Minimally invasive outpatient hysterectomy for a benign indication: A systematic review.

BACKGROUND: Outpatient surgery in gynaecology may offer advantages including cost reduction, patient convenience and hospital bed optimisation without compromising patient safety and satisfaction. With the continual rise in health costs since 2000, outpatient surgery could be a line of action to improve financial resource utilisation and a solution for continuing to treat patients during crises such as the coronavirus disease 2019 pandemic. OBJECTIVE: This systematic review provides an overview of the literature on minimally invasive outpatient hysterectomy for benign indications. METHOD: A focused systematic review of the medical literature between 2018 and 2022 on outpatient gynaecological surgery for a benign indication was conducted using the PubMed and Google Scholar search engines. We then narrowed our selection to articles that referred to hysterectomy. Successful same-day discharge (SDD) was defined as the patient's return home on the day of the procedure without an overnight stay. RESULTS: Fifteen articles that focused on minimally invasive surgery were included in this review. Most of the studies (n = 11) were conducted in the United States. Outpatient surgery had a mean success rate of 60 % and a mean readmission rate of 3 %. The main reasons for SDD failure were patient choice, failed voiding, the need for pain management, nausea or vomiting, or both and the late timing of surgery. SDD was not associated with more complications and readmissions compared with inpatient care. The three main attribute predictors of SDD were young age, early timing of surgery and short total operative time. Patient satisfaction with SDD was high in absolute terms and relative to satisfaction with hospitalisation. CONCLUSION: Minimally invasive outpatient hysterectomy for a benign indication is feasible and safe but is associated with a notable risk of failure. To increase the success rate of outpatient management, patients must be well selected and surgery pathways must be planned in advance. The implementation of enhanced recovery protocols may help promote outpatient hysterectomy for a benign indication.

Changes in Body Weight and Risk Factors for Overweight and Obesity in 5-6-Year-Old Children Attending School in Geneva.

Background: The prevalence of obesity and overweight in children is increasing in industrialized countries. Monitoring the evolution of these phenomena is essential for understanding prevention and health promotion programs. This study aims to present the analysis of anthropometric data collected by school nurses from the School Health Service of Geneva (Service de santé de l'enfance et de la jeunesse) for children aged 5 to 6 years during the 2021-2022 school year, as well as describe the trends in overweight and obesity from 2003-2004 to 2021-2022. Risk factors were also assessed in the 2021-2022 sample. Methods: This study included a random sample of 958 (479 girls and 479 boys) primary school pupils aged 5 to 6 years in Geneva. Data on weight, height and socioeconomic status were collected. BMI was analyzed using the Cole standard. A multivariate analysis was conducted to assess the influence of socioeconomic factors on overweight and obesity. We compared these results with BMI trends in students of the same age since 2003. Results: In 2021-2022, overall prevalence of overweight was 12.73%, and obesity was 5.64%. Girls had higher rates of overweight (14.20%) and obesity (6.68%) compared to boys (11.27% and 4.59%, respectively) (p < 0.0001). Overweight in boys significantly increased since the 2013-2014 and 2019-2020 measurements (p = 0.003). The trend for girls was similar but not statistically significant. Obesity rates have not significantly increased since 2019-2020 in both genders, but there is a significantly increasing trend for girls since 2013-2014 p = 0.045). Socioeconomic factors, particularly the socioeconomic class of parents, played a predictive role in overweight and obesity. Conclusions: The School Health Service of Geneva and the Directorate General of Health have a crucial role in monitoring and preventing childhood obesity. The prevalence of overweight and obesity has remained high since 2010, justifying continuous efforts for prevention. A significant increase in prevalence has been observed since 2020, particularly among overweight boys, and could be related to COVID-19 confinement measures.

Implementation and Evaluation of a Training Program for Traditional Healers to Improve Knowledge of Noma (Cancrum Oris) in Burkina Faso.

Noma (cancrum oris) is an orofacial gangrene affecting young children living in extreme poverty. The acute morbidity is high, and survivors suffer from physical and social sequelae. When diagnosed early, noma can be cured. Noma is especially prevalent in sub-Saharan Africa, where traditional medicine is the norm. The aim of this work was to provide 1-day training to traditional healers in Burkina Faso and to evaluate change in knowledge of noma across time. A sample of 78 healers who attended the training were asked to complete the same questionnaire before, immediately after, and 8 months after the training. A total of 66 healers completed the entire study. Before training, more than 40% of the participants did not know any of its key messages. Most of the key messages were acquired and still present after 8 months by a large proportion of the participants. Systematic intraoral examination was practiced by 7 (9.0%) of the traditional healers before training, and 43 (65.2%) reported doing so 8 months after training. The key messages aiming to improve early diagnosis as well as rapid and adequate treatment (the recognition of facilitating factors and the need to perform a systematic oral examination and to advise hospital transfer) have been well integrated. The study suggests that organizing a self-managed training program is feasible when done within an association, as was the case here, and owing to the willingness to collaborate shown by the traditional healers who participated in our study.

Vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland: protocol for an online national study.

Background: Vaccine hesitancy is a persistent challenge in public health, exacerbated by the proliferation of anti-vaccine sentiments facilitated by social networks. The COVID-19 pandemic has underscored the importance of addressing vaccine hesitancy, designated by the WHO as a top global health threat. This study explores vaccine hesitancy among nursing and midwifery undergraduate students in Switzerland-a cohort crucial to public health given their future roles as healthcare professionals-with a particular emphasis on the HPV vaccine, which exhibits lower confidence levels compared to other vaccines. Methods: This study will employ an online questionnaire distributed to nursing and midwifery undergraduate students from various healthcare universities. The questionnaire will collect data on vaccine hesitancy (general confidence in vaccines and specifically in the HPV vaccine), HPV vaccine coverage, socio-demographics, likelihood to recommend vaccines to patients, perception of vaccination education and interest in complementary medicine. Conclusion: The study's findings will contribute to our understanding of vaccine hesitancy among nursing and midwifery undergraduate students, providing insights that can inform targeted interventions and education strategies to bolster vaccine confidence among future healthcare professionals, thereby enhancing public health efforts.

Cervical cancer screening programs for female sex workers: a scoping review.

Background: Cervical cancer (CC) is the fourth most common neoplasia affecting women worldwide. Female sex workers (FSWs) are among those at highest risk of developing and succumbing to CC. Yet, they are often overlooked in CC screening programs and have limited access to CC healthcare globally. The development of CC screening programs for this high-risk target population is necessary to reduce the global burden of this disease and to reach the World Health Organization's objective of accelerating the elimination of CC. Objective: This review summarizes findings on CC screening programs for FSWs that have been implemented worldwide, and assesses their effectiveness and sustainability. Methods: A scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A literature search was performed on PubMed, Swisscovery, and Google Scholar for studies describing and assessing CC screening programs for FSWs. In addition, targeted searching online Non-Governmental and International Organizations websites identified grey literature. A single reviewer screened titles and abstracts, and extracted data from the research findings. Results: The search identified 13 articles published from 1989 to 2021. All implemented programs successfully reached FSWs and provided them with CC screening during the study period. The most effective and sustainable strategies were the Screen and Treat approach, introducing CC screening into existing STI services in drop-in or outreach clinics, HPV-DNA self-sampling, and integrating sex-workers-specific services in public health facilities. Follow-up was deemed the main challenge in providing and enhancing CC healthcare to FSWs with rates of loss to follow-up ranging from 35 to 60%. Conclusion: FSWs are often omitted in national CC screening programs. The further development and improvement of CC healthcare, including follow-up systems, for this high-priority target population are imperative.

Corrigendum: Motivating factors and barriers to help-seeking for casino gamblers: results from a survey in Swiss casinos.

[This corrects the article DOI: 10.3389/fpsyt.2023.1128291.].

The acceptability of HPV vaginal self-sampling for cervical cancer screening in Latin America: A systematic review.

Objective: This review summarizes women's acceptability of vaginal self-sampling for cervical cancer screening in Latin America. Study design: Systematic review. Method: A systematic literature search was performed in PubMed, Web of Science, and Embase regarding the acceptance of HPV vaginal self-sampling by women over 18 years old. Articles were selected for research that was conducted in Latin America and published between January 1st, 1993, and December 31st, 2022. Results: Fifteen publications were included. Eight publications reported an acceptance of HPV self-sampling as high as 80%, six papers found an acceptance rate between 50 and 80% and only one found an acceptance rate of less than 50%. Based on non-standardized questionnaires, women considered self-sampling more comfortable, easier, and less painful than conventional cytology. The procedure was associated with less embarrassment and a greater sense of privacy. Conclusion: HPV vaginal-self sampling appears to be an acceptable screening method amongst eligible Latin American women.

Santé sexuelle et reproductive des femmes ayant des rapports sexuels avec des femmes en Suisse.

INTRODUCTION: Sexual and reproductive health (SRH) of lesbians and other women who have sex with women (WSW) remains largely unexplored in Switzerland. A cross-sectional web- and pa-per-based survey was conducted in 2012. PURPOSE OF RESEARCH: The aim of this study was to gain more knowledge on the SRH of the WSW in French-speaking Switzerland in order to inform preventive activities and promote more adequate SRH services for these women. RESULTS: Sexual practices between women are very diverse, some of them potentially risky in terms of transmitting various STIs, but 71% of WSW never practice safer sex or other risk reduction strategies for HIV and other STIs with their female partners. Only 69% have had a gynecological check-up in the last 3 years. 16% had one or more children. 29% reported having experienced violence in a lesbian relationship. CONCLUSIONS: Specific information on SRH should be developed to match the specificities and needs of WSW and more research is needed on their SRH, their risk regarding breast cancer and ways to improve the cultural sensitivity and knowledge of gynecologists and other health care providers towards their lesbian, bisexual and other WSW patients.

Motivating factors and barriers to help-seeking for casino gamblers: results from a survey in Swiss casinos.

Introduction: Gambling can have serious consequences for many aspects of a person's life. Yet relatively few people with gambling problems seek help. This study examines the extent to which exclusion from casino venues among other factors may act as a motivator for further help-seeking among casino gamblers (both landbased and remote) with at-risk or disordered gambling behavior. In addition, the barriers that prevent gamblers from accepting help are examined. Methods: Gamblers from Swiss casinos completed a written questionnaire twice, at 6-month intervals. The questions included whether they had sought help in the past 6 months. Results: For those with a SOGS-R rating of 1 or over (n = 173) at the second survey point, a difference in help-seeking was found between the excluded and non-excluded gamblers (p < .001), suggesting that exclusion may be a motivator for help-seeking. Reported differences in levels of debt (p = .006), recognition of gambling problems (p = .010) and severity of gambling-related problems (p = .004) can be taken to suggest that other motivating factors may also influence help-seeking behavior. With regard to the support sought, the most frequently used forms of support were specialized addiction counseling centers (39.5%), followed by self-help groups (21.1%) and remote counseling centers (10.5%). In terms of barriers, reasons relating to attitude, such as denial, appear to pose greater barriers than treatment-related concerns. Discussion: From a public health perspective, an overarching strategy is required to increase the share of help-seekers among casino gamblers through targeted measures.

Validation of the Polish Problematic Tinder Use Scale and Its Relationship with Safe Sex Behaviors.

INTRODUCTION: Online dating is a common phenomenon. The manageability and access of the application allows people to quickly reach many potential partners, which can increase risky sexual behaviors. The Problematic Tinder Use Scale (PTUS) was developed and validated in a Polish population by analyzing the reliability, validity, and factor structure of the responses given by Polish-speaking participants. METHODS: Two samples of adult Tinder users were recruited online. The first study aimed to perform the reliability coefficient Cronbach's, interrater analysis, exploratory, and confirmatory factor analysis. The second sample was recruited to investigate the factor structure by combining it with the Safe Sex Behavior Questionnaire (SSBQ). The sociodemographic data, such as hours of use and number of dates, were also investigated. RESULTS: The Polish participants' responses to the PTUS (sample 1: N = 271, sample 2: N = 162) revealed the one-factor structure of the tool. The reliability of the measurement was α = 0.80. The construct validity was confirmed. The results showed a significant, negative, and weak correlation between the PTUS and SSBQ scores and their subscales: risky sexual behaviors (r = -0.18), condom use (r = -0.22), and avoidance of body fluids (r = -0.17). Moreover, the number of partners met in the real world had a statistically significant, moderate relationship with the PTUS scores. CONCLUSIONS: The PTUS measurement is valid and reliable for the Polish population. The findings highlight the need for harm prevention strategies related to potentially addictive Tinder use, as well as the possible risky sexual behaviors associated with dating app use.

Willingness to Pay for a Dating App: Psychological Correlates.

The smartphone dating app, Tinder, has become hugely popular in recent years. Although most people use a free version of the app, some pay for an augmented version to improve their experience. However, there is little evidence of the association between the willingness to pay for a dating app such as Tinder and users' psychological characteristics. This study thus aims to compare Tinder paying versus non-paying users in terms of their pattern of use, excessive use of Tinder, motives for using Tinder, impulsivity traits, depressive mood, and sociodemographic variables, as well as to examine which variables best predict group membership. A total of 1159 Tinder users participated in an online survey. Group comparisons indicated that payers were more frequently male, reported greater motives for using Tinder than non-payers, and differed in their pattern of use compared with non-payers. Impulsivity traits did not significantly differ between the two groups. Being male and reporting greater motives for Tinder use significantly predicted being a payer. These findings provide insights into the processes that stimulate users' greater consumption of online dating apps, such as reinforcement mechanisms and reward sensitivity.

18 Years of Changing Trends: Swiss Data on the Clinical Characteristics and Game Types Associated with Problem Gambling.

Recent changes in the Swiss gambling context include the introduction of a new gambling policy (Swiss Federal Act on Gambling; GA), and the associated opening of the online gambling market. Within this context it is important to observe evolving trends in gambling behavior. This study therefore aims to identify the gambling behavior and clinical characteristics of a treatment-seeking population over an 18-year period (2001 to 2018). Specifically, the proportion of referrals relating to the three most popular game-types; VLT play, slot machines and online gambling, and associated socio-demographic characteristics, gambling-related spending and clinical features. The results indicate the high addictive potential for VLT and slot-machine use, over the 18-year period with an increasing use of online gambling from 2012 to 2018 (even before the official opening of the market). Problem-gambling vulnerability factors such as low income, unemployment and debts as well as self-reported suicidal ideation, were also over-represented in the sample. This longitudinal overview provides a detailed picture of treatment-seeking referrals, for future comparisons and can be used to tailor clinical interventions.

Utility of extended HPV genotyping for the triage of self-sampled HPV-positive women in a screen-and-treat strategy for cervical cancer prevention in Cameroon: a prospective study of diagnostic accuracy.

OBJECTIVE: To explore the utility of extended Human Papillomavirus (HPV) genotyping to detect cervical intraepithelial neoplasia grade 2 or more (CIN2+) in a 'screen-and-treat' strategy for HPV-positive women in low-resource settings. DESIGN: Prospective study of diagnostic accuracy. SETTING: The study took place in West Cameroon between September 2018 and March 2020. PARTICIPANTS: 2014 women were recruited. Asymptomatic, non-pregnant women aged 30-49 years without history of CIN treatment, anogenital cancer or hysterectomy were eligible. INTERVENTIONS: Participants performed self-sampling for HPV testing with GeneXpert followed by visual inspection with acetic acid and Lugol's iodine (VIA) triage before treatment if required. MAIN OUTCOME MEASURES: Liquid-based cytology, biopsies and endocervical brushing were performed in HPV-positive women as quality control. We assessed the detection rate of CIN2+ by HPV genotyping (two pools of genotypes obtained from the Xpert system, pool_1 (HPV 16, 18, 45) and pool_2 (HPV 16, 18, 45, 31, 33, 35, 52, 58)), VIA and cytology. RESULTS: 382 (18.2%) women were HPV-positive among which 11.5% (n=44) were CIN2+. Of those 44 participants, 41 were triaged positive by extended genotyping, versus 35 by VIA and 33 by cytology. Overall, triage positivity was of 68.4% for extended genotyping, 59.3% for VIA and 14.8% for cytology, with false positive rates of 83.4%, 84.1% and 37.7%, respectively. Extended genotyping had a higher sensitivity for CIN2+ detection (93.2%, CI: 81.3 to 98.6) than VIA (79.5%, CI: 64.7 to 90.2, p=0.034) and cytology (75.0%, CI: 59.7 to 86.8, p=0.005). No significant difference was observed in the overtreatment rate in triaged women by extended genotyping or VIA (9.9%, CI: 8.6 to 11.3, and 8.8%, CI: 7.7 to 10.1), with a ratio of 6.0 and 6.3 women treated per CIN2+ diagnosed. CONCLUSION: Triage of HPV-positive women with extended HPV genotyping improves CIN2+ detection compared with VIA with a minor loss of specificity and could be used to optimize the management of HPV-positive women. TRIAL REGISTRATION NUMBER: NCT03757299.

Response to the Regulation of Video Games under the Youth Media Protection Act: A Public Health Perspective.

The Swiss Youth and Media Act, which is about to enter into force, is an attempt to provide a legislative framework for video game use. Among other inclusions, the law intends to make providers more accountable by taking measures to protect minors from harm that can be caused by improper use of video games. However, it is a challenge to create a legal framework that can adequately regulate the evolving features of video games. Legislators must find a suitable regulatory approach which takes into account the fact that there is an increasing convergence between video games and gambling, particularly with the introduction of loot boxes. Moreover, there is a need for regulation, including the prohibition of misleading designs, the introduction of additional protection for minors, and the assurance of transparency of transactions. Appropriate policy legislation and consumer-protection measures are needed to protect people using these types of products, particularly children and adolescents. Further work should focus on assessing game characteristics to refine regulatory models to promote safe gaming. Based on experiences from the field of psychoactive substances as well as that of gambling, it is now a matter of developing a matrix of harm with elaborated categories: a tool that makes it possible to evaluate the potential harms of certain game design in an evidence-based manner.

Factors Influencing the Decision to Vaccinate against HPV amongst a Population of Female Health Students.

BACKGROUND: In Switzerland, HPV vaccination has been recommended since 2007 for all adolescent girls aged between 11 and 14 years. More than 10 years after the introduction of this recommendation, immunization coverage targets have not been met. Very few studies at a national level describe the reasons for the reluctance of some young women to become vaccinated. The aim of this study is to describe the socio-demographic characteristics of a population of vaccinated and unvaccinated female health students and then to compare the different factors that may have influenced their vaccine choice. METHOD: Female health students in the French-speaking part of Switzerland, aged between 18 and 31, were invited to participate in the study. A total of 234 female students completed a questionnaire that included questions about their socio-demographic data, sexual behavior and vaccination status. RESULTS: 69% of the participants received at least one dose of the vaccine. Women who had not yet had sex were less likely to be vaccinated than sexually active women (ORa: 0.1, 0.0-0.4, 95% CI), the same as those who did not express an opinion about the importance of vaccination (ORa: 0.1: 0.0-0.6, 95% CI). The main reasons given for refusing vaccination were fear of side effects (26.0%), parental opposition (24.6%) and reluctance of the attending physician (13.6%). CONCLUSIONS: The main results of this study highlight a good rate of vaccine coverage in the sample population. Reasons for nonvaccination demonstrate the need to provide information on the vaccine to the target audience, as well as to parents and health professionals.

Smartphone-Based Visual Inspection with Acetic Acid: An Innovative Tool to Improve Cervical Cancer Screening in Low-Resource Setting.

Visual inspection with acetic acid (VIA) is recommended by the World Health Organization for primary cervical cancer screening or triage of human papillomavirus-positive women living in low-resource settings. Nonetheless, traditional VIA with the naked-eye is associated with large variabilities in the detection of pre-cancer and with a lack of quality control. Digital-VIA (D-VIA), using high definition cameras, allows magnification and zooming on transformation zones and suspicious cervical regions, as well as simultaneously compare native and post-VIA images in real-time. We searched MEDLINE and LILACS between January 2015 and November 2021 for relevant studies conducted in low-resource settings using a smartphone device for D-VIA. The aim of this review was to provide an evaluation on available data for smartphone use in low-resource settings in the context of D-VIA-based cervical cancer screenings. The available results to date show that the quality of D-VIA images is satisfactory and enables CIN1/CIN2+ diagnosis, and that a smartphone is a promising tool for cervical cancer screening monitoring and for on- and off-site supervision, and training. The use of artificial intelligence algorithms could soon allow automated and accurate cervical lesion detection.

Agonist Treatment for Opioid Dependence Syndrome: The Impact of Current Understanding upon Recommendations for Policy Initiatives.

The provision of opioid agonist treatments (OATs), as a standard approach towards opioid dependence syndrome, differs widely between countries. In response to access disparities, in 2014, the Council of Europe's Pompidou Group first brought together an expert group on framework conditions for the treatment of opioid dependence. The group used a Delphi approach to structure their discussions and develop guiding principles for the modernisation of OAT regulations and legislation. The expert group identified some 60 guiding principles, which were then the subject of wide public consultation. Endorsed by Pompidou Group member states, the final report identified four key recommendations: (1) Prescription and delivery without prior authorisation schemes; (2) Effective removal of financial barriers to access to care; (3) Coordination and follow-up by a national consultative body; and (4) Neutral, precise and respectful terminology. During meetings, the expert group hypothesised that inequalities in OAT access are likely to be linked to underlying rationales which in theory are contradictory, but in practice co-exist within the different political frameworks. The present article considers the perceived influence upon different regulatory frameworks. Discussion is centred around the potential impact of underlying rationales upon the effective implementation of a modernised framework.

Teenage Mothers in Yaoundé, Cameroon-Risk Factors and Prevalence of Perinatal Depression Symptoms.

BACKGROUND: Perinatal depression is defined as a non-psychotic depressive episode occurring during pregnancy or during the first year following childbirth. This depressive disorder is highly prevalent among teenage women but there is a lack of data in low- and middle-income countries. The objective of this study was to provide baseline data on the sociodemographic characteristics of pregnant teenagers or teenage mothers in an urban zone in Yaoundé, Cameroon. Risk factors were assessed, and prevalence of depressive disorders was determined. METHODS: Women aged 20 years old or less in the perinatal period were invited to participate in the study. A total of 1344 women participated in the four-stage data collection process involving a questionnaire including questions on sociodemographic background, an assessment of their risk of perinatal depression using the EPDS questionnaire (Edinburgh Postnatal Depression Scale), a clinical interview based on the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), and a final section focusing on risk factors of perinatal depression. RESULTS: The EPDS score was obtained for 1307 women. The prevalence of depressive disorder symptoms among teenage or young pregnant women is estimated to be 70.0%. This risk is significantly increased by different factors including unintended or unplanned pregnancy (aOR: 1.33, 1.14-1.56 CI95%), being separated or single (aOR: 1.34, 1.12-1.60 CI95%), experiencing depression and anxiety before childbirth (aOR: 1.50, 1.02-2.27 CI95%), abortion experience (aOR: 2.60, 1.03-7.14 CI95%) and domestic violence (aOR: 1.76, 1.12-2.83 CI95%). CONCLUSION: The results of this study reveal a high prevalence of depressive disorder symptoms within the study population. These findings highlight the need to develop maternal care programs to support both mothers and their infants.

A New Swiss Federal Act on Gambling: From Missed Opportunities towards a Public Health Approach?

In January 2019, a new Swiss Federal Act on Gambling (Loi federal de jeux d'argent: LJAr) entered into force following a vote by the Swiss electorate. Intended to modernize and harmonize previous law and open the market for online casinos; the new regulations have highlighted the need for a comprehensive monitoring system. The present article outlines work undertaken by experts within the field to identify and elaborate the first steps towards developing such a monitoring system. This work includes the mapping of institutional actors and draft conceptualization of an impact model, including structural (i.e., prevention and intervention-based components), process (means), and outcomes (effect) indicators. Initial estimations of effective access to indicators and their perceived priority for data gathering are also described. Subsequent steps necessary for implementation of this public health approach for gambling are considered including grey areas for future action.

[Clinical experience of an offloading orthosis to prevent and heal diabetic foot ulcers of the digits]. / Expérience clinique d'une orthèse de décharge pour prévenir et guérir les ulcères digitaux du pied diabétique.

Globally, every 30 seconds a lower limb amputation is carried out due to diabetes, in 85 % of cases preceded by a foot ulcer. One of the main causes of foot ulcer formation is abnormal mechanical pressure and shear, the alleviation of which is therefore a key element in the management of diabetic foot ulcers. The toes, often neglected in routine clinical examinations, are particularly vulnerable because of the thin soft tissue between the bones and the skin and because of trauma due to ill-fitting shoes. The orthosis described in this article provides effective protection of protruding and injured areas while being comfortable to wear with everyday shoes and compatible with an active lifestyle. When correctly designed, worn and monitored, it has the potential to prevent and heal diabetic ulcers of the Hallux and the lesser toes.

Toutes les 30 secondes, une personne dans le monde subit une amputation du membre inférieur due au diabète, précédée dans 85 % des cas d'un ulcère au pied. L'allègement d'une pression mécanique néfaste est un élément clé dans la prise en charge du pied diabétique. Les orteils, souvent négligés dans l'examen clinique, sont particulièrement vulnérables en raison de la minceur des tissus mous entre les os et la peau et à cause des chaussures potentiellement nuisibles car inadaptées à la forme et au volume de l'avant-pied. L'orthèse de décharge décrite dans cet article assure une protection efficace des zones saillantes et lésées tout en étant confortable à porter et compatible avec une vie active. Conçue et portée correctement, elle a le potentiel de prévenir et guérir les ulcères digitaux du pied diabétique.