[Electives during preclinical medical curriculum: the Geneva experience ]. / Modules à option au cours des études de médecine: l'expérience genevoise.

Electives have come of age in Medical Schools throughout Europe since the Bologna Guidelines were issued. At the Faculty of Medicine of Geneva its importance was recognized early to satisfy the students' curiosity, enlarge their visions, or deepen their knowledge in certain aspects of their curriculum. It was therefore decided to develop a great number of different electives ranging from basic biomedical research to emblematic clinical syndromes and humanitarian medicine for 2nd and 3rd year Bachelor students. The Electives taken have to be validated through specific examinations corresponding to 10% of the yearly ECTS credits. The experience has so far been a success, with high satisfaction as well of the student as of the teacher body. A major challenge for the future will be opening further these Electives to other Faculties and other professions.

[Factors associated with HPV immunization for 13-14-year-old girls in the Geneva district, Switzerland]. / Facteurs associés à la vaccination HPV chez les jeunes filles de 13 à 14ans dans le canton de Genève, Suisse.

BACKGROUND: School vaccination programs against human papilloma virus (HPV) have been implemented in most Western countries. Only a few studies have investigated socio-economic factors related to school-based vaccination. METHOD: A cross-sectional study was conducted using the vaccination cards of 1158 randomized girls aged 13 to 14 years enrolled in the public schools of the canton of Geneva. Several other socio-economic variables (nationality, socio-professional category and marital status of the parents) were collected. RESULTS: Immunization coverage for three doses of HPV vaccine was 56%. After having controlled the covariates, Portuguese adolescents (adjusted OR [95% CI]: 4.18 [1.76-9.92]), adolescents whose mothers were workers (adjusted OR [95% CI]: 1.91 [1.38-2.65]) or married (adjusted OR [95% CI]: 1.44 [1.06-1.98]) showed significantly higher immunization rates than Swiss adolescents or those whose mothers' socio-professional category was senior manager or executive. CONCLUSION: This study shows that the HPV vaccine coverage is not yet optimal in Geneva and varies significantly according to the socio-economic status, thus better promotion of HPV vaccination for certain target groups must be implemented.

Development and evaluation of a community immersion program during preclinical medical studies: a 15-year experience at the University of Geneva Medical School.

BACKGROUND: Significant changes in medical education have occurred in recent decades because of new challenges in the health sector and new learning theories and practices. This might have contributed to the decision of medical schools throughout the world to adopt community-based learning activities. The community-based learning approach has been promoted and supported by the World Health Organization and has emerged as an efficient learning strategy. The aim of the present paper is to describe the characteristics of a community immersion clerkship for third-year undergraduate medical students, its evolution over 15 years, and an evaluation of its outcomes. METHODS: A review of the literature and consensus meetings with a multidisciplinary group of health professionals were used to define learning objectives and an educational approach when developing the program. Evaluation of the program addressed students' perception, achievement of learning objectives, interactions between students and the community, and educational innovations over the years. RESULTS: The program and the main learning objectives were defined by consensus meetings among teaching staff and community health workers, which strengthened the community immersion clerkship. Satisfaction, as monitored by a self-administered questionnaire in successive cohorts of students, showed a mean of 4.4 on a five-point scale. Students also mentioned community immersion clerkship as a unique community experience. The learning objectives were reached by a vast majority of students. Behavior evaluation was not assessed per se, but specific testimonies show that students have been marked by their community experience. The evaluation also assessed outcomes such as educational innovations (eg, students teaching other students), new developments in the curriculum (eg, partnership with the University of Applied Health Sciences), and interaction between students and the community (eg, student development of a website for a community health institution). CONCLUSION: The community immersion clerkship trains future doctors to respond to the health problems of individuals in their complexity, and strengthens their ability to work with the community.

[Non traumatic lesions of the foot, calluses and nails: socioeconomic impact of an unexplored issue]. / Lésions non traumatiques du pied, cors et ongles: impact socio-écono- mique d'un problème méconnu.

Up to 20% of the general population, especially women and old people, suffer from non traumatic lesions of the foot. These lesions have repercussions on a person's health and wellbeing. Nevertheless, the clinical examination of the foot rarely forms part of routine medical consultations. Using questionnaires and individual interviews, this pilot study investigated the foot problems of 96 patients attending a podiatrist's practice, as well as the level of communication between the patients and their doctor. 85% of the participants said they never talked about calluses and nails with their doctor. The results were confirmed by fifteen individual interviews. Clinicians have an important role to play in the early detection of these lesions, allowing an efficient management of this issue.

[Translation and validation in French of a multidimensional scale to evaluate the degree of satisfaction during childbirth]. / Traduction et validation en langue française d'une échelle multidimensionnelle évaluant le degré de satisfaction, lors de l'accouchement.

BACKGROUND: Validation of the French version of the questionnaire: Women's Views of Birth Labour Satisfaction Questionnaire, version 4 (WOMBLSQ4). This self-administered questionnaire measures patient satisfaction with care dispensed during childbirth. METHODS: The WOMBLSQ4 comprises 30 items divided into ten dimensions. Items were translated from English into French and then underwent a linguistic adaptation. The results have been submitted to a descriptive analysis and psychometric tests used for questionnaires, i.e., the Cronbach alpha coefficient and Spearman correlation coefficient. The test-retest reliability has been assessed by a calculation of the intraclass correlation and by Bland-Altman plots. RESULTS: The study was presented to 116 primiparous patients between March and September 2004. One hundred and two (88%) patients agreed to participate in the study and received the French translation of WOMBLSQ4, as well as the Short-Form 12 Health Survey and the Edinburgh Postnatal Depression Scale, 2 months after childbirth. Ninety-two patients (90%) returned the questionnaires. The Cronbach alpha coefficient for the WOMBLSQ4 is 0.85. The results of the test-retest are between 0.54 and 0.83 for the intraclass correlation depending on the scale dimension, and show a homogeneity of the mean differences between the two measures according to the Bland-Altman plot. The average score of satisfaction is 65.2 (+/-12) with a minimum of 35.5 and a maximum of 86.4 according to the dimensions. CONCLUSION: On the technical level, the French version of the WOMBLSQ4 fully meets the criteria for the measurement of quality of care in obstetrics. The internal validity and reproducibility of the WOMBLSQ4 in French are satisfactory. However, in order to obtain results that can be fully interpreted in a French-speaking population, a transcultural adaptation should be considered for certain elements of the questionnaire.

[Need for health and human rights training: survey in six French-speaking African countries]. / Besoins de formation en santé et droits de l'homme: une enquête dans six pays d'Afrique Francophone.

The purpose of this study was to assess the need of healthcare and non-healthcare professionals for training in the field of health and human rights as a basis for developing relevant education programs. In 2007 a self-administered survey questionnaire was sent to 360 health professionals and human rights activists in Chad, the Democratic Republic of the Congo, the Republic of the Congo, Mali, Burkina-Faso, and Ivory Coast. The response rate was 67% (242/360). The most common training needs involved planning tools (87%), types of human rights violations in health systems (85%), risk factors for human rights violations (80%), and human rights monitoring tools (74%). The preferred training approaches were mixed and participative methods (60%) and practical applications as a means of validation (65%). There was a high degree of homogeneity between the needs expressed by the healthcare and non-healthcare professionals. The findings of this survey indicate that healthcare and non-healthcare professionals wish to obtain the knowledge and skills necessary to prevent and/or identify human rights issues in healthcare systems and to provide adequate responses. Training programs dealing with human rights in healthcare systems should reflect these needs.

[Evolution of vaccine coverage from school year 2003-2004 to 2006-2007, for 5 to 6-year-old children in Geneva]. / Evolution de la couverture vaccinale de l'année scolaire 2003-2004 à 2007-2008 pour les enfants de cinq à six ans à Genève.

OBJECTIVE: The authors had for aim to study the evolution of vaccination coverage for diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella (MMR) and Haemophilus influenzae b (Hib) in 5 to 6-year-old children in Geneva, from school year 2003-2004 to 2006-2007. DESIGN: The data was collected from vaccination cards of 17,184 children attending public schools in the Geneva canton. RESULTS: The average vaccination coverage over the study period was 93.4% for diphtheria, 93.5% for tetanus, 92.5% for pertussis, and 92.4% for poliomyelitis. For MMR and Hib, the coverage was 80.6, 78.4, 79.1 and 81.2% respectively. Between 2003 and 2007, an increase of coverage was observed for all vaccines. It was especially observed for MMR and Hib vaccines, even though the coverage remained below 90%. CONCLUSION: In the Geneva canton, epidemiological surveillance of vaccination coverage of 5 to 6-year-old children can be achieved through systematic data analysis of children's vaccination cards. All commonly used vaccines reached the recommended coverage rates, except for MMR and Hib, even though their coverage had significantly increased.

[Preventing occupational eye trauma (Geneva, Switzerland)]. / Prévention des traumatismes oculaires professionnels (Genève, Suisse).

INTRODUCTION: Occupational eye trauma causes injuries with often serious socioprofessional, medical-legal, and economic consequences, not only for workers themselves, but also for employers. In spite of today's legislation and the efforts to encourage prevention, the frequency of occupational ocular accidents remains relatively high despite how easy it is to protect the eyes. In this study, the reasons that these accidents persist despite the progress made in preventive measures was investigated. MATERIAL AND METHODS: From January to July 2005, we analyzed the parameters related to 175 occupational eye injuries. All patients agreed to take part in this study, which was carried out in the emergency unit of the Ophthalmology Clinic at Geneva University Hospital. Additional data was collected in companies. RESULTS: Construction workers were the most exposed (41.1%). The activity with the greatest risk was grinding (19.4%). The most affected structure of the eye was the cornea (84%), 72.6% patients were not equipped with ocular protection at the time of the accident, and 17.4% wore poorly adapted eye protection. This can be explained by negligence, lack of awareness, etc. Overall, workers, employers, and the legislation in force are all responsible. DISCUSSION: Our results are comparable with those found in the literature, with certain particularities because heavy industry was underrepresented in our sample. Analysis of the law on the prevention of occupational accidents and diseases shows that the worker is not sufficiently aware of his responsibilities. To our knowledge, the legal aspects treated herein have not been studied. As done in certain studies, we emphasize the importance of preventive ophthalmologic examinations as well as improvement of both working conditions and worker awareness in the workplace. RECOMMENDATIONS AND CONCLUSIONS: Primary prevention must be reinforced. Information campaigns within the workplace aimed at workers and revision of the laws on occupational safety are some of the recommendations that are proposed to control occupational ocular accidents.

[Should medical schools train students in human rights? An exploratory study among medical students in 46 countries]. / Faut-il former les etudiants en médecine aux droits de l'homme? l'Opinion d'etudiants en médecine de quarante-six pays.

The interest of medical students from 46 countries for human rights issues and training was investigated in a cross sectional study. Training in human rights is demanded by 85,4% of respondents. Nearly 55% consider that such training should be compulsory. Nearly 85% of students consider as specific tasks of a medical practitioner "to prevent actively professional practices that violate basic human rights in the health systems" or "to develop and promote attitudes respectful of human rights in care". Our study suggests that human rights training could be integrated into basic medical curriculum.

[Medical ethics and human rights training in Europe]. / Enseignement de l'éthique et des Droits de l'Homme en Europe.

In 1999 the World Medical Association (WMA) issued a declaration recommending that there be the teaching of medical ethics and human rights included in the basic medical school curricula across Europe. The study aims to investigate the level of medical ethics and human rights training provided and to take an inventory of the existing programmes in the European Union's medical schools. The study was carried out using a self-administered questionnaire which was disseminated in the year 2002 to 219 schools of medicine in 14 of the 15 European Union member states (Luxembourg did not yet have a school of medicine). One-fourth of the medical schools solicited sent back a reply. Medical ethics are taught in 93% of medical schools; its teaching is of a multi-disciplinary and cross-cutting nature in 80% of the schools. Courses on ethics are compulsory in 75% of the cases. Human rights are taught in 63% of the European medical schools, and it is most often the case that the teaching of human rights is incorporated into the ethics courses. Even if the WMA's recommendation is not always fully implemented according to the guidelines of their declaration, this study demonstrates and reveals nonetheless the increasing of awareness and realization by European medical schools of the significance of including such a track in their programme.

[Health and human rights: perceptions of health professionals and human rights defenders]. / Santé et droits humains: perceptions de leurs défenseurs et des professionnels de santé.

A self-administered questionnaire served as the basis for a study carried out between February and June 2003 covering a panel of 125 experts from 33 countries spread over 5 continents. The objective of this study was to identify the human rights problems perceived as having a very negative health impact from approximately fifty proposals. This study also aimed at identifying the variables which could explain the differences in the perceptions observed. At the global level, the threats to physical integrity and attacks on human life, economic problems of a health or social nature, questions of political or democratic origin, as well as a wide spectrum of other problems are perceived as having very harmful effects on health with an average adhesion rate of severity (TMAG) ranging from 90-75%. For the same categories of problems at the national level, the TMAG varies from 67-40%: The observed consensus around the severity of human rights problems is tempered by the differences in perceptions according to profession, sex, and the level of the country's and continent's development. Other than the fact that these results corroborate the shared international concerns with regard to the state of the world's human rights, they suggest that the experts' opinions constitute a complementary source of information necessary for work on the international mechanisms for the surveillance of the implementation of international treaties; while at the same time, they indicate priorities for action in the field of public health and human rights.

[Coronary artery bypass by mini-thoracotomy: noticeable benefits with clinical experience of the treatment team]. / Pontages coronariens par mini-thoracotomie: bénéfices visibles avec l'expérience croissante de l'équipe traitante.

AIM OF THE STUDY: Minimally invasive coronary artery bypass surgery is fundamentally different as compared to open sternal approach under cardiopulmonary bypass. Modifications of the surgical, anesthesiologic and post-operative techniques are necessary before evaluation of its real benefit. We analyze the potential effect of a learning period on the short term results of this technique. METHODS: From July 1997 to February 1999, 20 patients were operated using this method. We compare the results of the first 10 patients (group 1: 8M/2F, 59.6 +/- 13.8 years) to those of the last 10 patients (group 2: 8M/2F; age = 63.2 +/- 6.1 years). DISCUSSION: Progress between the two groups is striking. Left anterior descending coronary clamping time could be reduced from 28.5 +/- 2.4 min. in group 1 to 22.2 +/- 1.8 min. in group 2 (p < 0.05), and operative time was reduced from 125 +/- 4 min. to 97 +/- 5 min. (p < 0.005). The post-operative atrial fibrillation rate diminished from 4/10 in group 1 to 1/10 in group 2.3/10 patients in group 1 suffered a post-operative pneumonia whereas none in group 2 had pulmonary complication. The stay in the intensive care unit could be reduced from 2.3 +/- 0.3 days to 1.4 +/- 0.2 days (p < 0.05) and the total post-operative stay diminished from 8.5 +/- 0.9 days to 4.7 +/- 0.5 days (p < 0.005). CONCLUSION: There are evidence for a learning period in minimally invasive cardiac surgery. Short term benefits of this technique are then evident as demonstrated by a reduction in the ICU stay and the hospital stay.

[Malignant hyperthermia]. / L'hyperthermie maligne.

Malignant hyperthermia is a serious anesthetic complication, presenting with various manifestations, with high mortality and morbidity. There are several incomplete and abortive forms, and the clinicians must be aware of the possibility of malignant hyperthermia, and recognize the first signs of the hyperthermic crisis hyperthermia, hypermetabolism and muscular rigidity. Screening is performed by in vitro contracture testing on a muscular biopsy. Treatment is based on discontinuation of triggering agents and dantrolene administration, as well as supportive care. Cellular investigations demonstrate that the malignant hyperthermia crisis presents as an intracellular flooding with calcium, leading to an abnormal muscular contracture. Several mutations in particular involving the ryanodine receptor gene have been linked to malignant hyperthermia.

[Educational strategies and tools in a public health program at the University of Geneva]. / Stratégies et outils pédagogiques dans le cadre d'un Diplôme de Santé publique: une expérience à l'Université de Genève.

In the Swiss context, the newly developed MPH programme at the University of Geneva is experimental in educational matters. Indeed the programme is fully learner-centered and community-oriented. Throughout the curriculum students plan, implement and evaluate intervention programmes or/and research projects related to health problems of the communities they are in charge of. In this article, we describe the educational strategies and tools used in this MPH curriculum (professional profile, mind-mapping procedures, field-work either on research projects or on intervention programmes, group work and evaluation procedures). These strategies and tools might assist some educational experimentation in MPH programmes in search of public health relevance and pedagogic efficacy.