.

BACKGROUND: ED overcrowding represents a significant public health problem in developed countries. Frequent users of the emergency departments (FUEDs; reporting 5 or more ED visits in the past year) are often affected by medical, psychological, social, and substance use problems and account for a disproportionately high number of ED visits. Past research indicates that case management (CM) interventions are a promising way to reduce ED overcrowding and improve FUEDs' quality of life. There is, however, very limited knowledge about how to disseminate and implement this intervention on a large scale to diverse clinical settings, including community hospitals and non-academic centers. This paper describes the protocol of a research project aiming to implement a CM intervention tailored to FUEDs in the public hospitals with ED in the French-speaking region of Switzerland and evaluate both the implementation process and effectiveness of the CM intervention. METHODS: This research project uses a hybrid study design assessing both implementation and clinical outcomes. The implementation part of the study uses mixed methods a) to describe quantitatively and qualitatively factors that influence the implementation process, and b) to examine implementation effectiveness. The clinical part of the study uses a within-subject design (pre-post intervention) to evaluate participants' trajectories on clinical variables (e.g., quality of life, ED use) after receiving the CM intervention. We designed the study based on two implementation science frameworks. The Generic Implementation Framework guided the overall research protocol design, whereas the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework guided the implementation and effectiveness evaluations. DISCUSSION: This research project will contribute to implementation science by providing key insights into the processes of implementing CM into broader practice. This research project is also likely to have both clinical and public health implications. TRIAL REGISTRATION: NCT03641274 , Registered 20 August 2018.

Characteristics and predictors of mortality among frequent users of an Emergency Department in Switzerland.

OBJECTIVES: Frequent Emergency Department (ED) users have an elevated mortality, yet little is known about risk factors. Our aim was to characterize deceased frequent ED users and determine predictors of mortality. METHODS: This is a post-hoc analysis of all-cause mortality among frequent ED users participating in a randomized clinical trial on case management at the Lausanne University Hospital (Switzerland). We enrolled 250 frequent ED users (5+ visits/past year) in a 12-month randomized clinical trial; those with an estimated survival of fewer than 18 months were excluded. The primary outcome was 12-month all-cause mortality. We performed descriptive statistics to compare the baseline characteristics of living and deceased participants, and examined predictors of all-cause mortality using logistic regressions, including age adjustment. RESULTS: Twenty of the 250 (8%) frequent users died during the 12-month follow-up. Seven (35%) deaths were because of cardiac causes and six (30%) were because of cancer. The median age at death was 71 years. Deceased participants were older and more likely to report any somatic determinant, chronic illness, and medical comorbidity. Age (odds ratio 1.07, 95% confidence interval 1.04-1.11) and medical comorbidity (odds ratio 4.76, 95% confidence interval 1.86-12.15) were statistically significant predictors of mortality. CONCLUSION: Despite excluding those with an estimated survival of fewer than 18 months, 8% of frequent ED users died during the study. Age and medical comorbidity were significant predictors of mortality. Interventions, such as case management, should target older frequent ED users and those with multiple medical conditions, and future research should explore their potential impact on mortality.

[It's never too late to be infected with mumps]. / Il n'est jamais trop tard pour les oreillons.

Mumps, although rare since the introduction of a systematic vaccination of children in 1981 in Switzerland, occurs principally in children and is uncommon in adults. Nevertheless, it should be considered in adult patients with a typical clinical presentation or with an atypical presentation suggesting the disease. The diagnosis is established based on the clinical presentation and the treatment is symptomatic.

Le diagnostic des oreillons, bien que rare depuis l'introduction en 1981 de la vaccination de routine chez les enfants en Suisse, est de nos jours essentiellement posé chez ces derniers et rarement chez les adultes. Il faut néanmoins y penser face à un tableau typique rencontré chez des patients adultes ou lors de présentation atypique partiellement évocatrice de cette maladie. Le diagnostic reste essentiellement clinique et le traitement symptomatique.

[2016 literature findings in internal general medicine]. / Acquisitions thérapeutiques en médecine ambulatoire en 2016.

Treatment with diclofenac appears to be more effective compared to other NSAIDs in the treatment of osteoarthritis of the large joints. Opioids do not diminish significantly the pain in chronic lower back pain. Degenerative tears of the meniscus, without signs of osteoarthritis, should be treated conservatively. Acute appendicitis without perforation signs should be treated conservatively if possible. Mindfulness meditation could prevent the recurrence of episodes in major depression. Oropharyngeal exercises could reduce the frequency and intensity of snoring. The choice of treatment in Helicobacter pylori infection must consider its effectiveness and tolerance. Concomitant use of statins and vitamin D could be an interesting alternative treatment in migraines.

Le traitement par diclofénac semble être le plus efficace comparé aux autres AINS dans le traitement de la gonarthrose et de la coxarthrose. Les opioïdes ne diminuent pas la douleur de manière significative lors de lombalgies chroniques. Les ruptures dégénératives du ménisque, sans signe d'arthrose, devraient être traitées conservativement. L'appendicite aiguë sans signe de perforation devrait l'être également. La méditation en pleine conscience permettrait de prévenir les récidives lors de dépression majeure. Les exercices oropharyngés pourraient réduire la fréquence et l'intensité des ronflements. Le choix du traitement éradicateur de l'Helicobacter pylori doit tenir compte de son effectivité et de sa tolérance. La prise de statines et de vitamine D constituerait une alternative lors de migraines.

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial.

BACKGROUND: Frequent emergency department (ED) users account for a disproportionately high number of ED visits. Studies on case management (CM) interventions to reduce frequent ED use have shown mixed results, and few studies have been conducted within a universal health coverage system. OBJECTIVE: To determine whether a CM intervention-compared to standard emergency care-reduces ED attendance. DESIGN: Randomized controlled trial. PARTICIPANTS: Two hundred fifty frequent ED users (5 or more visits in the prior 12 months) who visited a public urban ED at the Lausanne University Hospital between May 2012 and July 2013 were allocated to either an intervention (n = 125) or control (n = 125) group, and monitored for 12 months. INTERVENTIONS: An individualized CM intervention consisting of concrete assistance in obtaining income entitlements, referral to primary or specialty medical care, access to mental health care or substance abuse treatment, and counseling on at-risk behaviors and health care utilization (in addition to standard care) at baseline and 1, 3, and 5 months. MAIN MEASURES: We used a generalized linear model for count data (negative binomial distribution) to compare the number of ED visits during the 12-month follow-up between CM and usual care, from an intention-to-treat perspective. KEY RESULTS: At 12 months, there were 2.71 (±0.23) ED visits in the intervention group versus 3.35 (±0.32) visits among controls (ratio = 0.81, 95 % CI = 0.63; 1.02). In the multivariate model, the effect of the CM intervention on the number of ED visits approached statistical significance (b = -0.219, p = 0.075). The presence of poor social determinants of health was a significant predictor of ED use in the multivariate model (b = 0.280, p = 0.048). CONCLUSIONS: CM may reduce ED use by frequent users through an improved orientation to the health care system. Poor social determinants of health significantly increase use of the ED by frequent users.

Screening of mental health and substance users in frequent users of a general Swiss emergency department.

BACKGROUND: The objectives of this study were to determine the proportions of psychiatric and substance use disorders suffered by emergency departments' (EDs') frequent users compared to the mainstream ED population, to evaluate how effectively these disorders were diagnosed in both groups of patients by ED physicians, and to determine if these disorders were predictive of a frequent use of ED services. METHODS: This study is a cross-sectional study with concurrent and retrospective data collection. Between November 2009 and June 2010, patients' mental health and substance use disorders were identified prospectively in face-to-face research interviews using a screening questionnaire (i.e. researcher screening). These data were compared to the data obtained from a retrospective medical chart review performed in August 2011, searching for mental health and substance use disorders diagnosed by ED physicians and recorded in the patients' ED medical files (i.e. ED physician diagnosis). The sample consisted of 399 eligible adult patients (≥18 years old) admitted to the urban, general ED of a University Hospital. Among them, 389 patients completed the researcher screening. Two hundred and twenty frequent users defined by >4 ED visits in the previous twelve months were included and compared to 169 patients with ≤4 ED visits in the same period (control group). RESULTS: Researcher screening showed that ED frequent users were more likely than members of the control group to have an anxiety, depressive disorder, post-traumatic stress disorder (PTSD), or suffer from alcohol, illicit drug abuse/addiction. Reviewing the ED physician diagnosis, we found that the proportions of mental health and substance use disorders diagnosed by ED physicians were low both among ED frequent users and in the control group. Using multiple logistic regression analyses to predict frequent ED use, we found that ED patients who screened positive for psychiatric disorders only and those who screened positive for both psychiatric and substance use disorders were more likely to be ED frequent users compared to ED patients with no disorder. CONCLUSIONS: This study found high proportions of screened mental health and/or substance use disorders in ED frequent users, but it showed low rates of detection of such disorders in day-to-day ED activities which can be a cause for concern. Active screening for these disorders in this population, followed by an intervention and/or a referral for treatment by a case-management team may constitute a relevant intervention for integration into a general ED setting.