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Prevention and screening recommendations have to be adapted on a regular basis to the latest scientific data and should be completed by tools made to facilitated the implication of patients in decision-making. The prevention and screening webpages hosted on the website of the Department of community medicine and ambulatory care of the University of Lausanne facilitate access to clinical recommendations identified by members of the five medical faculties in Switzerland (EviPrev national program), and to various information sources for physicians and patients, including patient decision aids. These webpages have been developed with primary care physicians who have participated in a pilot project in the canton of Vaud. The webpages have also been tested and welcome by a participatory group of citizen-users., Competing Interests: Ce projet a reçu un financement par le Service de Santé publique du canton de Vaud dans le cadre du projet « Vieillissement et Santé ».

Lung cancer is the leading cause of cancer related deaths worldwide. Since the advent of immunotherapy, survival has significantly improved. Though encouraging treatment results, initially only some patients used to benefit significantly and specifically from immunotherapy administered alone. Recently, different combinations of immunotherapy treatments with cytotoxic chemotherapy and anti-angiogenic treatments were tested in order to improve the results. Six immunotherapy treatment strategies are currently approved in Switzerland for the treatment of advanced lung cancer, either in first or later line of treatment, alone or in combination with other cytotoxic treatments. In this paper we will review the results of the latest clinical trials testing immunotherapy that led to change of the standard of care for non-small cell lung cancer, and will mention the latest perspectives of the treatment for locally advanced cancers and for small cell lung cancer., Competing Interests: Heyfa Meganem, Roxana-Maria Socianu et Ana Dolcan n’ont déclaré aucun conflit d’intérêts en relation avec cet article. Hasna Bouchaab: participation à des comités consultatifs de MSD, BMS, F. Hoffmann-La Roche, AstraZeneca, Novartis, Pfizer et Takeda. Nuria Mederos: participation à des comités consultatifs d’AstraZeneca. Tu Nguyen: a reçu une bourse de formation, a reçu des indemnités en tant que consultant, a donné des conférences et a participé à des comités consultatifs pour AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, F. Hoffmann-La Roche, Merck, Sharp and Dohme, et Novartis, qui lui ont versé des honoraires. Solange Peters a reçu des fonds éducationnels, travaillé comme consultant indépendant et/ou donné des conférences pour: Abbvie, Amgen, AstraZeneca, Bayer, Biocartis, Boehringer-Ingelheim, Bristol-Myers Squibb, Clovis, Daiichi Sankyo, Debiopharm, Eli Lilly, F. Hoffmann-La Roche, Foundation Medicine, Illumina, Janssen, Merck Sharp et Dohme, Merck Serono, Merrimack, Novartis, Pharma Mar, Pfizer, Regeneron,Sanofi, Seattle Genetics et Takeda, de qui elle a reçu des honoraires.

High speed sequencing is revolutionizing the various genetic tests and in particular preimplantation genetic diagnosis (PGD), opening the doors to an increasingly efficient predictive medicine. PGD itself is not new, and the various legistations have been dealing with it for some twenty years. National ethics committees, for their part, have widely debated antenatal tests in the context of medically assisted procreation. This paper examines the work of these Committees on PGD in three States, France, Belgium and Switzerland, in order to highlight their similarities and differences. The subject has also been raised and discussed in the context of the États généraux de la bioéthique which took place this year in France and, given the progresses made recently, they have echoed certain demands of civil society. However, in France, caution continues to dominate., (© 2019 médecine/sciences – Inserm.)

Children of patients with psychiatric disorders are at higher risk to develop a psychiatric illness. In addition, phases of crisis and hospitalization of the parent are often traumatizing to the children, especially during childhood. Although a specific offer to face these issues is compulsory in some countries, such is not the case in Switzerland. In this paper we describe the implementation of a special offer for children of parents with mental illness (Famille +) in the service of general psychiatry at the Department of psychiatry of the Lausanne University hospital in Switzerland. We will also discuss the development and implementation of the Joint Crisis Plan, a collaborative tool where psychiatric patients and clinicians define the strategies that should be applied in case of crisis, which strengthens the empowerment of patients and their participation to decisions about their treatment., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

An important number of psychiatric patients have difficulties to live outside of hospital and to stabilize their living situation. This results in long hospitalizations which are in conflict with the current strategies of brief hospital admissions for acute treatment. In order to tackle this issue, the service of general psychiatry of the Department of psychiatry of the CHUV, in Lausanne, Switzerland, has opened in June 2016 a rehabilitation inpatient unit of 18 beds focusing specifically on the development of the minimal abilities required to adapt to living in a flat or in a sheltered accommodation. This paper describes the first 12 months of activity of this unit., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts avec cet article.

Despite the increasing number of specialized addiction services and the constant deployment of health care resources, a coordinated needs-based treatment is not always available for people with severe drugs and/or alcohol problems. Too often the involved health care professionals feel helpless and overwhelmed by the complexity of the situation. In order to promote the treatment engagement of the hard-to-reach substance users, a multidisciplinary mobile team project for addiction (SIMA) was developed in Lausanne, Switzerland, in 20174. This paper describes the model of intervention, the profile of the population followed during the first year of intervention and illustrates, through two clinical cases, the advantages of this approach.

In Switzerland all children's liver transplants are centralized at the University Hospitals of Geneva (HUG) since 1989. Approximately 150 children have received transplants since then, and their survival rate is higher than 90%--one of the highest in Europe. Maximizing the chances of long-term success requires that patients comply with follow-up treatment, something which mandates a sound understanding of their medical condition. The KidsETransplant project aims to help the child--and his family--to understand better his state of health. To this end, our tool offers secured, unrestricted access to the patient's medical record, with a view to both increase patient autonomy and improve communication with healthcare professionals. This paper describes KidsETransplant, as well as its implemented evaluation process.

The purpose of this current paper is to give a simple update and overview about vaccinations for dental health care workers considering the new guidelines published in February 2014 by the Swiss Federal Office of Public Health. It is recommended to have at least a valid protection against hepatitis B, measles, mumps, rubella, influenza, varicella, diphtheria, tetanus, poliomyelitis and pertussis. Dental health care workers are highly exposed and high risk carriers for inoculable diseases, therefore regular refreshment of vaccinations is necessary for public health and their own health.

Emotional disorders are common during the perinatal period and can have negative consequences on the woman's physical and mental health, as well as on the mother-child relationship. Screening for these difficulties is complicated because of a lack of knowledge and a lack of simple and validated tools that can be used on a large scale. A Geneva multidisciplinary team has developed a prenatal interview model, provided by specifically trained midwives. It aims to sensitize pregnant women, offer them a personalized space of listening, detect psychological weakness, develop resources and orient patients in need to specific care centers. This paper describes this interview and its main implications for clinical practice.

This paper examines the role of an interactive website--named Oneself--on patients' chronic low back pain self-management in the Italian part of Switzerland. As part of a qualitative evaluation, we conducted semi-structured interviews with a purposive sample of 18 Oneself users. Results confirm that the Internet may promote attitudes and behaviors of self-management of chronic low back pain. However, it seems that individuals take advantage of this means differently, based on their profile (age, familiarization with the web) and stage of advancement in the self-management process. We conclude that information and support provided online should be tailored according to these different criteria.

The 2012 Swiss consensus paper on diagnosis and management of patients suffering from dementia resulted from the work of an expert panel who met on March 23d to 25th in Luzem. Based on a literature review, panel members wrote a first draft that was subsequently circulated among multiple dementia experts in Switzerland. After adaptation and revisions according to comments, all consulted dementia specialists and panel members fully endorse the consensus content. The conference was financed by the Swiss Alzheimer Forum.

Polymorbidity affects an increasing number of patients of all ages as demonstrated by a recent epidemiological study and represents a real challenge for the organization of health care. Appropriate management of polymorbid patients requires an interdisciplinary approach associating generalist and specialist physicians, but also nurses, other health professionals and social workers. An improvement in transition care between the community and the hospital is necessary in both directions. Prioritizing the treatment objectives is essential to allow patient adherence and avoid cumulative drug interactions and adverse effects. Those objectives are difficult to attain in the context of our present health care organization. This paper attempts to identify the difficulties involved in caring for polymorbid patients and propose ways to improve it.

In the history of the clinic, the introduction of quantitative methods in mid-19th century medicine was obviously of great epistemological importance. The controversy about Louis's "numerical method" in the 1830's was an essential step in medical statistics. This paper deals with three Genevan dissertations from 1809 submitted to the prize essay contest on croup announced by Napoleon. It shows that collecting and comparing medical cases was practised well before 1830. An analysis of the numerical methods used by the Geneva physicians reveals international cultural influences. The awareness of the potential of numbers in medicine was increasing but marked by difficulties.

The new history of the clinic, developed mainly after the publication of Othmar Keel's L'avènement de la médecine clinique moderne en Europe, 1750-1815 in 2001, invites the scholars to turn upside down the chronology adopted by Michel Foucault in his classic Birth of the Clinic. This paper investigates the philosophical consequences of this chronological displacement, showing that the medical empiricism of the clinic cannot have the characteristics attributed by Foucault. If the myth of the purity of such empiricism cannot be taken seriously anymore thanks to Foucault, is has been substituted by the myth of the creation of the clinic on the basis of enlightened empiricism. The clinic is, however, older than empiricism à la Condillac. It refers to an earlier medical empiricism developed in the 17th century which in its turn allowed for Condillac's philosophy. The clinic had in fact to choose between an elder medical empiricism and a new chemical empirism that appeared in the late 17th century. But the clinic was not a creation of the Enlightenment.

Primary care medicine is first in line to meet the necessary changes in our health care system. Innovations in this field pursue three types of objectives: accessibility, quality and continuity of care. The Department of ambulatory care and community medicine of the University of Lausanne (Policlinique médicale universitaire) is committed to this path, emphasizing interprofessional collaboration. The doctor, nurse and medical assistant coordinate their activities to contribute efficiently to meet the needs of patients today and tomorrow. This paper also addresses how our department, as a public and academic institution, might play a major role as a health care network actor. A master degree dissertation in health management has started to identify the critical success factors and the strategic core competencies needed to achieve this development.

In Switzerland, cervical cancer screening has been introduced in the 60s and has allowed a significant reduction in the incidence and mortality of this disease. More recently, the HPV vaccine was introduced with public target of girls aged 11 to 14 years. Gradually, this vaccinated population will reach the age of screening. Vaccinated population will present less HPV infection and less cytological abnormalities and consequence will conduct to a lower performance of cytology. In this context, the HPV test with its objectivity will become the most suitable means for cervical cancer screening. The aim of this paper was to conduct a synthesis of current knowledge about primary and secondary prevention of cervical cancer and define the best options for the future.

Objectives: Assertive Community Treatment (ACT) is known to have a positive impact on the number and length of inpatient stays. Yet, research is needed in order to help understand how ACT programs may ease off families' burden, e.g. in terms of economic expenditures. Indeed, many families with siblings suffering from chronic mental illness, who disengaged from psychiatric services, report needs related to ACT. This paper aims to describe the impact of a new ACT program in Geneva on patients and their families' burden., Methods: Out of 91 patients consecutively treated by the ACT program for at least 3 months, 55 consented to participate in the research. Twenty-one allowed us to contact their families (out of 37 who had relatives in the area). Data were gathered on patients and families before and after a 6-month-follow-up., Results: For the patients, after adjustment for the time spent during follow-up, most of the studied variables evolved favorably, particularly for their symptoms. At baseline, most of the family members felt overburdened by the financial cost (59.1%) related to their relatives with severe mental disorder and experienced inconvenience at having to give them assistance in daily life (68.2%) and to supervise them in daily activities (54.5%). Several variables evolved favorably during follow-up. Notably the best changes were observed for the inconvenience relating to assistance in daily life and relatives' emotional distress. Families of patients with delusional disorder featured less or no improvement during the ACT follow-up. The best correlate of improvement in familial burdens was improvement in patient's positives symptoms. Among those patients, being a female and suffering from a schizo-affective disorder was known to have had a higher impact on the number of interventions provided by families., Discussion: ACT should be recommended for patients who feature a poor outcome when treated in other settings. In addition, our results suggest that their families can also improve considerably, particularly those confronted with patients with persistent and enduring disturbing behaviors related to positive symptoms which do not, however, warrant hospitalization. Clinicians should pay particular attention to patients suffering from delusional disorder and their families, as this disorder does not appear to be associated with improvement in family burdens. These data do not allow definitely disentangling whether the improvement of families' burden is directly related to ACT interventions with them, to the implementation of support by other structures (such as peer support groups) or to an indirect effect related to patients' improvement. To our knowledge no similar study on the effect of ACT on family burden exists. Hence, such research needs to be replicated in other areas with different clinical and cultural backgrounds., (Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Teaching community medicine represents a significant challenge for medical schools, which tend to struggle to promote interest in the issue among students. In 2009, the Lausanne medical school introduced a "community immersion" module specifically designed to address the issue. The new module requires students working in small groups under the supervision of a tutor to investigate a health question of their choice. The investigation involves conducting interviews with stakeholders (health professionals, patients, politicians, etc.), carrying out a survey, and presenting the results of the investigation in a "congress". An external evaluation showed that the objectives of the initiative had been largely achieved, with an increase of interest in community medicine for over 50% of students (based on a total cohort of 150 students) and a high level of satisfaction for over 90% of students and tutors. This paper presents the results of the initiative and its use for promoting community-oriented medicine.

Non-invasive mechanical ventilation in patients with chronic neuromuscular disorders is an effective tool for treating dyspnea or sleep disturbances often observed in such patients. So, NIV has to be considered as a palliative treatment and it must systematically be offered to these patients. Mechanical ventilation, non-invasive or invasive (via a trachesotomy) have to be considered systematically with patients and families at an earlier stages of these diseases in order to design a strategy in case of acute respiratory failure. In a second parent paper of this issue, we discuss the medico-legal implications of mechanical ventilation in neuromuscular failure, particularly the end-of-life aspects.

Hip fracture in the elderly can be associated with dramatic issues like death in the year or severe handicap requiring admission in a nursing home. Implementation of a close cooperation between orthopaedic surgeon and geriatrician materialize in the creation of unit, known as orthogeriatric unit where the roles of each member are precisely defined from admission to discharge, with coordinated care protocols and standardized orders. Benefits of the orthogeriatric ward are clarified in this paper, referring to literature, with description of an improvement of functional score after 3 months, reduction of in-hospital mortality and post-operative complications.

Recently some key papers and consensus have shed some new light on antiphospholipid syndrome (APS). Concerning the tests the search for lupus anticoagulant is now better defined. A modified antibeta2-glycoprotein I assay has been shown to be more specific for clinical complications. It seems necessary to still perform anticardiolipin antibodies in case of pregnancy morbidity but not in case of thrombosis which raises the question of two separate clinical entities with different pathologic mechanisms. Concerning the pathophysiology, new data emphasize the role of complement and underscore the role of genetic predisposition. The data of some large cohort followed prospectively such as the European cohort (1000 APS patients) as well the data of some registries (APS in children and patients with a catastrophic APS) bring some new important information on the clinical aspects of the syndrome. Finally this review will propose some algorithms to treat patients with APS.

Various factors oblige today's parents to entrust their children to a child-care worker (CCW), providing services in the domestic sphere, either at the child's parental house or at the day-care worker's (DCW's) own home. Taking this into account, this paper examines job offers and applications for DCWs published in a regional Swiss newspaper as well as other job offers and applications published on a website called bestnounou.ch. The parents often tend to use a variety of terms, which do not point to the child-caring or rearing activity itself, but rather emphasise sociological characteristics of the CCW (age, gender, civil status), requesting, for example, a “lady”, a “grandmother”, a “student”. Thereby, the parents present the child-care work as: (1) a secondary and temporary activity in relation to another major stable activity (motherhood, apprenticeship, retirement); and (2) an activity that does not require professional skills but inborn aptitudes. Moreover, employers use as synonyms distinctive terms, which refer to various categories of CCW and domestic workers, whose schedules of conditions and salaries are regulated and differ. The parents' inclination to use terms designating the most precarious and underpaid CCW underscores the importance of child-care in the domestic sphere. It leads also to a public image of child-care workers as being a fragmented, unstable, little qualified and economically inconsistent workforce, in contrast to the stable and structural need for their specific services, allowing parents to face their familial and professional responsibilities.

Medical fee schedules are controversial. In this paper we examine the reasons that justify the imposition of fee schedules in the presence of a socially financed health insurance system, and examine the ways of constructing a medical fee schedule. The weakness of fee-for-service tariffs is that they do not allow a control of health care costs if the volume of services is unchecked. Current solutions to this problem--audit of doctors' average cost per case, freeze on new medical practices, or the insurers' discretion in choosing the doctors they reimburse--have multiple drawbacks. Alternatives to fee-for-service payment--such as flat fees, or payment based on the quality of medical services--are discussed.

This paper discuss the development of the new curriculum (bachelor, master) for clinical skills (history taking, physical examination, patient communication, professionalism) at the Medical School in Lausanne. Some specific aspects are reviewed: a structured and longitudinal curriculum, improving bedside clinical teaching, assessment of clinical competences, integrating teaching into the institutional values.

The prevalence of psychiatric disorders and symptoms in nursing homes is high. This phenomenon could potentially harm the residents' quality of life but also complicate their treatment. To offer a regular psychiatric input, a group of psychiatrists and nurses specialized in psychogeriatrics have set up a consultation-liaison service in 14 nursing homes in the canton of Fribourg. In this paper, we report the results of a satisfaction inquiry realized after one year of collaboration. Dementia and depression were the two most common psychiatric diagnoses, accounting for more than two thirds of the cases. These services were found to be very satisfying, especially their educational dimension for the nursing home staff.

This paper aims at investigating causes and potential remedies of increased psychiatric hospitalization in this country. The data suggest that there was growing pressure on psychiatric hospitals from 1950 to 2000. This may result from inappropriate management of a new type of acute psychiatric patient rather than severed epidemiology of acute psychiatric disorders. More focus on innovative crisis intervention programs emphasizing the central role of the general hospital in contemporary psychiatry may strongly contribute to better mental care. Despite significant advances in psychotherapy and medical research such an evolution is contended from the exquisite entropy of psychiatric systems. Those cultural and psychological factors associated with this issue require careful consideration and further studies.

Since the year 2000, the concept of "bientraitance" (for which no equivalent term has yet emerged in either the English or German language) has gained widespread credence among educators, sociologists and health professionals in France and Belgium. This concept emphasizes a constructive approach to care and education rather than merely one of prevention of disasters. Applied in public health, and in particular to mental health promotion, the use of the concept of "bientraitance" can help promote both effectiveness and meaning in the design and planning of community interventions. The article presents an example of an intervention for children and adolescents in Fribourg, Switzerland. The underpinning hypothesis is that the children and youth groups (such as sports clubs, artistic and cultural associations, scouts and guides) represent largely untapped, or under-tapped, informal health resources with a favourable cost-effectiveness profile. "Bientraitance" criteria are used in selecting certain associations offering structured extracurricular group educational activities and collective out-of-school (or after school) programmes. Support is provided to the organisations selected for recruiting new members, in particular those with potentially lower levels of access, for example disabled children or new migrants. The results will be evaluated for the impact of participation in various out-of-school activities on health and health determinants from a prospective and comparative perspective. This paper shows how the concept of "bientraitance" can be useful in the development of a public health intervention.

The debate on the legimity of having two distinct medical societies and specialist degrees in Switzerland, one for family medicine and the other for internal medicine, is currently reactivated due to the rapid evolution of medical demographics and of our health system. In this paper, the academic representatives of those disciplines from the French-speaking part of Switzerland sum up the arguments for and against creating a single medical society for generalists and internists, in the perspective of education and research. They conclude that the advantages vastly outweigh the inconveniences and support this project. Moreover, they propose a training track individualized according to the trainee's future practice environment (hospital-based, urban or suburban outpatient practice).

About 1/5 of patients are undernourished in Swiss hospitals. Despite of a high morbidity and mortality associated with this pathology, nearly 1/3 of them do not receive an appropriate nutritional support which can be even indicated at an obese patient. This paper approaches the key points of early nutritional care. NRS-2002 is presented like a simple tool able to identify patients nutritionally at-risk who are likely to benefit from nutritional support. Moreover, the major role of a diet adapted to the specific needs of the patient points out the need for an institutional policy coordinated around diet-nutrition.

Education in nursing research in nursing schools in Switzerland has been in existence for many years but has had little impact on professional practice. This kind of education does not meet the needs of the students and the profession. Education in nursing research must be adapted, must address epistemological questions and must be integrated into the entire training programme and not only be offered at the end of the education. It could be summarised in five dimensions: 1) professional teaching founded on research results; 2) the regular reading of research papers; 3) meetings with researchers; 4) teaching of research methodology adapted to the field; and 5) a dissertation adapted to the field and considering the conditions of students' research.

Background: Public health stakeholders are concerned about program sustainability. However, they usually conceive sustainability in accordance with financial criteria for at least one reason. No simple frameworks are operationally and theoretically sound enough to globally evaluate program sustainability. The present paper aims to describe an application of one framework assessment tool used to evaluate the sustainability level and process of a Nutritional Care Unit managed by a Swiss humanitarian agency to fight against severe child malnutrition in a Haitian area. The managing agency is committed to put this Unit back into the structure of a local public hospital., Methods: The evaluation was performed within the sustainability framework proposed in a former article. Data were collected with a combination of tools, semi-structured interviews (n=33, medical and support staff from the agency and the hospital), participatory observation and document review. Data concerned the four characteristics of organizational routines (memory, adaptation, values and rules) enabling assess to the level of sustainability. In addition, data were related to three types of events distinguishing routinization processes from implementation processes: specific events of routinization, routinization-implementation joint events, and specific events of implementation. Data analysis was thematic and results were validated by actors through a feed-back session and written comments., Results: The current level of sustainability of the Nutritional Care Unit within the Hospital is weak: weak memory, high adaptation, weak sharing of values and rules. This may be explained by the sustainability process, and the absence of specific routinization events. The relevance of such processes is reasonable, while it has been strongly challenged in the troublesome Haitian context. Riots have been widespread over the last years, creating difficulties for the Hospital., Conclusion: This experience suggests the proposed framework and sustainability assessment tools are useful when the context permits scrutinization of program sustainability.

Since 1999, the Canton of Jura has been contributing to international and national efforts towards sustainability. In this context, and under strong political support, people in this Canton have been engaging upon implementation of health impact assessment techniques. This paper describes the main lessons to be learned from this local experience.

Studies undertaken in general hospital confirm the high prevalence of alcohol problems among hospitalised patients. Unfortunately, only few of them will be recognised and receive relevant information according to their clinical situation. As far as we know, early screening and targeted intervention are useful to prevent more severe alcohol-related problems but most of care givers as doctors or nurses fail to screen and counsel adequately problem drinkers. Considering the importance of the problem in hospitalised patients, screening and intervention is a public health issue. Hospitalisation is a good opportunity for achieving these goals. This paper describes the activity of a specialised health professional who implemented a bed-patient consultation for those who were screened as problem drinkers during their hospitalisation for any reason but alcohol detoxification or rehabilitation. Strategies to talk about alcohol issues with resistant to change patients are discussed.

Schizophrenia has long been considered with pessimism, but the recent interest in the early phase of psychotic disorders has modified this often unjustified perception. Literature has demonstrated the benefit of the development of programs specialised in the treatment of early psychosis, which tend to be developed in many countries. It is however important to match them to local needs as well as to the structure of local health services. This paper reviews elements that justify such a development in Lausanne, Switzerland, and describe its various elements.

Medical problems involving driving aptitude are more and more common nowadays. Each doctor in Switzerland could be asked to give a certificate of driving aptitude for one of his/her patient. This paper relates to the problem of substance abusers in the current legal context and the growing complexity of care.

Rapid antagonist induction under anesthesia is a method that has been increasingly used to detoxify opiate addicts. These procedures are useful to reduce the duration and the discomfort of withdrawal. However, the high risk and the cost of these methods require randomized clinical trial to evaluate safety and clinical effectiveness. The University Substance Abuse Division of Lausanne and the Intensive Care Unit of the St-Loup Hospital work on a randomized clinical trial comparing anesthesia-assisted versus traditional clonidine detoxification combined with an additional psychosocial week. This paper describes the technique of anesthesia used in our study. Our clinical experience suggests that, integrating this technique in a multidisciplinary network, with a strong emphasis on post-anesthetic follow-up, is a viable and safe option in the treatment of opiate dependence.

This paper, in a sociological and historical perspective, aims at positioning the main issues linked to the idea of utilizing evidence-based practices in health promotion. It begins to do so by looking at the international evolution of health promotion and evidence-based practices, and by providing definitions for these concepts. In a second section, the paper analyzes how the evidence based practices approach has confronted the field of health promotion, especially since the second half of the 1990s. It argues that this has occurred in the context of the evaluative concerns put forward by governments all over the world, in order to downsize their publicly funded health systems. The reaction, often negative, of the health promotion field to evidence-based practices is also documented. Finally, some methodological and political issues raised by the idea of utilizing evidence-based practices in health promotion are presented. The paper concludes that this approach is far from a panacea but has potential limited utilization for certain kinds of health promotion practices. Alternative suggestions on how to establish "best practices" in this field are also offered.

Always more health problems require integrated care. So professionals needs to be aware of local and regional network resources (social, legal, home care, etc.) and specific offers of each individual institution. This article present a method used for creating a register of institutions involved in adults violence and elder abuse, for health professionals. Dates collected by interviewing professionals permitted to class institutions by intervention domain and offer. Five utility indicators (POUCE method) were selected for the register. A score has been attributed to each institution according to their problematic-related offers. Professional in charge of each institution validated information. This map, available in paper or CDrom, affords general practitioneer a quick and targeted access to a large number of dates, according to patient needs. This method could be useful for other health problems requiring exhaustive and targeted information about local and regional community resources (alcoholism, addiction, palliatives care, etc.)

Medicine can be dangerous for the patients, the caregivers, the visitors and the environment. Technological progress provides devices and drugs that are always more powerful, more efficacious, but at the same time able to lead to severe side effects. This paper describes the system set up in a university hospital to fulfill legal requirements. Specialists in specific fields build up commissions, which are united in a coordination office. A general policy for the hospital has been decided, but each commission is responsible for managing the risks in its field. The overall philosophy moved from a quality assurance to a quality management system, in which the employee involved in an incident or an accident is no longer considered the only culprit except in cases of obvious violation of established procedures. In order to be efficient, the system must be as simple as possible, and well known, so that collaborators gain confidence in it. Once this cultural revolution is accomplished, quality but also security of the procedures will be improved. Its impact on cost is more questionable, as the system generates running costs which might be higher than the savings it might bring.

Surgical site infection (SSI) is a feared complication of any surgical procedure. Despite clear progresses during the last decades, recent studies (some from Switzerland) show that many patients still suffer from SSIs and that SSIs have a huge impact for patients and public health. Thus, the prevention of SSIs must constitute a priority of nosocomial infections control in hospitals. In addition to classical approaches focusing on skin preparation, antibiotic prophylaxis, asepsis, and operative environment, surveillance has proved effective in decreasing the incidence of SSIs. The present paper reviews the principles and the main components of an SSI surveillance program.

T. Lyssenko (1898-1976) was an Ukrainian agricultural expert who defended and tried to proof the inheritance of acquired characteristics. He rejected the validity of the chromosome theory of heredity inspired by Mendel and Morgan and finally came to the top of the scientific authorities of Soviet biology. Since 1948 he was known in the Western countries, and a few scientists adopted his views, especially in France, Belgium and Geneva. At the Institute of Botany of the University of Geneva several papers inspired by him were written and a doctoral thesis; a public debate also took place in 1949. Lyssenko lost power in the sixties and since then has lost credibility everywhere.

The paper is describing the design and the performance of the computerized system, from its introduction in 1982 until the present day. The first device, using the MUMPS language on a mini-computer, followed by a VAX computer with terminals have been replaced in 1996 by an application program, using ORACLE, based on the client-server concept. The content and the particularities of the different data groups are discussed, concerning the functional components of the data bank: 'PATIENTS', 'SPECIMEN', 'SENDERS', 'REPORT' and 'DIAGNOSES'. By means of examples, we demonstrate the chronological evolution of the registration of persons, the distribution of the diagnoses according to the organ systems, the possibilities to combine various lesions and an algorithm to assure that a given lesion is registered only once per patient. In first place, the efficiency and the reliability of manual coding by a pathologist using the Systematized Nomenclature of Medicine (SNOMED; 2nd edition [1979/1982]) is discussed. The data bank currently contains 530,000 diagnoses, distributed among on SNOMED's five main modules, obtained from 1500 autopsies, 140,000 surgical and 180,000 cytological specimens. Concluding the article, an analysis is made of desirable developments in the future with the aim of a better integration of the acquired information in routine work and an enhanced use of the medical content for epidemiological research or statistical analysis.

With the example of a study on population health in the Swiss cantons Jura and Neuchâtel, the paper proposes a mechanism for priority setting of problems that could be acted upon preventively. Concepts are reviewed: public health needs as defined by epidemiology, supply of preventive activities, demands expressed by the population and different stakeholders. The role of general practitioners is stressed, not only as preventive services suppliers, but also as actors of priority setting.

The number of patients belonging to migrant populations who consult Lausanne's Hôpital de l'Enfance (HEL) has increased massively in an exponential manner. HEL is a facility dedicated to children with a vocation of public health and training in a university setting and it has to make a point of developing an adequate and pertinent health care system for these populations. In order to do this, a study was undertaken in the form of a prospective survey including over a thousand ambulatory patients. Administrative data (origin, date of migration, nature of the permit and legal situation), social data (home language, professional situation, number of siblings), medical (diagnosis) and psychosomatic data (sleep, enuresis) was recorded as well as data testing the level of understanding between carrier and patient. The study allowed us to define priorities of intervention: introduction of a service of translators--cultural mediators trained by the association "Appartenances" (as well as on going follow-up and assessment of this service), training of health care workers in the fields of cultural mediation and the different aspects of migrant population medicine and, finally, the creation of a steering group within the Institution. Having allowed rapid and spectacular improvement in the quality of the service provided by the HEL, this process is also included in the will to improve health care given to migrant populations at local and national levels in accordance with the priorities defined by the WHO in this domain. It is this experience which is reported in this paper.

In Lausanne, Switzerland, there is a growing population of migrant people of different origins. This evolving situation calls for a continuous adjustment between need and offer in terms of healthcare. Up to now, this adjustment, which involves cross-cultural adaptation processes, was based on the use of untrained interpreters. However, clinical experience shows that the use of untrained interpreters tends to keep migrant patients in an unfavourable position. This paper describes an action-research in Lausanne, which aims at the evaluation of the changes that are brought by the introduction of trained cultural mediators and interpreters (CMI) into the medical field. The paper enumerates the clinical issues that gave birth to the project and the methodological choices that were made. After discussing the first results, the authors describe how the different research stages are adapted and modified through continuous mutual influences between the field and the research process itself.

Background: The objectives of the present study were to evaluate Aids prevention in drug users attending low threshold centres providing sterile injection equipment in Switzerland, to identify the characteristics of these users, and to monitor the progress of indicators of drug-related harm., Methods: This paper presents results from a cross-sectional survey carried out in 1994., Results: The mean age of attenders was 28 years, and women represented 27% of the sample. 75% of attenders used a combination of hard drugs (heroin and cocaine). Mean duration of heroin consumption was 8 years, and of cocaine 7 years; 76% of attenders had a fixed abode, but only 34% had stable employment; 45% were being treated with methadone; 9% had shared their injection material in the last 6 months; 24% always used condoms in the case of a stable relationship, and 71% in casual relationships. In a cluster analysis constructed on the basis of multiple correspondence analysis, two distinct profiles of users emerge: highly marginalised users with a high level of consumption (21%); irregular users, better integrated socially, of which the majority are under methadone treatment (79%)., Conclusion: Theses centres play a major role in Aids prevention. Nevertheless, efforts to improve the hygiene conditions of drug injection in Switzerland should be pursued and extended. At the same time, prevention of HIV sexual transmissions should be reinforced.

As numerous publications attest, knowledge on hantaviruses progressed rapidly since the isolation of the agent of Korean hemorrhagic fever in 1978. This trend was even enhanced after the recognition of a previously unknown hantavirus that caused an outbreak of acute respiratory distress syndromes in the southwestern United States in 1993. Hantaviruses are carried by rodents worldwide and may cause severe diseases in humans. Hantavirus pulmonary syndrome in the New World and hemorrhagic fever with renal syndrome in Asia and Europe are being more and more reported. This could reflect a growing threat to public health as a consequence of behavioural and environmental changes. Though such infections are likely to occur in Switzerland too, prevalence and incidence of hantaviral infections among wild rodents and humans have not been studied yet in this country. The present paper reviews the epidemiology and clinical presentations of hantavirus infections.