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The timing of taking antihypertensive medication does not have an impact on the cardiovascular plan. Geniculate block is an alternative to oral analgesic treatment for knee osteoarthritis. Feedback and audits are ineffective in reducing the inappropriate prescription of antibiotics in Switzerland. The intervention of community health professionals in collaboration with general practitioners allows for the control of arterial hypertension. In the case of peripheral facial paralysis, it is relevant to systematically consider performing magnetic resonance imaging. Aspirin is an alternative to enoxaparin in thromboembolic prophylaxis after surgery for a traumatic fracture. Walking 8,000 steps a few days a week reduces mortality. Opioids are not effective for acute neck and lower back pain., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The REVIAC device was designed ten years ago, with the aim of advising social workers in their efforts to support and reintegrate people in vulnerable situations. In this article, it will be a question of identifying the current issues and the challenges to be met for the future., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

There is an important gap in health knowledge about vulnerable and hard-to-reach groups. The development of research projects and the implementation of interventions require strategies adapted to the particularities of these groups. This article reviews some of the main issues through the lens of recent projects conducted in French-speaking Switzerland., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

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., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

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., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Agent-Based Modelling (ABM) is a computer modelling technique that simulates the behaviour and interactions of autonomous agents within a virtual environment. Applied to health equity, this technique allows for a better understanding of the complex social and economic determinants that contribute to health inequities and enables the evaluation of the potential effects of public policies on the latter. Despite some limitations related to the accessibility and quality of health data and the complexity of the models, ABM appears to be a promising tool in the field of health equity, both for researchers in public or community health and for policy makers., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

While several recent studies suggest that approximately 1 in 6 young people in Switzerland are part of the rainbow diversity, a high proportion of health professionals have never had a course on LGBTIQ+ (lesbian, gay, bisexual, transgender, intersex, queer, questioning or other) health. This situation leads to significant gaps in the medical care of LGBTIQ+ persons as well as difficulties in accessing equitable, culturally appropriate and quality care. This article presents the ambitious and novel e-learning project I-CARE (Improving Care and Access for Rainbow Equity) which should contribute, from the end of this year, to filling the current gaps in the undergraduate and continuing education of health professionals., Competing Interests: Les auteur-es n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In patients aged 65 or older, the risk of dementia decreases with cataract surgery. Mental stress doubles the risk of a cardiac event in patients with stable coronary artery disease. The one-legged stance performance estimates total mortality in patients 50 years or older. Patients with chronic pain benefit from treatment with dronabinol or nabiximols. Salt substitutes are an alternative to regular salt in hypertensive patients aged 60 years or more. The promotion of physical activity in the office is effective in reducing sedentary behavior. Music has a favorable impact on the mental dimensions of quality of life. Colonoscopies performed on patients aged 75 years or more have a higher risk of non-gastrointestinal complications than gastrointestinal complications., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

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., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In June 2021, the Swiss parliament accepted a legislative proposal calling for the introduction of a fee to fight emergency department (ED) overcrowding. Although this issue remains a major challenge for health policies, the introduction of such a fee raises many questions, notably regarding health equity. However, other more equitable solutions exist: improving the case management of ED frequent users and improving coordination between ED and primary care., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Psychotherapy diminishes depression relapses when antidepressants are reduced or stopped. Delayed antibiotic therapy is effective and safe while treating community-acquired respiratory infection. Physical rehabilitation after hospitalization due to acute cardiac decompensation is useful in frail patients. Six hours of sleep appears to be associated with a higher risk of dementia in people aged 50-70 years. Patients modify healthcare use after losing their referring physician. Screening for atrial fibrillation in healthy patients aged 65 or older is not beneficial. Physicians' ECG reading skills decrease in the absence of regular training. Patients hospitalized with COVID-19 are often clinically, psychologically, and economically impacted., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The exceptional health challenges generated by the COVID-19 pandemic have sparked a wave of mobilization among medical students. We were four students to provide support to the Migrant Care Units of the Vulnerability and Social Medicine Department of Unisanté. This two-month experience, very different from the academic framework we were used to during our studies, allowed us to discover a clinic grappling with social and cross-cultural issues, and taught us the mutual benefits of an interprofessional collaboration with experienced nurses. Through a few clinical vignettes, we would like to share the challenges of the care we have seen, as well as the significant lessons we have learned from them., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Competing Interests: Intérêts concurrents: Aucun déclaré.

Climate change and forced migration are two major global health concerns. They are closely related, with climate change causing an increasing number of forced migrants. Natural disasters, sea-level rising or land aridification are examples of consequences of climate change that have an impact on forced migration. Moreover, the health of forced migrants can be directly affected by climate change, during the migration process or in the host country. The absence of a legal status of « climate refugee » can be an important barrier of access to health care. These vulnerable populations are among the first to be affected, which is an important health equity issue., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

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 «cost» of caring., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Functional weakness of the limbs has an uncertain prognosis and little chance of recovery. Obese people in precarious situations may succeed in losing weight through an intensive lifestyle-based weight loss program. In patients with gonarthrosis, physiotherapy may decrease pain and disability when compared to injected corticosteroids. Patients suffering from an alcohol dependence syndrome can reduce their consumption with short-term consultations conducted by general practitioners. Fatigue and dyspnea are two frequent symptoms that may persist after the acute phase of the SARS-CoV-2 infection. PCR analysis for the detection of SARS-CoV-2 could be performed with the same degree of sensitivity on a nasopharyngeal or salivary swab., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Consistent with the principles of evidence-based medicine, communicating clinical risks to patients and their families is an essential part of informed consent and decision-making. Communication of clinical risks can take place during and after consultations, orally or in writing, based on the latest available scientific data, when available. Numerous studies show that there are different degrees of innumeracy in the general population, meaning more or less significant difficulties mastering numbers in everyday situations. It is therefore imperative to communicate risks in a way that is adapted to the patients' variable numeracy and health literacy levels. This article presents a synthesis of international research on risk communication, as well as recommendations for clinical practice., Competing Interests: Marie-Anne Durand a développé l’outil d’aide à la décision « Option Grid », qui est sous licence auprès de la compagnie EBSCO Health. Elle est consultante pour EBSCO Health. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Our medical practice brings us to meet people from all walks of life. Some of our patients experience multiple vulnerabilities and are at greater risk of stigma and discrimination. In the field of asylum, they are often firstly designated by words reflecting their socio-administrative reality. These words are supposed to define their identity. The individual is dehumanized because reduced to an administrative status. These terms carry a denotative meaning, valuable in understanding the context in which the patient evolves ; but also a connotative meaning, which through implicit bias leads the caregiver to adopt attitudes that may be detrimental to the proper care of the patient. Words must be carefully chosen and brought in a timely manner, because words matter., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The new catalogue of objectives for medical education at Swiss universities (PROFILES) underlines the importance of teaching the impact of ethnic, cultural, spiritual and religious differences and the socio-economic determinants of health and illness on health and care. At the same time, the social reality of the moment reminds us that racism is still present in our societies. Therefore, education for medical students is necessary. This should include basic knowledge but also, and above all, an understanding of the underlying mechanisms that will enable them to grasp the notions of prejudice, stereotypes and discrimination. Finally, introspection, the acquisition of cross-cultural skills and cultural humility will help to deal with this other epidemic., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The current new coronavirus pandemic has highlighted the importance of taking into consideration population groups particularly at risk of contracting Covid-19 disease or developing severe forms of the disease. The medical literature, the press and the authorities have thus stepped up the use of the expression « vulnerable populations » in recent weeks to refer to it. However, behind this general expression there are diverse but often interdependent realities whose specific consideration and understanding seem essential for the effective management of the epidemic and its health and socio-economic consequences., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Since the emergence of the COVID-19 pandemic, the Confederation has referred to « vulnerable populations » over the age of 65 and/or with co-morbidities as potentially at risk. This group should not overshadow other highly vulnerable populations such as forced migrants, people deprived of their liberty, and the homeless. In the context of the current pandemic, there is a risk of increasing inequities in care among these populations. In this practical article, we list the marginalized and disadvantaged left behind populations in the canton of Vaud and the issues of inequities in care in the context of the pandemic; we also present the implementation of procedures sometimes original, always inter-professional and interdisciplinary, specifying who the partners are and what the resources are for front-line caregivers., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In healthy adults, vitamin D does not prevent falls or hip fractures. The diabetogenic effect of topical steroids is significant and dose dependent. Pulmonary embolism can be surely ruled out by the YEARS algorithm adapted to pregnancy. Patients with osteoarthritis treated with tramadol have a higher risk of death when compared to those treated with non-steroidal anti-inflammatory drugs. Inappropriate prescribing in elderly patients can be reduced by an educational intervention deployed in pharmacies. Medical scribes are effective in improving visit quality and job satisfaction of family physicians. Impedance studies lead to new diagnostic approaches in chronic fatigue. In healthy individuals, isolated check-up interventions do not have an impact on morbidity and mortality., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.