Screening for tuberculosis in an urban shelter for homeless in Switzerland: a prospective study.

BACKGROUND: Whereas high risk groups such as asylum seekers are systematically screened for active tuberculosis (TB) upon entry in Switzerland, this strategy does not apply to homeless persons despite a reported high risk. Geneva health and social authorities implemented an intersectoral project to screen for active TB in homeless persons. We aimed to assess acceptability of this program and prevalence of active TB in this group. METHODS: This prospective study targeted all homeless adults registering for shelter accommodation in Geneva during winter 2015. Applicants were proposed a questionnaire-based screening ( www.tb-screen.ch ) exploring epidemiological and clinical risk factors for active TB. Participants with a positive score underwent diagnostic procedures at Geneva University Hospital. Enhanced TB surveillance targeting homeless persons in the community was continued 3 months after the study termination. RESULTS: Overall, 726/832 (87.3%) homeless persons accepted the screening procedure. Most were young male migrants without access to care in Switzerland. Male gender (adjusted OR: 2.14; 95% confidence interval: 1.27-3.62), age below 25 years (aOR: 4.16; 95% CI: 1.27-13.64) and short duration of homelessness (aOR: 1.75; 95% CI: 1.06-2.87) were predictors of acceptance. Thirty (4.1%) had positive screening scores but none of the 24 who underwent further testing had active TB. Post-study surveillance did not identify any incident case in Geneva. CONCLUSIONS: Active TB screening targeting highly mobile homeless persons in shelters was well accepted and feasible. The participants' sociodemographic profile highlighted the heterogeneity of homeless groups in Europe and the null TB prevalence the variability of their active TB risks. These findings underline the feasibility of health programs targeting this hard to reach group and the need for close monitoring of this social group considering the rapid changes in international mobility patterns to tailor preventive and screening strategies to the local context.

[Health and healthcare of homeless persons]. / Santé et soins des personnes sans abri.

Homelessness is a complex issue linked to poverty and structural conditions. It is increasing in Western countries with younger people and multiple generations being affected. Hard and unstable living conditions and inappropriate access to care predispose people to increase morbidity with poor health outcomes. This article reviews recent evidence about homeless health and strategies to improve health outcomes while harnessing societal benefits.

Le défaut de logement stable est fortement lié à la pauvreté et à des causes structurelles. Les sans-abri constituent une population croissante dans les pays occidentaux, diverse dans son degré de précarité et d'accès au logement, de plus en plus jeune et multigénérationnelle. Leur santé est fortement influencée par les conditions de vie précaires et leur accès aux soins souvent mal adaptés aux besoins. Cet article passe en revue les données épidémiologiques et cliniques récentes et présente des stratégies innovantes de prise en charge globale susceptibles d'apporter des bénéfices à l'échelle de l'individu, du système de santé et de la société.

Relapse of Tropheryma whipplei endocarditis treated by trimethoprim/sulfamethoxazole, cured by hydroxychloroquine plus doxycycline.

The best treatment for Tropheryma whipplei infections is controversial. We report a patient who suffered from T. whipplei aortic native valve endocarditis that relapsed despite surgery and four weeks of intravenous ceftriaxone followed by several months of oral trimethoprim/sulfamethoxazole. Cure was achieved after replacement of the prosthesis with a homograft and 18 months of oral doxycycline-hydroxychloroquine. We discuss the need for a change in treatment guidelines for T. whipplei infections.

[Medical certification for high altitude travel and scuba diving]. / Certificats médicaux pour les séjours en haute montagne et la plongée sous-marine.

People are more and more looking for adventures and discovery of unusual locations. Journeys to high altitude and scuba diving are part of these activities and their access has become easier for a lot of people not necessarily experienced with their dangers. The general practitioner will have to be able to deliver some advices and recommendations to his patients about the risks related to these activities and their ability to practice them. He will also have to deliver some certificates of medical fitness to dive. This paper proposes a brief review of the most important medical aspects to know about high altitude and scuba diving.