[Integrative and complementary primary care medicine: new evidence in 2020]. / Médecine complémentaire intégrative : nouveautés utiles en médecine de premier recours.

Integrative medicine proposes a coordinated approach to conventional medicine and complementary treatments. This approach is of particular interest in the field of prevention and in comprehensive primary care. This article presents some key studies published in 2020, which highlight the potential benefits of an integrative approach in primary care medicine.

La médecine intégrative permet de coordonner médecine conventionnelle et traitements complémentaires. Cette approche est particulièrement intéressante dans le domaine de la prévention et dans la prise en charge globale en médecine de premier recours. Cet article présente quelques études clés, publiées en 2020, qui mettent en lumière les bénéfices potentiels d'une approche intégrative en médecine de premier recours.

[Knowing how to deliver healthcare is now as important as having medical knowledge]. / Savoir délivrer les soins est -désormais aussi important que d'avoir -les -connaissances médicales.

Traditionally, the doctor has focused his efforts on mastering medical knowledge. Given the challenges facing him, the medical institutions and the society, it becomes clear that his concern must also be about how this medical knowledge hits the patients and the general population. Knowing how to deliver our care is now as important as having the medical knowledge ! In this article, we present new models of healthcare delivery that we implemented or plan to implement in Geneva, Switzerland.

Traditionnellement, le médecin a concentré ses efforts sur la maîtrise de la connaissance médicale. Face aux enjeux qui se présentent à lui, aux institutions et à la société, il devient évident que sa préoccupation doit également se porter sur la façon dont cette connaissance médicale atteint les patients et la population en général. Savoir délivrer nos soins est désormais aussi important que d'avoir les connaissances médicales ! Dans cet article, nous présentons des nouveaux modèles de soins de santé que nous avons mis en œuvre ou prévoyons de mettre en œuvre à Genève, en Suisse.

Design and synthesis of 3-phenyltetrahydronaphthalenic derivatives as new selective MT2 melatoninergic ligands. Part II.

Following our studies of the melatoninergic receptors, we have developed new tetrahydronaphthalenic derivatives of melatonin that have been tested as selective melatonin receptors ligands. Regarding the role of the phenyl substituent to obtain selective ligands, modulation of selectivity and activity have been achieved by modifications of the acyl group and substitutions on the phenyl ring. Ten of the seventeen evaluated derivatives have MT(2) receptor affinity similar to that of melatonin. Moreover, we have achieved remarkable MT(2) selectivity over MT(1) (selectivity >100) and have been able to further extend the RSA of the tetrahydrophthalenic series. However, the compounds presented here display partial agonist or antagonist behavior instead of full agonist.

Synthesis of 3-phenylnaphthalenic derivatives as new selective MT(2) melatoninergic ligands.

A series of naphthalenic analogues of melatonin were prepared and evaluated as melatonin receptor MT(2) selective ligands. Activity and MT(2) selectivity can be modulated with suitable variations of the C-3 phenyl and the acyl group on the C-1 side chain. Surprisingly, in contrast with what had been previously described in other series (2-benzylindoles, 2-benzylbenzofurans and 3-phenyltetralins), the presence of a C-3 phenyl with a functional group on the meta position seems to be primordial for MT(2) affinity and selectivity. Indeed, N-[2-(3-(3-hydroxymethylphenyl)-7-methoxynaphth-1-yl)ethyl]acetamide (21) is one of the best MT(2) selective ligands described until now and behaves as an antagonist.

Screening of mental disorders in asylum-seekers from Kosovo.

OBJECTIVE: To determine how the use of trained and ad hoc interpreters during a medical screening interview affects referral to medical and psychiatric care. METHODS: We reviewed 319 structured interviews conducted by nurses with asylum-seekers from Kosovo during a systematic medical screening at time of entry, consisting of questions about health conditions, past exposure to traumatic events, and posttraumatic symptoms. RESULTS: The majority (72%) of asylum-seekers were male and the median age was 24 years. Forty-eight per cent were single and 55% declared having relatives already living in Switzerland. Screening interviews resulted in 36% of asylum-seekers being referred to a general practitioner and 6% to a psychiatrist. Relatives served as ad hoc interpreters in 18% of interviews and trained interpreters in 16%. The detection of traumatic events and psychological symptoms significantly improved when trained interpreters were present (traumatic events: no interpreters 55%, ad hoc interpreters 46%, trained interpreters 77%, P = 003; psychological symptoms: 12%, 14%, 33%, respectively, P = 0.001). Adjusted for traumatic events and posttraumatic symptoms, referral to medical care was more frequent when relatives served as ad hoc interpreter (OR: 1.9, 95% CI 1.0-3.6), while interviews conducted with trained interpreters were not significantly associated with increased referral to medical (OR: 1.3, 95% CI 0.6-2.6) and psychiatric care (OR: 2.3, 95% CI 0.7-7.0). CONCLUSION: The use of trained interpreters improved the quality of communication, the detection of severe symptoms and traumatic situations, and facilitated therapeutic orientation of traumatized asylum-seekers.