Education, disease prevalence and health service utilization in the Swiss National Health Survey "SOMIPOPS".

The relation among education, disease prevalence, and frequency of health service utilization was analyzed using data from the Swiss National Health Survey SOMIPOPS, conducted in 1981-1983 on a randomly selected sample of 4,255 individuals, representative of the entire Swiss population. The prevalence of several important cardiovascular, respiratory, digestive, osteoarticular, and psychiatric disorders was higher among less educated individuals; only allergic conditions were directly associated with indicators of social class. More educated individuals reported lower frequencies of general practitioner visits, but higher frequencies of specialized consultations. These findings confirm that education is an important determinant not only of mortality but also of morbidity and health-care utilization and require careful consideration in terms of the planning and evaluation of health services.

Alexithymia in patients recently diagnosed with cancer

Background: Contrary to the frequent assumption that alexithymia is a rather static personality trait hampering psychotherapeutic approaches, we have observed that cancer patients who qualify for the criteria of alexithymia may benefit from psychotherapy. Therefore, in patients facing a cancer diagnosis, alexithymia can often be considered as a state due to the threat of the disease (secondary alexithymia).Aims: To identify prevalence of alexithymia in newly diagnosed cancer patients and to document its evolution with and without psychotherapeutic interventions.Methods: Between 2006 and summer 2009, every newpatient of the Oncology Service of the University Hospital Lausanne was invited to benefit from psychotherapeutic support. Accepting patients were randomly assigned to a psychotherapeutic intervention or to a 4-month waiting list. Psychotherapies were formalized as psychodynamic-oriented short interventions (1-4 sessions) or brief psychodynamic psychotherapies (16 sessions). Patients who declined psychotherapeutic support were asked to participate in an observational group. Socio-demographic and medical data, alexithymia (TAS), anxiety and depression (SCL-90, HADS) and quality of life (EORTC) of participants of all groups were recorded at base line and at 1, 4, 8 and 12-months follow-up. Results: Of the 419 patients included, 190 desired psychotherapeutic support (94 were assigned to an immediate and 96 to a delayed intervention) and 229 patients accepted to be followed in the observational group. A very high proportion, almost 2/3 of the patients in all groups, qualified for alexithymia. With regard to the evolution of alexithymia, no significant changes were observed within and between groups and psychological symptoms also remained almost stable.Conclusions: Secondary alexithymia seems to be highly prevalent in newly diagnosed cancer patients. This raises important clinical and scientific questions: are these patients deprived from psychological support? How should interventions be conceptualized? Are interventions necessary and beneficial? Does alexithymia neutralize the effect of interventions on symptoms of anxiety and depression? Which outcome should be chosen for patients with secondary alexithymia?Keywords: Alexithymia, cancer, psycho-oncology, psychotherapy, secondary alexithymia

Analysis of patient physical restraints usage in a Swiss emergency service

Introduction: Emergency services (ES) are often faced with agitated,confused or aggressive patients. Such situations may require physicalrestraint. The prevalence of these measures is poorly documented,concerning 1 to 10% of patients admitted in the ES. The indications forrestraint, the context and the related complications are poorly studied.The emergency service and the security service of our hospital havedocumented physical restraint for several years, using specific protocolsintegrated into the medical records. The study evaluated the magnitudeof the problem, the patient characteristics, and degree of adherence tothe restraint protocol.Methods: Retrospective study of physical restraint used on adultpatients in the ES in 2009. The study included analysis of medical anddemographic characteristics, indications justifying restraint and qualityof restraint documentation. Patients were identified from computerizedES and security service records. The data were supplemented byexamination of patients' medical records.Results: In 2009, according to the security service, 390 patients (1%)were physically restrained in the ES. The ES computerized systemidentified only 196 patients. Most patients were male (62%). The medianage was 40 years (15-98 years; P90 = 80 years). 63 % of the situationsoccurred between 18h00 and 6h00, and most frequently on Saturday(19%). Substance or alcohol abuse was present in 48.7% of cases andacute psychiatric crisis was mentioned in 16.7%. In most cases,restraint was motivated by extreme agitation or auto / hetero-aggressiveviolence. Most patients (68 %) were restrained with upper limb andabdominal restraints. More than three anatomic restraints werenecessary in 52 % of the patients. Intervention of security guards wasrequired in 77% of the cases. 61 restraint protocols (31 %) were missingand 57% of the records were incomplete. In many cases, the protocolsdid not include the signature of the physician (22%) or of the nurse(43.8%). Medical records analysis did not allow reliable estimation ofthe number of restraint-induced complications.Conclusions: Physical restraint is most often motivated by majoragitation and/or secondary to substance abuse. Caregivers regularlycall security guards for help. Restraint documentation is often missing orincomplete, requiring major improvement in education and prescription.

Psychodynamic psychotherapy in newly diagnosed cancer patients: a randomized controlled trial

Background and aims: More than 30% of cancer patients develop a psychiatric disorder during the evolution of their disease. While evidence exists, that psychotherapy can improve psychological distress, questions, such as the prevalence of patients accepting psychotherapy, treatment indications and effectiveness of psychotherapeutic interventions in the oncology setting remain unanswered. The aims were: (1) To assess the prevalence of newly diagnosed cancer patients motivated to engage in psychotherapeutic interventions; (2) to identify those who benefit; and (3) to evaluate their effectiveness. Methods: Every new patient of the Oncology Service at the University Hospital Lausanne was informed of the possibility of benefitting from psychotherapeutic support. Patients who accepted were randomly assigned to individual psychotherapy or to a 4-month waiting list. Psychotherapies were formalized as psychodynamicoriented short interventions (1-4 sessions) or brief psychodynamic psychotherapies (16 sessions). Patients who refused psychotherapy were asked to participate in an observational group. Socio-demographic and medical data, anxiety, depression, alexithymia and quality of life (SCL- 90, HADS, TAS, EORTC) of all participants were evaluated at base line and at 1, 4, 8 and 12 -months Follow- Up. Results: So far 1047 patients have been approached, 20% were included in the study (intervention n=68, observation n=122), 32% were excluded, 22% could not be contacted and 26% refused to participate. At baseline, patients who accepted psychotherapeutic support showed higher depression and anxiety scores (HADS, SCL-90) compared to controls. 56% benefited from 4 sessions of psychological support, 44% engaged in 16 sessions of brief psychodynamic therapy. Conclusions: The preliminary results of this ongoing trial suggest that a minority of newly cancer patients accept psychotherapeutic intervention. These patients are more depressed than controls. Their motivation for short interventions and for brief psychotherapies is comparable.

Motifs de consultation en médecine du travail [Reasons for consultation in occupational medicine].

The inability to characterize more precisely the extent of occupational diseases limits the implementation of an effective preventive policy. Furthermore, not all work-related conditions are reported by the Swiss workers' compensation system. A seven-year (1986 to 1992) retrospective study of medical visits in an Institute of Occupational Health Sciences is presented. The objective of this study is to expand data on occupational diseases for clinical and public health intervention. 298 patients have been examined for a possible work-related condition. In 140 cases (47%), an occupational disease according to the Swiss Law was found. Respiratory tract was the main target of industrial pollutants. Respiratory irritation , solvent intoxications, contact dermatitis and asthma were the most frequent conditions seen. 97 workplace visits (32% of all medical visits) were necessary for diagnostic purposes. Painters (construction, cars) and other solvent exposed workers were at particular risk. Rare alpha-1-antitrypsin phenotypes were found several times in workers with respiratory diseases confirming the value of this test in occupational medicine. Despite many referral biases, direct clinical and public health applications of the data are possible. This study confirms the hypothesis that occupational respiratory diseases and intoxications are probably underreported in the workers' compensation statistics. Activities with an increased risk of work-related diseases have been identified so workplace intervention could be highly targeted. This study shows also that a more intense collaboration between primary care physicians, hospital services and occupational medical specialists is necessary to improve clinical and epidemiological surveillance of work-related health conditions.

La consultation pour le test sérologique de dépistage VIH : enjeux pour le couple et pour le médecin

La pratique du test au centre de dépistage anonyme VIH de la Policlinique médicale universitaire de Lausanne semble indiquer que de plus en plus de personnes demandent à être testées, souvent au moment inaugural de la constitution de la vie du couple. L'indication au test de dépistage devrait être le résultat d'une négociation entre le patient et son médecin. Ce dernier est en outre confronté à la complexité des enjeux sociétaux et éthiques que le test représente. Il s'agit d'une tâche difficile, d'autant plus que la requête d'un test n'implique pas le seul devenir du sujet, mais aussi, dans la dimension sexuelle, le devenir de la personne qu'il rencontre. L'avènement du Sida a modifié la vie du couple en rendant la sexualité plus problématique et en donnant un caractère impératif l'exigence de négociation entre les partenaires du couple. La pratique de la prévention révèle aussi comment le Sida met en jeu la responsabilité que les médecins ont de négocier avec leurs patients, à l'instar de ce que ces derniers devraient faire avec leur partenaire dans un but de protection.

Analysis of patient physical restraints usage in a Swiss emergency service

Introduction: Emergency services (ES) are often faced with agitated,confused or aggressive patients. Such situations may require physicalrestraint. The prevalence of these measures is poorly documented,concerning 1 to 10% of patients admitted in the ES. The indications forrestraint, the context and the related complications are poorly studied.The emergency service and the security service of our hospital havedocumented physical restraint for several years, using specific protocolsintegrated into the medical records. The study evaluated the magnitudeof the problem, the patient characteristics, and degree of adherence tothe restraint protocol.Methods: Retrospective study of physical restraint used on adultpatients in the ES in 2009. The study included analysis of medical anddemographic characteristics, indications justifying restraint and qualityof restraint documentation. Patients were identified from computerizedES and security service records. The data were supplemented byexamination of patients' medical records.Results: In 2009, according to the security service, 390 patients (1%)were physically restrained in the ES. The ES computerized systemidentified only 196 patients. Most patients were male (62%). The medianage was 40 years (15-98 years; P90 = 80 years). 63 % of the situationsoccurred between 18h00 and 6h00, and most frequently on Saturday(19%). Substance or alcohol abuse was present in 48.7% of cases andacute psychiatric crisis was mentioned in 16.7%. In most cases,restraint was motivated by extreme agitation or auto / hetero-aggressiveviolence. Most patients (68 %) were restrained with upper limb andabdominal restraints. More than three anatomic restraints werenecessary in 52 % of the patients. Intervention of security guards wasrequired in 77% of the cases. 61 restraint protocols (31 %) were missingand 57% of the records were incomplete. In many cases, the protocolsdid not include the signature of the physician (22%) or of the nurse(43.8%). Medical records analysis did not allow reliable estimation ofthe number of restraint-induced complications.Conclusions: Physical restraint is most often motivated by majoragitation and/or secondary to substance abuse. Caregivers regularlycall security guards for help. Restraint documentation is often missing orincomplete, requiring major improvement in education and prescription.