391 research outputs found
Douleur irradiant dans l'hypochondre gauche?. [Pain irritating in the left hypochondre?]
We report the case of a 43-year-old man with subacute epigastric pain and
left hypochondriac irradiation. The final diagnosis is a splenic infarction. A
typical manifestation of this disease is a sudden diffuse pain in the left
hypochondrium, accompanied by nausea and early satiety. Etiology is usually
hematologic for patients under 40 years old and embolic for patients over
40. Abdominal scanner can be used to confirm the diagnosis, the treatment is
conservative. Splenic infarction is rare, and therefore not often included in the
differential diagnosis. More than 20% of the cases can lead to complications
such as an abscess or rupture. Therefore splenic infarction should be included
in the differential diagnosis in the situation of left hypochondriac pain
Couples’ dyadic coping in the context of child-related stressors: A systematic review across three decades
The relevance of dyadic coping (DC), a concept how couples cope with stressors together, has been established in different contexts (e.g., daily hassles, mental and physical health) and is related to different outcomes such as relationship satisfaction, relationship quality and stability, psychological well-being, and child behavior. The current systematic review aims at providing an integration of the field of research on couple’s DC with child-related stressors which are understood as demands that arise for couples due to becoming or being parents. DC and related search terms were used for the literature search in PsycINFO, Psyndex, and Medline. We included 55 publications (reporting empirical data on 6,779 couples in total) including quantitative, qualitative, and mixed-methods studies published between 1990 and 2020. We applied a narrative synthesis approach organizing the results around six identified areas of child-related stressors: pregnancy and transition to parenthood, parenting, child mental health, child disability, child chronic physical illness, and child death. Overall, results show the importance of DC for both individual and relationship functioning in the context of child-related stress. Surprisingly, effects of parental DC on child outcomes remained understudied, although the existing studies yield promising results for child adjustment. In conclusion, adapting a “we”-perspective, mutual understanding and support is of importance not only to overcome the stressor but also to grow together as a couple. As DC plays a significant role for couples to cope in a resilient way when facing child-related stressors it should be more promoted in couple- and family counseling and therapy
Les comportements face au VIH/sida parmi les migrants originaires d'Afrique subsaharienne en Suisse : Enquête ANSWER 2013-2014
L'enquête Internet ANSWER (African Net Survey WE Respond!) auprès des migrants provenant d'Afrique subsaharienne (ASS) a été menée entre septembre 2013 et février 2014, sur mandat de l'OFSP et avec la collaboration de l'ASS. Cette enquête s'inscrit dans le cadre du mandat de surveillance épidémiologique de deuxième génération du VIH et des autres IST auquel l'IUMSP participe activement. Le but de cette enquête a été de décrire dans cette population les connaissances, attitudes et comportements (en particulier, les comportements sexuels, l'usage de préservatifs et la réalisation de tests de dépistage du VIH) en lien avec la prévention du VIH et des autres infections sexuellement transmissibles. Une analyse exploratoire de facteurs associés à certains comportements (partenaires multiples, utilisation de préservatifs, réalisation de tests) a
également été menée. Il s'agissait d'une enquête par Internet auto-administrée disponible en 7 langues, à laquelle les personnes originaires d'Afrique subsaharienne étaient invitées à participer. Un groupe d'accompagnement composé de professionnels de la prévention du VIH et de médiateurs culturels de différents pays africains a participé activement à toutes les étapes du projet (conception du questionnaire, traductions, cognitive testing, promotion de l'enquête, mobilisation communautaire)
Dyadic coping and mental health in couples: A systematic review
Globally, one out of three people suffer from a mental health issue during their lifetime. In romantic relationships, impaired mental health does not only affect the individual but also their partner and therefore needs to be coped with dyadically. In this systematic review, we summarize research examining dyadic coping (DC) in the context of mental health and individual and relational outcomes. We searched for peer-reviewed articles published between January 1990 and April 2023 on PsycInfo, Medline, and PSYNDEX on DC and mental health within romantic relationships. A total of 60 qualitative, quantitative, and intervention studies met the inclusion criteria, reporting on 16,394 individuals and 4,945 dyads. To synthesize the studies, we used a narrative synthesis approach. Overall, stress expression and positive DC yielded beneficial individual and relational outcomes, whereas, for negative DC, the opposite was true. Results differed between mental health clusters and context played an important role (e.g., symptom severity, life phase). Due to the great diversity of studies and variables, further research should focus on understudied mental health clusters (e.g., anxiety disorders). Clinicians are advised to view mental health issues as a dyadic rather than an individual phenomenon (“we-disease”) and develop tailored couple-centered interventions
Extradyadic stress as a barrier to sexual activity in couples? A Dyadic Response Surface Analysis
Sexuality is integral to most romantic relationships. Through stress spillover, however, factors such as individually experienced stress outside of the relationship (i.e., extradyadic stress) can negatively impact sexuality. In this study, we explored how a possible (mis)matching of both partners' levels of extradyadic stress is related to sexual activity and tested for gender differences. Analyzing 316 mixed-gender couples from Switzerland, we employed Dyadic Response Surface Analysis to assess how extradyadic stress is associated with sexual activity. Our results showed that extradyadic stress was positively linked to sexual activity for women (in general) and men (in the case of matching stress levels). As this result was surprising, we conducted additional exploratory analyses and split the measure of sexual activity into (1) exchange of affection and (2) eroticism (petting, oral sex, and intercourse) and controlled for age. Results from this second set of analyses showed that for women, matching stress levels were associated with higher exchange of affection, whereas men’s exchange of affection was higher if men reported higher stress levels than women. Notably, after accounting for age, the link between stress and eroticism dissipated. Our findings suggest that exchange of affection may serve as a coping mechanism for stress, with gender influencing this dynamic. However, future research investigating stress and sexual activity should consider additional factors such as age, relationship satisfaction, stressor type, and stress severity
Primary Care-Led Transition Clinics Hold Promise in Improving Care Transitions for Cancer Patients Facing Social Disparities: A Commentary.
Transitions in care are key junctions during which care coordination, communication, and individualized support are required to ensure optimal health outcomes for patients. This is particularly true for patients who face social disparities, such as poverty, limited health literacy, or belonging to a racial or ethnic minority, who are particularly at risk for experiencing poor care transitions. Interdisciplinary primary care-led transition clinics are an intervention that have shown promise in improving care transitions for diverse patient populations, including those that face social disparities, but their role in improving transitions in cancer care remains largely untapped. In this commentary we highlight why the time-limited support of an interdisciplinary primary care-led transition clinic that targets socially vulnerable cancer patients holds the promise of achieving more equitable healthcare access, healthcare quality, and ultimately more equitable health outcomes for cancer patients
Undocumented Migrants in Switzerland: Geographical Origin Versus Legal Status as Risk Factor for Tuberculosis
Undocumented migrants, meaning migrants without a legal residency permit, come to Geneva from countries with high tuberculosis (TB) incidence. We estimate here whether being undocumented is a determinant of TB, independently of origin. Cross-sectional study including undocumented migrants in a TB screening program in 2002; results were compared to 12,904 age and frequency matched participants in a general TB screening program conducted at various workplaces in Geneva, Switzerland from 1992 to 2002. A total of 206 undocumented migrants (36% male, 64% female, mean age 37.8 years (SD 11.8), 82.5% from Latin America) participated in the TB screening program. Compared to legal residents, undocumented migrants had an adjusted OR for TB-related fibrotic signs of 1.7 (95% CI 0.8;3.7). The OR of TB-related fibrotic signs for Latin American (vs. other) origin was 2.7 (95% CI 1.6;4.7) among legal residents and 5.5 (95% CI 2.8;10.8) among undocumented migrants. Chest X-ray screening identified a higher proportion of TB-related fibrotic signs among Latin Americans, independently of their residency statu
Detecting and describing heterogeneity in health care cost trajectories among asylum seekers.
The mechanism underlying the health care cost trajectories among asylum seekers is not well understood. In the canton of Vaud in Switzerland, a nurse-led health care and medical Network for Migrant Health ("Réseau santé et migration" RESAMI) has established a health care model focusing on the first year after arrival of asylum seekers, called the "community health phase". This model aims to provide tailored care and facilitate integration into the Swiss health care system. The aim of this study is to explore different health care cost trajectories among asylum seekers during this phase and identify the associated factors.
We detected different patterns of health care cost trajectories using time-series clustering of longitudinal data of asylum seekers in the canton of Vaud in Switzerland. These data included all adult asylum seekers and recipients of emergency aid who entered the canton between 2012 and 2015 and were followed until 2018. The different clusters of health care cost trajectories were then described using a multinomial logistic regression model.
We identified a concave, an upward trending, and a downward trending cluster of health care cost trajectories with different characteristics being associated with each cluster. The likelihood of being in the concave cluster is positively associated with coming from the Eastern Mediterranean region or Africa rather than Europe and with a higher share of consultations with an interpreter. The likelihood of being in the upward trending cluster, which accrued the highest costs, is positively associated with 20-24-year-olds rather than older individuals, coming from Europe than any other region and having a mental disorder. In contrast to the other two clusters, the likelihood of being in the downward trending cluster is positively associated with having contacted the RESAMI network within the first month after arrival, which might indicate the potential of early intervention. It is also positively associated with older age and living in a group lodge.
Asylum seekers are heterogeneous in terms of health care cost trajectories. Exploring these differences can help point to possible ways to improve the care and supporting services provided to asylum seekers. Our findings could indicate that early and patient-centered interventions might be well-suited to this aim
Assessing We-Disease Appraisals of Health Problems: Development and Validation of the We-Disease Questionnaire
In couples dealing with health problems, we-disease appraisals can influence dyadic coping strategies to alleviate distress. This study describes the development and validation of a self-report scale to assess we-disease appraisals of health problems. The newly developed We-Disease Questionnaire (WDQ) was administered in three samples: parents of children with type 1 diabetes (n = 240) or cancer (n = 125) and individuals with visual impairment and their partners (n = 216). Reliability was measured by coefficient omega. To assess construct validity, correlations with other measures of individual and dyadic adjustment were examined. Descriptive statistics across all samples were compared. A 4-item version of the WDQ demonstrated good reliability and validity and showed meaningful associations with established scales. We-disease appraisals were highest among parents of children with cancer and lowest among couples with visual impairment. The WDQ is a reliable and valid measure that can be used across different health problems
Multimorbidity and patterns of chronic conditions in a primary care population in Switzerland: a cross-sectional study
To characterise in details a random sample of multimorbid patients in Switzerland and to evaluate the clustering of chronic conditions in that sample.
100 general practitioners (GPs) each enrolled 10 randomly selected multimorbid patients aged ≥18 years old and suffering from at least three chronic conditions. The prevalence of 75 separate chronic conditions from the International Classification of Primary Care-2 (ICPC-2) was evaluated in these patients. Clusters of chronic conditions were studied in parallel.
The final database included 888 patients. Mean (SD) patient age was 73.0 (12.0) years old. They suffered from 5.5 (2.2) chronic conditions and were prescribed 7.7 (3.5) drugs; 25.7% suffered from depression. Psychological conditions were more prevalent among younger individuals (≤66 years old). Cluster analysis of chronic conditions with a prevalence ≥5% in the sample revealed four main groups of conditions: (1) cardiovascular risk factors and conditions, (2) general age-related and metabolic conditions, (3) tobacco and alcohol dependencies, and (4) pain, musculoskeletal and psychological conditions.
Given the emerging epidemic of multimorbidity in industrialised countries, accurately depicting the multiple expressions of multimorbidity in family practices' patients is a high priority. Indeed, even in a setting where patients have direct access to medical specialists, GPs nevertheless retain a key role as coordinators and often as the sole medical reference for multimorbid patients
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