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Aims. Frequent users of the emergency department (FUED; five ED visits or more per year) often have negative experiences in health care settings, potentially aggravating their health problems. Scarce research has explored FUED experiences in health care in Europe, none in Switzerland. Thus, this study aimed to conduct an in-depth exploration of FUED experiences in health care settings in Switzerland. Methods. Semi-structured interviews were conducted among 20 FUED (75% female; mean age = 40.6, SD = 12.8). Qualitative data were subject to inductive content analysis. Results. Five main themes emerged from the analysis. The main findings documented that FUED experiences in health care were mostly negative, leading to negative emotions, dissatisfaction and a loss of confidence in the system, although some positive experiences were reported as well. The relationship with health care workers was perceived as playing a key role in FUED experiences. Conclusion. The findings indicate that FUED often have negative experiences in the health care system in Switzerland. The relationship with the health care staff is reported as a decisive ingredient of the experience in health care. Future research is needed to develop awareness-raising interventions for health care staff to improve FUED experiences in health care.

BackgroundPrevious research revealed the vulnerability of frequent users of emergency department (FUED) because of concomitant medical, psychological and social issues. Case management (CM) provides FUED with effective medical and social support, however, the heterogeneity of this population has highlighted the need to explore the specific needs of FUED subpopulations. In response, this study aimed to explore qualitatively the lived experience of migrant and non-migrant FUED in the healthcare system to identify unmet needs.MethodsAdult migrant and non-migrant FUED (≥ 5 visits in the ED in the past 12 months) were recruited in a Swiss university hospital to collect qualitative data on their experience within the Swiss health system. Participants were selected based on predefined quotas for gender and age. Researchers conducted one-on-one semistructured interviews until reaching data saturation. Inductive conventional content analysis was used to analyse qualitative data.ResultsIn total, 23 semistructured interviews were conducted (11 migrant FUED and 12 non-migrant FUED). Four main themes emerged from the qualitative analysis: (1) self-evaluation of the Swiss healthcare system; (2) orientation within the healthcare system; (3) relationship with caregivers and (4) perception of own health. While both groups were overall satisfied with the healthcare system and care provided, migrant FUED reported language and financial barriers to access it. Both groups expressed overall satisfaction over their relationship with healthcare professionals, although migrant FUED reported a feeling of illegitimacy to consult the ED based on social status, whereas non-migrant FUED felt more often the need to justify their use of the ED. Finally, migrant FUED perceived their own health to be affected by their status.ConclusionThis study highlighted difficulties specific to subpopulations of FUED. For migrant FUED, these included access to care and impact of migrant status on own health. Adapting CM to the specific needs of migrant FUED could help reduce their vulnerability.

Background: Effective management of frequent users of emergency departments (FUED) remains challenging. Case management (CM) has shown to improve patient quality of life while reducing ED visits and associated costs. However, little data is available on FUED’s perception of CM outside of North America to further improve CM implementation. Objectives: Explore the FUED’s perspectives about CM in Switzerland. Design, Setting & Participants: Semi-structured qualitative interviews eliciting FUED’s experiences of CM were conducted among 20 participants (75% female; mean age = 40.6, SD = 12.8) across 6 hospital ED. Outcomes measures & Analysis: Inductive content analysis. Main Results: Most participants were satisfied with the CM program. In particular, FUEDs identified the working relationship with the case manager (cm) as key for positive outcomes, and also valued the holistic evaluation of their needs and resources. Overall, patients reported increased motivation and health literacy, as well as facilitated interactions within the healthcare system. Conversely, a small number of participants reported negative views on CM ( ie, stigmatization, lack of concrete outcomes). Barriers identified were cm’s lack of time, COVID-19′s negative impact on CM organization, as well as lack of clarity on the objectives of CM. FUED perceived CM as useful, in particular establishing a working relationship with the cm. Our results suggest that CM can be further improved by (1) professionals remaining non-judgmental toward FUED, (2) making sure the aims and objectives of the CM are understood by the participants, and (3) allowing more time for the cm to carry out their work.

The O/ME-SA/Ind-2001d has been the main foot-and-mouth disease virus (FMDV) lineage responsible for FMD epidemics outside the Indian subcontinent from 2013 to 2017. In 2014, outbreaks caused by this FMDV lineage were reported in Maghreb, where it was initially detected in Algeria and Tunisia and later in Morocco. This was the first incursion of an FMDV type O of exotic origin in the Maghreb region after 14 years of absence. In this study, we report analyses of both VP1 and whole-genome sequences (WGSs) generated from 22 isolates collected in Algeria and Tunisia between 2014 and 2015. All the WGSs analysed showed a minimum pairwise identity of 98.9% at the nucleotide level and 99% at the amino acid level (FMDV coding region). All Tunisian sequences shared a single putative common ancestor closely related to FMDV strains circulating in Libya during 2013. Whereas sequences from Algeria suggest the country experienced two virus introductions. The first introduction is represented by strains circulating in 2014 which are closely related to those from Tunisia, the second one, of which the origin is more uncertain, includes strains collected in Algeria in 2015 that gave origin to the 2015 outbreak reported in Morocco. Overall, our results demonstrated that a unique introduction of O/Ind-2001d FMDV occurred in Maghreb through Tunisia presumably in 2014, and from then the virus spread into Algeria and later into Morocco.

Background d/Deaf people suffer from inequitable access to healthcare and health information. This results in worse health literacy and poorer mental and physical health compared to hearing populations. Various interventions aimed at improving health equity for d/Deaf people have been documented but not systematically analyzed. The purpose of this systematic review is to obtain a global overview of what we know about interventions aimed at improving health equity for d/Deaf people. Methods Medline Ovid SP, Embase, CINAHL EBSCO, PsycINFO Ovid SP, Central—Cochrane Library Wiley and Web of Science were searched for relevant studies on access to healthcare and health-related interventions for d/Deaf people following the PRISMA-equity guidelines. We focused on interventions aimed at achieving equitable care and equitable access to health information for d/Deaf people. Results Forty-six studies were identified and analyzed. Seven categories of interventions facing healthcare or health education inequities emerged: use of Sign Language (1), translation, validation and identification of clinical tools and scales (2), healthcare provider training program (3), development of adapted healthcare facilities (4), online interventions (5), education programs (6) and videos (7). Despite some methodological limitations or lack of data, these interventions seem relevant to improve equity of care and health education for d/Deaf people. Conclusion Interventions that promote healthcare equity, health education amongst d/Deaf patients and healthcare provider awareness of communication barriers and cultural sensitivity show promise in achieving more equitable care for d/Deaf patients. Meaningful engagement of d/Deaf individuals in the conceptualization, implementation and evaluation of health-related interventions is imperative.

Young adult drinkers engage in a range of drinking patterns from abstaining to heavy drinking in both the United States and Sweden. Heavy drinking during young adulthood in both countries is associated with a variety of negative consequences. Personalized feedback interventions have been identified as effective prevention strategies to prevent or reduce heavy drinking in the United States. This study examined transitions in drinking profiles and compared the efficacy of a personalized feedback intervention for 3965 young adults in the United States (1,735) and Sweden (2230) during their transition out of high school. Using goodness-of-fit criteria, results indicated that three drinking profiles exist among young adults transitioning out of high school: very low drinkers/abstainers, moderate to heavy drinkers, and very heavy drinkers. Latent Markov models revealed a moderating effect of country on personalized feedback intervention such that intervention condition participants in the United States were more likely to belong to the light drinker/abstainer or moderate to heavy profile relative to the very heavy drinking profile at 6-month follow-up. There was no significant effect of personalized feedback intervention in Sweden. Future research could investigate the impact of when personalized feedback interventions are administered and could examine if personalized feedback interventions should be more intentionally culturally adapted in order to be more effective.

Background Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population. Objective This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population. Methods The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ≥18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing. Results The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: “General Acceptance of the App,” “Importance of the Targeted and Relevant App Content,” “Importance of Credibility,” “Importance of the App Usability,” “Importance of a Simple and Attractive Design,” “Importance of Notifications to Ensure App Use over Time.” Besides a general acceptance of the app, these themes reflected participants’ recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved. Conclusions Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time. Trial Registration ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-020-4145-2

Previous research has utilized survey and administrative data to document health problems among Housing First (HF) residents; however, little is known about residents' personal perspectives on their health. The purpose of this study was to utilize conventional content analysis to analyze health-related concerns among HF residents with histories of alcohol use disorder. Between June and December 2013, we interviewed 44 adults who had histories of chronic homelessness and alcohol use disorder and were residing in single-site HF in Seattle, Washington. Responses centered on five primary topics: alcohol-related harm, perceived health vulnerability, concern for fellow residents' health, end of life, and health and safety promotion. HF residents experience complex alcohol-exacerbated health difficulties and existing health services may not meet the needs of those whose health is particularly compromised. Considering that HF facilitates aging in place, end-of-life care and grief counseling should be integrated into HF services.

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.En juin 2021, le Parlement fédéral a accepté une proposition législative demandant l’instauration d’une taxe aux urgences pour lutter contre leur surfréquentation. Bien que cette problématique demeure un enjeu majeur des politiques de santé, l’instauration d’une telle taxe pose de nombreuses questions, notamment d’équité en santé. Pourtant, d’autres solutions existent, en améliorant la prise en charge des usager-ère-s fréquent-e-s des urgences, ainsi que la coordination entre soins primaires et services d’urgences.

Understanding the factors influencing SARS-CoV-2 transmission in asylum seekers and refugees living in centres is crucial to determine targeted public health policies protecting these populations fairly and efficiently. In response, this study was designed to explore the pandemic's spread into asylum centres during the first wave of the pandemic in Switzerland. Specifically, it aimed to identify the risk factors associated with a positive anti-SARS-CoV-2 seroprevalence test after the first semi-confinement period (16 March to 27 April 2020) amongst asylum seekers and refugees living in centres. This research is part of SérocoVID, a seroepidemiologic study of SARS-CoV-2 infection conducted in the canton of Vaud, Switzerland. Migrants living in two asylum centres, one known to have had an epidemic outbreak, were invited to participate in this study. Anti-SARS-CoV-2 IgG and IgA antibodies targeting the spike viral protein were measured in all participants using a Luminex immunoassay. Each participant also completed a questionnaire measuring socio-demographic characteristics, medical history (comorbidities, smoking status, BMI, flu-like symptoms), health literacy, public health recommendations (wearing a masque in a public area, social distancing and hands cleaning), behaviours and exposures (daily life activities, number of contacts weekly). The association of these independent variables with the serologic test result were estimated using a multivariable logistic regression model. A total of 124 participants from the two asylum centres took part in the study (Centre 1, n = 82; Centre 2, n = 42). The mean participation rate was 36.7%. The seroprevalence in Centres 1 and 2 were 13% [95% CI 0.03, 0.14] and 50% [0.34, 0.65], respectively. Next, 40.63% of SARS-CoV-2 positive people never developed symptoms (asymptomatic cases), and no one had severe forms of the Covid-19 disease requiring hospitalisation. Participants report high compliance with public health measures, especially hygiene rules (96.3% of positive answers) and social distancing (88.7%). However, only 11.3% said they always wore a masque in public. After adjusting for individual characteristics, infection risk was lower amongst people with high health literacy (aOR 0.16, p = 0.007 [0.04, 0.60]) and smokers (aOR 0.20, p = 0.013 [0.06, 0.69]). Despite the lack of severe complications of Covid-19 disease in this study, findings suggest that developing targeted public health measures, especially for the low health literacy population, would be necessary to limit the risk of outbreaks in asylum centres and improve this population's safety. Further investigations and qualitative approach are required to understand more finely how living conditions, risks and behaviours such as tobacco consumption, and the adoption of protective measures impact SARS-CoV-2 infection.

Background Management of frequent users of the emergency department (FUED; ≥5 visits/year) is a known challenge. Studies show that case management (CM) improves FUEDs' quality of life while reducing their number of emergency department visits and associated costs. However, little is known about FUEDs' own perspectives on CM. Methods This qualitative study was part of a larger study aiming to implement CM for FUED in French-speaking Switzerland. Participants were FUEDs included in the parent study, who had either completed the CM intervention or were still enrolled. Semi-structured qualitative interviews were conducted with 20 participants (75% female; mean age=40.55, SD = 12.84), randomly drawn from the parent study sample. Content analysis was performed by two researchers to assess participants' perceptions on the CM intervention. Results Most participants endorsed general positive perceptions of CM. CM differed from their usual treatment by two characteristics: its holistic approach and the quality of the relationship with the case manager. Also, moral support was perceived as a main benefit. FUEDs perceived four outcomes: an increase in motivation (e.g., day-to-day life or health-related), better orientation in and interaction with the healthcare system and improved health literacy. Finally, FUEDs identified two negative aspects to the CM: few perceived benefits (e.g., not enough concrete outcomes) and negative consequences (e.g., feeling ashamed to come back to ED). Three obstacles were identified: case manager's lack of time, COVID-19's influence (e.g., less personal contact) and uncertainty around the program (e.g., organization, aims). The personal relationship with their case manager was perceived as the main driver to positive outcomes. Conclusions FUED perceived the program as useful and considered the relationship with the case manager as key for positive outcomes. Our findings also suggest ways to improve CM, such as clarifying its organization and aims. Key messages In FUEDs’ opinion, the CM intervention had many positive outcomes, often relying on the relationship with the case manager. However, the CM intervention had also some negatives.

Background: General population surveys using self-reported measures show alcohol use disorder (AUD) to be most prevalent in young adulthood, but this may be due to misinterpretations of AUD criteria among inexperienced drinkers. The present study investigated changes in prevalence of criteria during emerging adulthood. Methods: 4924 young Swiss men were followed across three waves (age at wave 1 (w1): 20; w2: 21; w3: 25 years). We measured AUD according to the 11 DSM-5 criteria and estimated Item Response Theory models for each wave and differential item functioning across waves, related to the cohort growing older. Results: Endorsement of several AUD criteria varied considerably as a function of age in a period of only five years: Five criteria showed differential item functioning between waves 1 and 3 (i.e. between the age of 20 and 25), including the three most frequently endorsed criteria. Prevalence of tolerance (w1, 57.8%; w3, 29.6%) decreased in relation to the AUD score (Mantel–Haenszel OR = 0.26), whereas the use of alcohol larger/longer than intended (w1, 73.7%; w3, 84.8%; OR = 1.93) and hazardous use (w1, 62.7%; w3, 68.4%; OR = 1.31) increased, resulting in an unchanged mean AUD score and prevalence, but changing combinations of criteria to qualify AUD. Conclusions: Considerable differential item functioning over five years among several of the most endorsed AUD criteria suggests shifts in the interpretation of DSM-5 criteria during emerging adulthood. Self-reported measures of DSM-5 AUD criteria may require reformulation to account for young people’s different perceptions and to yield comparable diagnoses over time and across age groups.

Foot and mouth disease (FMD) is a highly contagious viral disease that affects all Artiodactyla. Seven immunologically distinct serotypes of FMD virus (FMDV) exist. In Chad, although FMD is included in the list of diseases monitored by the Chadian Animal Disease Surveillance Network (REPIMAT), the epidemiological situation remains unclear. A serological survey was conducted in the cattle population in eight of the nine administrative regions of the country (those regions with the highest cattle densities), to evaluate the prevalence and serotypes of circulating FMDV.A total of 796 sera from randomly selected cattle were analysed at the World Organisation for Animal Health/Food and Agriculture Organization of the United Nations FMD Reference Laboratory at the Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna(IZSLER), in Brescia (Italy). An enzyme-linked immunosorbent assay (ELISA), called 3ABC ELISA, was used to detect antibodies against non-structural proteins (NSPs), as well as a series of six competitive ELISAs to detect and serotype antibodies against the structural proteins of FMDV serotypes O, A, SAT 1, SAT 2, Asia 1 and C. Based on the detection of anti-NSP antibodies, the animal-level seroprevalence was 35.6%(95% confidence interval [CI]: 32.2-38.9) and the herd-level seroprevalence was 62.3% (95%CI: 53.0-71.5). FMD was present in all livestock administrative divisions surveyed, with a higher prevalence in southern regions, which are characterised by higher rainfall and humidity and more important transboundary animal movements. Cattle aged more than four years had a higher seroprevalence, which may be due to repeated exposure. Semi-sedentary farming and transhumance were also risk factors. Antibodies against serotypes A, O, SAT 1 and SAT 2 were detected.

Background: D/deaf and hard of hearing populations are at higher risk for experiencing physical and mental health problems compared to hearing populations. In addition, they commonly encounter barriers to accessing and benefiting from health services, which largely stem from challenges they face in communicating with healthcare providers. Healthcare providers commonly lack tailored communication skills in caring for D/deaf and hard of hearing populations, which lead to difficulties and dissatisfaction for both staff and D/deaf and hard of hearing communities. This research project aims to develop and evaluate a capacity-building intervention for healthcare providers with the goal of increasing their awareness of D/deaf and hard of hearing individuals' experiences with the healthcare system, their distinct needs, and improving their capacity to communicate effectively with this patient population.Methods: This research project features a participative action research design using qualitative and quantitative methods. Consistent with participative action research, the study will actively involve the target populations, key stakeholders and representative associations. The intervention will be developed and tested through iterative phases. The Integrated Model of Training Evaluation and Effectiveness will guide prospective evaluation of the intervention. The latter will involve qualitative and quantitative assessments in participants before and after the intervention and at 6-months follow-up.Discussion: Results will contribute to research aimed at decreasing barriers to accessing and benefiting from healthcare services for D/deaf and hard of hearing individuals. Findings will be presented to representative associations and political authorities, as well as disseminated at research conferences and in peer-reviewed journals.

BackgroundThere is growing interest in reproductive issues in patients with Spondyloarthritis (SpA) and Psoriatic arthritis (PsA).ObjectivesTo describe a real-life cohort of prospectively-followed pregnancies in SpA and PsA patients, focusing on obstetric outcome and on flare during pregnancies and post-partum.MethodsData on SpA and PsA pregnancies prospectively-followed in 2 European pregnancy clinics from 2010 to 2021 were retrospectively analysed.Disease activity was assessed using ASDAS-CRP or DAS28-CRP according to the main involvement (peripheral or axial). Disease flare was defined as the need to treatment modification (introduction or increase ≥5mg/day of prednisone, introduction of cDMARD or bDMARD). Miscarriages were excluded from the analysis of flares.ResultsData on 122 pregnancies (53 PsA and 69 ‘other SpA’: 39 axialSpA, 20 undifferentiated SpA, 6 IBD-related SpA, 4 reactive arthritis) in 102 patients (median age at conception: 34 [IQR: 31-36] years; median disease duration: 72 [24-132] months) were collected.We recorded 98 (86%) live births and 16 (14%) miscarriages (8 missing data).Cesarean section was performed in 15/98 (15%) cases. Median week of gestation at delivery was 39 [38-40]; 8 preterm births (Fourty-two pregnancies (40%) had at least 1 flare during pregnancy; 7 pregnancies had more than 1 flare. Overall, there were 13, 24 and 12 flares in the 1st, 2nd and 3rd trimester, respectively.A higher frequency of patients with axial involvement was observed in the ‘flare’ group as compared to pregnancies without flare (83% vs 59%, p=0.02) (Table 1).Table 1.Comparison between ‘flare’ and ‘without flare’ groups.FLARE (42)WITHOUT FLARE (64)pAge at conception (years)33 (31-37)33 (31-35)0.88Disease duration at conception (months)71 (24-120)60 (24-137)0.74PsA13 (31%)31 (48%)0.11‘Other SpA’29 (69%)33 (52%)0.11Axial involvement35 (83%)38 (59%)0.02Peripheral involvement30 (%)54 (%)0.17bDMARD useAny time before pregnancy16 (38%)19 (30%)0.49Stop at + pregnancy test/1st trimester8 (19%)4 (6%)0.09Start/continue 1st trimester7 (17%)10 (16%)0.89Start in 2ndtrimester5 (12%)00.02Start in 3rd trimester2 (5%)00.30Post-partum flare11/34 (32%)22/49 (45%)0.36Continuous variables were compared using Mann-Whitney test; categorical variables were compared using Chi-square with Yates’ correction or Fisher’s exact test.Medications resumed to treat flare were steroids (29 pregnancies), csDMARDs (14 pregnancies) and TNF-inhibitors (7 pregnancies: 5 during the 2nd and 2 during the 3rd trimester).A post-partum flare was registered in 33/83 (40%) of cases, without difference between ‘flare’ group vs ‘without flare’ group (Table 1), as well as between PsA vs ‘other SpA’ pregnancies (47% vs 33%, p=0.2).ConclusionIn this cohort of SpA pregnancies, 40% experienced a flare during pregnancy and 40% during post-partum. Flares occurred more frequently in the 2nd trimester and especially in patients with axial involvement, requiring the start of a TNF-inhibitor during the 2nd or the 3rd trimester in 7 pregnancies. Having a flare during pregnancy was not associated with a post-partum flare.Disclosure of InterestsNone declared

Transition into adulthood is a risky period for young people with attention deficit-hyperactivity disorder (ADHD), but empirical studies on this topic are scarce. This study investigated the association between the level of ADHD symptoms and transition into adulthood. Data were collected in the Cohort Study of Substance Use and Risk Factors among a representative sample of young Swiss men (n = 4681) over three waves. Measures included the level of ADHD symptoms and emerging adulthood assessed with the Inventory of the Dimensions of Emerging Adulthood and indicators of successful transition into adulthood. The level of ADHD symptoms was associated with a lower success in the transition into adulthood. Young people with high level of ADHD symptoms had a reduced increase in indicators of successful transition over time. Inattention symptoms were more strongly associated with emerging adulthood measures in comparison with hyperactive symptoms. The level of ADHD symptoms may delay the transition into adulthood, especially inattentive symptoms. Providing tailored interventions to emerging adults with ADHD symptoms may decrease the substantial impairments adults with ADHD experience in life.

Peer influence is a strong predictor of drinking behaviors, yet not all young adults respond to its influence in the same way. This study aimed to identify young adults who are more vulnerable to peer influence by prospectively examining whether sensation seeking and aggression traits moderate the associations between peer influence and alcohol use and related consequences among young male drinkers. Participants (N=4,624 participants) were young Swiss men from the Cohort Study on Substance Use Risk Factors. Measures of peer influence (i.e. descriptive norms and peer pressure to engage in misconduct), sensation seeking, aggression and alcohol use and related consequences were used from the baseline and 15-month follow-up assessments. Findings indicated that neither sensation seeking nor aggression significantly moderated the associations between peer influence and alcohol-related consequences. However, they revealed that sensation seeking and aggression had a moderating effect on the association between peer influence and total drinks per year, such that this association was overall stronger among participants scoring lower on personality traits. These findings suggest that young male drinkers with low scores on sensation seeking and aggression may benefit from stand-alone selective interventions targeting peer influence, whereas those scoring higher on these personality traits may rather benefit from programs that include interventions targeting both peer influence and personality risk factors of drinking behaviors.

Background Frequent users of emergency departments (FUED; 5 ED visits during the preceding 12 months) account for a disproportionate part of ED visits, causing a wide range of work difficulties to ED staff potentially leading to FUED discrimination. Whereas case management (CM) tailored to FUED leads to a reduction in ED visits, CM impact on ED staff has not been explored yet. This study aimed to compare ED staff perceptions of FUED with and without dedicated CM support. Methods Participants (N = 253) were ED staff (81 physicians; 172 nurses/assistant nurses) of two Swiss university hospitals, one with CM and one without CM support. Perceptions regarding FUED (i.e., knowledge and awareness of the issue extent; related work difficulties; FUEDs’ legitimate use of ED resources) were measured with a 25-item online survey (4 to 10-level Likert scales). Multivariable regression analyses were conducted to 1) explore the associations between CM implementation and FUED perceptions, and 2) test the moderating effect of profession (physician or nurse/nurse assistant) on these associations. All analyses were adjusted by gender and years of practical experience. Results Physicians with CM considered FUED as a less important problem (=.375, R2=.11, p Conclusions These results suggest that CM intervention for FUED is a potential source of support for ED physicians working with FUED. Further qualitative research is needed to explore why nurses without CM support reported feeling less failure and helplessness regarding FUED. Key messages By highlighting a different impact of CM on nurses’ perception, this study illustrates where CM intervention might be improved. This study supports CM as a promising intervention for FUED by potentially having a positive impact on ED physicians’ perception besides the one previously proved on FUEDs’ number of visits and QOL.

Background Frequent users of emergency department (FUEDs; ≥ 5 ED visits/ year) are often vulnerable individuals cumulating medical, social and substance use problems. FUEDs often require complex and sustained care coordination generally unavailable in ED and are commonly considered contributing to ED crowding. In view of supporting ED health-care providers through specific training and interventions tailored to FUEDs, this study aimed to explore ED healthcare providers’ perceptions of difficulties related to FUEDs. Methods Participants (N = 208) were ED healthcare providers (i.e., nurses, physicians) from 75 university and community hospitals in Switzerland (71% of all EDs) who answered a questionnaire on FUEDs. They were asked to indicate the extent to which FUEDs represent a problem in their ED. Perceived difficulties related to FUEDs were elicited by an open-ended question. Conventional content analysis was used to extract common categories and themes. Results Among the 208 participants, 134 (64%) reported that FUEDs represent a problem. Of those, 132 provided 1 to 5 answers to the open-ended question. Twenty-eight categories were identified and organized in 4 themes. First, participants reported difficulties related to FUEDs’ characteristics themselves (e.g., problem’s chronicity; behavioural difficulties) leading to healthcare complexity. Second, participants perceived negative consequences related to the presence of FUEDs in the ED (e.g., work overload, staff helplessness and fatigue). Third, ED healthcare offer was considered inappropriate and inefficient to respond to FUEDs needs and fourth collaborating with FUEDs’ existing healthcare network was perceived as difficult. Conclusions ED healthcare providers experience a wide range of difficulties related to the management of FUEDs. Providing training and implementing a case management intervention tailored to FUEDs might support ED health-care providers and contribute to address FUEDs’ complex needs. Key messages ED healthcare providers perceive FUEDs to represent a problem. Perceived difficulties might decrease through training and case management support might contribute to better address FUEDs complex needs.

Foot and mouth disease (FMD) is a highly contagious viral disease that affects all Artiodactyla. Seven immunologically distinct serotypes of FMD virus (FMDV) exist. In Chad, although FMD is included in the list of diseases monitored by the Chadian Animal Disease Surveillance Network (REPIMAT), the epidemiological situation remains unclear. A serological survey was conducted in the cattle population in eight of the nine administrative regions of the country (those regions with the highest cattle densities), to evaluate the prevalence and serotypes of circulating FMDV.A total of 796 sera from randomly selected cattle were analysed at the World Organisation for Animal Health/Food and Agriculture Organization of the United Nations FMD Reference Laboratory at the Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna(IZSLER), in Brescia (Italy). An enzyme-linked immunosorbent assay (ELISA), called 3ABC ELISA, was used to detect antibodies against non-structural proteins (NSPs), as well as a series of six competitive ELISAs to detect and serotype antibodies against the structural proteins of FMDV serotypes O, A, SAT 1, SAT 2, Asia 1 and C. Based on the detection of anti-NSP antibodies, the animal-level seroprevalence was 35.6%(95% confidence interval [CI]: 32.2-38.9) and the herd-level seroprevalence was 62.3% (95%CI: 53.0-71.5). FMD was present in all livestock administrative divisions surveyed, with a higher prevalence in southern regions, which are characterised by higher rainfall and humidity and more important transboundary animal movements. Cattle aged more than four years had a higher seroprevalence, which may be due to repeated exposure. Semi-sedentary farming and transhumance were also risk factors. Antibodies against serotypes A, O, SAT 1 and SAT 2 were detected.La fièvre aphteuse est une maladie virale extrêmement contagieuse qui affecte l’ensemble des artiodactyles. Sept sérotypes du virus de la fièvre aphteuse ont été répertoriés, qui sont distincts au plan immunologique. Au Tchad, bien que la fièvre aphteuse figure sur la liste des maladies visées par le Réseau d’épidémiosurveillance des maladies animales du Tchad (REPIMAT), la situation épidémiologique demeure mal connue. Une enquête sérologique a été réalisée dans la population bovine de huit régions administratives sur les neuf que compte le pays (afin de couvrir les régions où la densité de la population bovine est la plus élevée), dans le but d’évaluer la prévalence du virus de la fièvre aphteuse et de caractériser les sérotypes présents. Au total, 796 sérums prélevés sur des bovins sélectionnés de manière aléatoire ont été analysés au Laboratoire de référence pour la fièvre aphteuse de l’Organisation mondiale de la santé animale/Organisation des Nations Unies pour l’alimentation et l’agriculture à l’Istituto Zooprofilattico Sperimentale dellaLombardia e dell’Emilia Romagna (IZSLER) de Brescia (Italie). Les anticorps dirigés contre les protéines non structurales ont été détectés au moyen d’une épreuve immuno-enzymatique 3ABC (ELISA 3ABC) tandis qu’une série de six ELISA de compétition a permis de détecter et de caractériser les anticorps spécifiques des protéines structurales des sérotypes O, A, SAT 1, SAT 2, Asia 1 et C du virus de la fièvre aphteuse. D’après les résultats de la détection d’anticorps dirigés contre les protéines non structurales, la prévalence sérologique à l’échelle individuelle était de35,6 % (avec un intervalle de confiance [IC] à 95 % de 32,2 à 38,9) tandis que la prévalence à l’échelle des troupeaux s’élevait à 62,3 % (IC à 95 % de 53,0 à 71,5).La fièvre aphteuse était présente dans chacune des divisions administratives étudiées, avec une prévalence plus élevée dans les régions méridionales, qui se caractérisent par des précipitations et une hygrométrie plus fortes et par l’importance des mouvements transfrontaliers d’animaux. La prévalence sérologique était plus élevée chez les bovins âgés de plus de quatre ans, ce qui s’explique probablement par un nombre répété d’expositions. Le rôle de l’élevage semi-sédentaire et de la transhumance en tant que facteurs de risque a été misen lumière. Les anticorps détectés étaient dirigés contre les sérotypes A, O, SAT 1et SAT 2.La fiebre aftosa es una patología vírica muy contagiosa que afecta a todos los artiodáctilos. Existen siete serotipos inmunológicamente diferenciados del virus que la causa. En el Chad, aunque la fiebre aftosa figura en la lista de enfermedades sometidas a vigilancia por la Red Chadiana de Vigilancia Zoosanitaria (REPIMAT), la situación epidemiológica de la enfermedad sigue rodeada de incertidumbre. Los autores describen un estudio serológico realizado en la población vacuna de ocho de las nueve regiones administrativas del país (las que presentan la mayor densidad de ganado vacuno) con objeto de determinar la prevalencia y los serotipos del virus de la fiebre aftosa circulante. Tras seleccionar aleatoriamente un total de 796 cabezas de ganado y obtener de ellas muestras de suero, estas fueron analizadas en el Istituto Zooprofilattico Sperimentale della Lombardia e dell’EmiliaRomagna (IZSLER) de Brescia (Italia), que es el Laboratorio de Referencia de la Organización Mundial de Sanidad Animal y la Organización de las Naciones Unidas para la Alimentación y la Agricultura para la fiebre aftosa. Para detectar anticuerpos dirigidos específicamente contra proteínas no estructurales se empleó un ensayo inmunoenzimático (ELISA) denominado ELISA 3ABC, a lo que se agregó una serie de seis técnicas ELISA de competición concebidas para detectar y tipificar anticuerpos dirigidos contra las proteínas estructurales de los serotipos O, A,SAT 1, SAT 2, Asia 1 y C del virus de la fiebre aftosa. A tenor de los niveles detectados de anticuerpos contra proteínas no estructurales, la seroprevalencia individual era de un 35,6% (intervalo de confianza [IC] al 95%:32,2–38,9) y la seroprevalencia de rebaño era de un 62,3% (IC 95%: 53,0–71,5).La fiebre aftosa, presente en todas las divisiones administrativas ganaderas estudiadas, alcanzaba sus máximos niveles de prevalencia en las regiones meridionales, caracterizadas por tasas de pluviosidad y humedad más altas y por un mayor volumen de movimientos transfronterizos de animales. La seroprevalencia era más elevada en los ejemplares de más de cuatro años de edad, hecho que puede deberse a exposiciones reiteradas. La producción ganadera en régimen semisedentario y la trashumancia eran también factores de riesgo. Se detectaron anticuerpos contra los serotipos A, O, SAT 1 y SAT 2.

Objective The Protective Behavioral Strategies Scale (PBSS-20) is one of the most commonly used measures of engagement in protective behavioral strategies (PBS). This research aimed to examine the psychometric properties of a French and German version of the PBSS-20 in a large sample of young males in Switzerland. Method The sample included 5,017 young males (mean age = 25.44) participating in the Cohort Study on Substance Use Risk Factors in Switzerland. Measures of PBS use, total drinks per week, and alcohol-related consequences were used from a second follow-up assessment. Results Confirmatory factor analysis testing different models previously documented in the literature provided initial support for a four-factor model. Fit statistics indicated that this model adequately reflects the structure of data. Further findings also provided support for adequate internal consistency and for convergent validity of this four-factor model, whereas metric-but not scalar-measurement invariance across linguistic regions was demonstrated. Conclusion Although further research testing measurement invariance across linguistic regions and gender is warranted, results of the current study suggest that the French and German PBSS-20 is reliable and that it may represent a promising research and clinical tool that can be used in both French- and German-speaking countries.

Background Alcohol use disorder (AUD) is known to co-occur with other addictions, as well as with mental health problems. However, the effects of other addictions co-occurring with AUD on mental health problems were rarely studied and not considering them may bias estimates of the association between AUD and mental health problems. This study investigated which role co-occurring addictions play for the cross-sectional associations between self-reported AUD and mental health problems. Method Participants were 5516 young Swiss men (73.0% of those that gave written informed consent) who completed a self-report questionnaire. Using short screening questionnaires, we assessed three substance use disorders (alcohol, cannabis and tobacco), seven behavioural addictions (internet, gaming, smartphone, internet sex, gambling, work, exercise) and four mental health problems (major depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD) and social anxiety disorder). Differences in the proportions of mental health problems were tested using logistic regressions between (1) participants with no AUD and AUD, (2) participants with no AUD and AUD alone and (3) participants with no AUD and AUD plus at least one co-occurring addiction. Results Overall, (1) participants with AUD had higher proportions of major depression (Odds ratio (OR [95% confidence interval]) = 3.51 [2.73, 4.52]; ADHD (OR = 3.12 [2.41, 4.03]); bipolar disorder (OR = 4.94 [3.38, 7.21]) and social anxiety (OR = 2.21 [1.79, 2.73])) compared to participants with no AUD. Considering only participants with AUD alone compared to participants with no AUD (2), differences in proportions were no longer significant for major depression (OR = 0.83 [0.42, 1.64]), bipolar disorder (OR = 1.69 [0.67, 4.22]), social anxiety (OR = 1.15 [0.77, 1.73]) and ADHD (OR = 1.65 [1.00, 2.72]) compared to participants with no AUD. In contrast, (3) proportions of mental health problems were considerably higher for participants with AUD plus at least one other addiction when compared to participants with no AUD, with OR’s ranging from 2.90 [2.27, 3.70] for social anxiety, 4.03 [3.02, 5.38] for ADHD, 5.29 [4.02, 6.97] for major depression to 6.64 [4.44, 9.94] for bipolar disorder. Conclusions AUD was associated with all four measured mental health problems. However, these associations were mainly due to the high proportions of these mental health problems in participants with AUD plus at least one co-occurring addiction and only to a lesser degree due to participants with AUD alone (i.e. without any other co-occurring addictions). Hence, estimates of the association between AUD and mental health problems that do not consider other addictions may be biased (i.e. overestimated). These findings imply that considering addictions co-occurring with AUD, including behavioural addictions, is important when investigating associations between AUD and mental health problems, and for the treatment of AUD and co-morbid disorders.

Background: Gaming disorder (GD) has been shown to co-occur with attention deficit hyperactivity disorder (ADHD), yet few studies to date have investigated their longitudinal associations. Method: The sample included 5,067 young Swiss men (mean age was 20 years at wave 1 and 25 years at wave 3). Measures were the Game Addiction Scale and the Adult ADHD Self-Report Scale (6-item screener). Longitudinal associations were tested using autoregressive cross-lagged models for binary measures of GD and ADHD, as well as continuous measures for GD score and ADHD subscales of inattention and hyperactivity. Results: ADHD at age 20 increased the risk for GD at age 25 (probit = 0.066 [0.023, 0.109]; p = 0.003). GD at age 20 also increased the risk for ADHD at wave 3 (probit = 0.058 [0.013, 0.102]; p = 0.011). Only the ADHD inattention subscale showed a bidirectional longitudinal relationship with the GD score (standardized Beta from inattention at age 20 to GD score at age 25: 0.090 [0.056, 0.124]; p < 0.001; from GD score at age 20 to inattention at age 25: 0.044 [0.016, 0.071]; p = 0.002), whereas associations between the hyperactivity subscale and GD were not significant. Discussion: GD had bidirectional longitudinal associations with ADHD, in that ADHD increased the risk for GD and GD increased the risk for ADHD, and they may reinforce each other. These associations may be linked more to the inattention ADHD component than to the hyperactivity ADHD component. Individuals with ADHD or GD should be screened for the other disorder, and preventive measures for GD should be evaluated in individuals with ADHD.

Although young men or young adults with mental health disorders are at higher risk to engage in problematic drinking, they typically evince stronger associations between protective behavioral strategies (PBS) and fewer alcohol outcomes. This study aimed to contribute to this line of research by examining the moderating effect of depression, bipolar spectrum disorder, borderline personality disorder and social anxiety disorder on the association between PBS and alcohol outcomes. Participants (N = 4,960; mean age = 25.43) were young men participating in the Cohort Study on Substance Use Risk Factors. Measures of PBS use, typical drinks per week, alcohol-related consequences, depression, bipolar spectrum disorder, borderline personality disorder and social anxiety disorder were used from the second follow-up assessment. Main results indicated that the negative association between PBS and alcohol use was stronger in participants with borderline personality disorder than among those without this disorder. Unexpectedly, in participants with depression, PBS were not significantly associated with alcohol use, whereas they were related to fewer drinks among those without the disorder. Similarly, in participants with bipolar spectrum disorder, the association between PBS and alcohol-related consequences was not significant, whereas PBS were associated with fewer consequences in those without the disorder. Finally, findings indicated that social anxiety disorder did not significantly moderate the associations between PBS and alcohol outcomes. If replicated by future research, these findings imply that PBS-intervention may not equally impact young adults with diverse mental health disorders.

Background Peer pressure (PP) toward misconduct is a well-known risk factor for substance use. However, the way it interacts with social factors and the associations of the aspects of PP other than PP toward misconduct have been understudied. This study examined the associations of three aspects of PP with risky substance use and tested whether the associations of PP toward misconduct were moderated by social factors. Method A representative sample of 5,680 young Swiss males completed a questionnaire assessing risky alcohol, cigarette, and cannabis use, PP toward misconduct, toward peer involvement, and toward peer conformity, as well as social support (SS) and neighbourhood cohesion. Multinomial logistic regression models were used. Results PP toward misconduct was positively associated with all substance use outcomes. The PP toward misconduct–risky alcohol use association was stronger in individuals reporting high than in those reporting low levels of PP toward peer involvement, SS, and neighbourhood cohesion. The PP toward misconduct–risky cannabis use association was stronger in individuals reporting high than in those reporting low levels of SS and neighbourhood cohesion. The PP toward misconduct–smoking association was stronger in individuals reporting high than in those reporting low levels of PP toward peer involvement. Conclusions The risk for substance use associated with PP toward misconduct varies as a function of social factors. Being well connected with others (high level of PP toward peer involvement and SS), and living in a cohesive neighbourhood may amplify the risk for risky substance use associated with PP toward misconduct.