The pandemic toll and post-acute sequelae of SARS-CoV-2 in healthcare workers at a Swiss University Hospital.

Healthcare workers have potentially been among the most exposed to SARS-CoV-2 infection as well as the deleterious toll of the pandemic. This study has the objective to differentiate the pandemic toll from post-acute sequelae of SARS-CoV-2 infection in healthcare workers compared to the general population. The study was conducted between April and July 2021 at the Geneva University Hospitals, Switzerland. Eligible participants were all tested staff, and outpatient individuals tested for SARS-CoV-2 at the same hospital. The primary outcome was the prevalence of symptoms in healthcare workers compared to the general population, with measures of COVID-related symptoms and functional impairment, using prevalence estimates and multivariable logistic regression models. Healthcare workers (n=3,083) suffered mostly from fatigue (25.5%), headache (10.0%), difficulty concentrating (7.9%), exhaustion/burnout (7.1%), insomnia (6.2%), myalgia (6.7%) and arthralgia (6.3%). Regardless of SARS-CoV-2 infection, all symptoms were significantly higher in healthcare workers than the general population (n=3,556). SARS-CoV-2 infection in healthcare workers was associated with loss or change in smell, loss or change in taste, palpitations, dyspnea, difficulty concentrating, fatigue, and headache. Functional impairment was more significant in healthcare workers compared to the general population (aOR 2.28; 1.76-2.96), with a positive association with SARS-CoV-2 infection (aOR 3.81; 2.59-5.60). Symptoms and functional impairment in healthcare workers were increased compared to the general population, and potentially related to the pandemic toll as well as post-acute sequelae of SARS-CoV-2 infection. These findings are of concern, considering the essential role of healthcare workers in caring for all patients including and beyond COVID-19

Analyse comportementale tridimensionnelle de l’intention de réaliser une réanimation cardio-pulmonaire par des non professionnels et de son évolution dans le temps

L’arrêt cardio-respiratoire extra-hospitalier est un problème de santé publique au vu de son caractère fréquent, de sa létalité et des années de vie perdues qu’il engendre. La survie dépend de l’action précoce des témoins et de l’initiation rapide d’une réanimation cardio-pulmonaire. En utilisant le modèle comportemental tridimensionnel d’Yzer, ce travail mesure l’évolution temporelle des représentations (ce que je pense utile de faire), des normes perçues (ce qui est attendu de moi) et de la confiance en soi (ce que je me sens de faire) après un cours de premiers secours. L’analyse montre que la confiance en soi diminue de façon significative six mois après le dernier cours de premiers secours. La diffusion de la responsabilité (le fait d’attendre que les autres portent d’abord secours) suit la même tendance. Ces résultats montrent l’intérêt de courtes et fréquentes sessions de sensibilisation aux premiers secours, axées sur des populations mieux définies

Less is more

After decades of remarkable development, medicine is facing a tough economic reality and new challenges. These challenges include defining the values, objectives and tasks of sustainable medicine. In this context, the concept of "less is more" emerged in North America. "Less is more" is an invitation to recognize the potential risks of overuse of medical care that may result in harm rather than in better health. It is therefore necessary to drive unnecessary and costly practices by streamlining care without rationing

Cinquante nuances de violences domestiques au féminin : l'implication des médecins est essentielle

Domestic violences are very common and constitute a criminal offence. Women are mainly victims but can also be perpetrators. Domestic violences have a major health impact on people, families and society. The primary care physician holds a major role in the targeted detection of domestic violences and their prevention. He must know their specificities and adapt his response according to the situations. This specific response does not prevent a rational approach: we propose to distinguish between different types of women's vulnerability. Management must involve an efficient network taking into account individual, family, community and social factors. In this context, use of regularly updated information from official websites is mandatory

Vulnerable populations and COVID-19 : need for innovation and cooperation to address health and social needs

La crise liée au Covid-19 a fragilisé les populations en situation préalable de précarité. L’émergence de l’insécurité alimentaire et de logement a poussé les acteurs de la santé, du travail social et les autorités à mettre en place des mesures innovantes et intersectorielles permettant de répondre rapidement et efficacement aux besoins essentiels de ces populations. Cet article présente trois de ces mesures, à savoir une équipe mobile interprofessionnelle de dépistage, un dispositif d’hébergement et d’encadrement sanitaire pour les personnes sans-abri et un programme de distribution alimentaire à large échelle. Ces trois exemples illustrent la nécessité d’une approche transversale et collaborative et le besoin d’agir sur les déterminants sociaux et politiques sous-tendant ces vulnérabilités.The COVID-19 crisis has rapidly increased the vulnerability of groups of population already facing precarious living conditions. The emergence of food and housing insecurity have forced health and social actors along with the local authorities to implement innovative responses in order to respond to these unmet needs. This article presents some of these responses, such as an interdisciplinary mobile COVID-19 screening team, an emergency housing program and a large-scale food assistance program. These examples highlight the need for an intersectoral, coordinated and collaborative response simultaneously targeting different domains of insecurity in parallel to actions on the underpinning social and political determinants of these vulnerabilities

Point de vue des médecins par apport aux coûts de la santé

Le but de cet article est de s’intéresser aux moyens possibles permettant d’arriver à une diminution de ces coûts, et ce, notamment, à partir de changements liés aux interventions médicales. Une des solutions préconisées à ce sujet serait la nécessité d’adopter un consensus, avec comme prémisse la feuille de route du «Système de santé durable» émise par l’Académie Suisse des Sciences Médicales

Association between prehospital physician clinical experience and discharge at scene – retrospective cohort study

BACKGROUND: Clinical experience has been shown to affect many patient-related outcomes but its impact in the prehospital setting has been little studied. OBJECTIVES:To determine whether rates of discharge at scene, handover to paramedics and supervision are associated with clinical experience. DESIGN, SETTINGS AND PARTICIPANTS: A retrospective study, performed on all prehospital interventions carried out by physicians working in a mobile medical unit (“service mobile d’urgence et de réanimationˮ [SMUR]) at Geneva University Hospitals between 1 January 2010 and 31 December 2019. The main exclusion criteria were phone consultations and major incidents with multiple casualties. EXPOSURE:The exposure was the clinical experience of the prehospital physician at the time of the intervention, in number of years since graduation. OUTCOME MEASURES AND ANALYSIS: The main outcome was the rate of discharge at scene. Secondary outcomes were the rate of handover to paramedics and the need for senior supervision. Outcomes were tabulated and multilevel logistic regression was performed to take into account the cluster effect of physicians. RESULTS: In total, 48,368 adult patients were included in the analysis. The interventions were performed by 219 different physicians, most of whom were male (53.9%) and had graduated in Switzerland (82.7%). At the time of intervention, mean (standard deviation [SD]) level of experience was 5.2 (3.3) years and the median was 4.6 (interquartile range [IQR]: 3.4–6.0). The overall discharge at scene rate was 7.8% with no association between clinical experience and discharge at scene rate. Greater experience was associated with a higher rate of handover to paramedics (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.13–1.21) and less supervision (aOR: 0.85, 95% CI: 0.82–0.88). CONCLUSION: In this retrospective study, there was no association between level of experience and overall rate of discharge at scene. However, greater clinical experience was associated with higher rates of handover to paramedics and less supervision

Neighbourhood socio-economic vulnerability and access to COVID-19 healthcare during the first two waves of the pandemic in Geneva, Switzerland: A gender perspective

Background: Neighbourhood socio-economic inequities have been shown to affect COVID-19 incidence and mortality, as well as access to tests. This article aimed to study how associations of inequities and COVID-19 outcomes varied between the first two pandemic waves from a gender perspective. Methods: We performed an ecological study based on the COVID-19 database of Geneva between Feb 26, 2020, and June 1, 2021. Outcomes were the number of tests per person, the incidence of COVID-19 cases, the incidence of COVID-19 deaths, the positivity rate, and the delay between symptoms and test. Outcomes were described by neighbourhood socio-economic levels and stratified by gender and epidemic waves (first wave, second wave), adjusting for the proportion of inhabitants older than 65 years. Findings: Low neighbourhood socio-economic levels were associated with a lower number of tests per person (incidence rate ratio [IRR] of 0.88, 0.85 and 0.83 for low, moderate, and highly vulnerable neighbourhood respectively), a higher incidence of COVID-19 cases and of COVID-19 deaths (IRR 2.3 for slightly vulnerable, 1.9 for highly vulnerable). The association between socio-economic inequities and incidence of COVID-19 deaths was mainly present during the first wave of the pandemic, and was stronger amongst women. The increase in COVID-19 cases amongst vulnerable populations appeared mainly during the second wave, and originated from a lower access to tests for men, and a higher number of COVID-19 cases for women. Interpretation: The COVID-19 pandemic affected people differently depending on their socio-economic level. Because of their employment and higher prevalence of COVID-19 risk factors, people living in neighbourhoods of lower socio-economic levels, especially women, were more exposed to COVID-19 consequences.</p

Impact of a Serious Game (Escape COVID-19) on the Intention to Change COVID-19 Control Practices Among Employees of Long-term Care Facilities: Web-Based Randomized Controlled Trial

Background: Most residents of long-term care facilities (LTCFs) are at high risk of complications and death following SARS-CoV-2 infection. In these facilities, viral transmission can be facilitated by shortages of human and material resources, which can lead to suboptimal application of infection prevention and control (IPC) procedures. To improve the dissemination of COVID-19 IPC guidelines, we developed a serious game called "Escape COVID-19" using Nicholson's RECIPE for meaningful gamification, as engaging serious games have the potential to induce behavioral change. Objective: As the probability of executing an action is strongly linked to the intention of performing it, the objective of this study was to determine whether LTCF employees were willing to change their IPC practices after playing "Escape COVID-19.