Search

Objective Psychiatric impact of COVID-19 is still explored and previous data suggest potential risks of anxiety, depression and PTSD related to COVID-19. We aimed to explore the predictive value of risk factors during hospitalization (T0) for COVID-19 for anxiety, depression and PTSD and at three months (T1) because they could differ over these two time points. Methods We performed a screening of mental suffering in hospitalized patients for COVID-19, as well as specialized care and three months longitudinal follow-up. We evaluated at T0 and at T1 the prevalence of anxiety, depression and PTSD in survivors who benefited from early detection and treatment, and assessed possible risk factors in adults surviving COVID-19 between the 30th March and the 1st of July 2020. Results 109 patients were screened at T0 and 61 of these were reassessed at T1. At T0, we found 44.9% pathological score on peritraumatic dissociation experiences questionnaire (PDEQ), 85.4% of post-traumatic stress disorder symptoms (PTSS), 14.6% of pathological rate of post-traumatic stress disorder scale 5 (PCL5) and at T1, 86.9% of PTSS, 10.6% of pathological rate of PCL5. Finally, PDEQ score at T0 during hospitalization was positively correlated to PCL-5 score at T1 (β = 0.26, p = 0.01) and that was confirmed in multivariate analysis (β = 0.04, p = 0.02 for the log of PCL-5 per point on the PDEQ). Conclusion Screening of psychiatric symptoms during hospitalization for COVID-19 should be systematic, especially peritraumatic dissociation to offer an early treatment and prevent PTSD, which seemed frequent for hospitalized patients for COVID-19 at three months.

Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors.The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative.From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date.At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history.SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

Neuropsychological deficits and brain damage following SARS-CoV-2 infection are not well understood. 110 patients, with either severe, moderate or mild disease in the acute phase underwent neuropsychological and olfactory tests, as well as completed psychiatric and respiratory questionnaires at 223 ± 42 days post-infection. Additionally, a subgroup of 50 patients underwent functional magnetic resonance imaging. Patients in the severe group displayed poorer verbal episodic memory performances, and moderate patients had reduced mental flexibility. Neuroimaging revealed patterns of hypo and hyper functional connectivity in severe patients, while only hyperconnectivity patterns were observed for moderate. The default mode, somatosensory, dorsal attention and cerebellar networks were implicated. Partial least squares correlations analysis confirmed specific association between memory performances and brain functional connectivity. The severity of the infection in the acute phase is a predictor of neuropsychological post-COVID syndrome. SARS-CoV-2 infection causes long-term memory and executive dysfunctions, related to largescale functional brain connectivity alterations.

Our selection of articles published in 2021 sheds light on topics related to risk, and to the use of electronic tools in primary care medicine. They cover blood pressure targets, telemonitoring, and the omega-3 fatty acid diet in the elderly and/or in patients with high cardiovascular risk. They present the role of primary care physicians in the management of patients with NAFLD, and in screening for domestic violence in all couples. They assess the risk of recurrence of a depressive episode after stopping antidepressant treatment. Finally, they discuss the place of apps to communicate with foreign-speaking patients and of vaping in smoking cessation.Notre sélection d’articles parus en 2021 propose un éclairage sur des sujets en lien avec le risque chez nos patient·e·s et l’usage d’outils électroniques. Ils abordent le thème des cibles tensionnelles, du télémonitoring, et du régime riche en acides gras oméga 3 chez la personne âgée et/ou à haut risque cardiovasculaire. Ils présentent le rôle des médecins de premier recours dans la prise en charge de patient·e·s avec une stéatopathie métabolique, et dans le dépistage des violences conjugales dans tous les couples. Ils évaluent les risques de récidive d’épisode dépressif à l’arrêt d’un traitement antidépresseur. Enfin, ils discutent la place des applications pour la communication avec les patient·e·s allophones et du vapotage dans l’arrêt du tabac.

Lack of awareness of cognitive impairment (i.e. anosognosia) could be a key factor for distinguishing between neuropsychological post-COVID-19 condition phenotypes. In this context, the 2-fold aim of the present study was to (i) establish the prevalence of anosognosia for memory impairment, according to the severity of the infection in the acute phase and (ii) determine whether anosognosic patients with post-COVID syndrome have a different cognitive and psychiatric profile from nosognosic patients, with associated differences in brain functional connectivity. A battery of neuropsychological, psychiatric, olfactory, dyspnoea, fatigue and quality-of-life tests was administered 227.07 ± 42.69 days post-SARS-CoV-2 infection to 102 patients (mean age: 56.35 years, 65 men, no history of neurological, psychiatric, neuro-oncological or neurodevelopmental disorder prior to infection) who had experienced either a mild (not hospitalized; n = 45), moderate (conventional hospitalization; n = 34) or severe (hospitalization with intensive care unit stay and mechanical ventilation; n = 23) presentation in the acute phase. Patients were first divided into two groups according to the presence or absence of anosognosia for memory deficits (26 anosognosic patients and 76 nosognosic patients). Of these, 49 patients underwent an MRI. Structural images were visually analysed, and statistical intergroup analyses were then performed on behavioural and functional connectivity measures. Only 15.6% of patients who presented mild disease displayed anosognosia for memory dysfunction, compared with 32.4% of patients with moderate presentation and 34.8% of patients with severe disease. Compared with nosognosic patients, those with anosognosia for memory dysfunction performed significantly more poorly on objective cognitive and olfactory measures. By contrast, they gave significantly more positive subjective assessments of their quality of life, psychiatric status and fatigue. Interestingly, the proportion of patients exhibiting a lack of consciousness of olfactory deficits was significantly higher in the anosognosic group. Functional connectivity analyses revealed a significant decrease in connectivity, in the anosognosic group as compared with the nosognosic group, within and between the following networks: the left default mode, the bilateral somatosensory motor, the right executive control, the right salient ventral attention and the bilateral dorsal attention networks, as well as the right Lobules IV and V of the cerebellum. Lack of awareness of cognitive disorders and, to a broader extent, impairment of the self-monitoring brain system, may be a key factor for distinguishing between the clinical phenotypes of post-COVID syndrome with neuropsychological deficits.

PurposeThe Actionable Register of Geneva Outpatients and inpatients with SARS-CoV-2 (ARGOS) is an ongoing prospective cohort created by the Geneva Directorate of Health. It consists of an operational database compiling all SARS-CoV-2 test results recorded in the Geneva area since late February 2020. This article aims at presenting this comprehensive cohort, in light of some of the varying public health measures in Geneva, Switzerland, since March 2020.ParticipantsAs of 1 June 2021, the database included 360 525 patients, among which 65 475 had at least one positive test result for SARS-CoV-2. Among all positive patients, 37.6% were contacted only once, 10.6% had one follow-up call, 8.5% had two and 27.7% had three or more follow-up calls. Participation rate among positive patients is 94%. Data collection is ongoing.Findings to dateARGOS data illustrates the magnitude of COVID-19 pandemic in Geneva, Switzerland, and details a variety of population factors and outcomes. The content of the cohort includes demographic data, comorbidities and risk factors for poor clinical outcome, self-reported COVID-19 symptoms, environmental and socioeconomic factors, prospective and retrospective contact tracing data, travel quarantine data and deaths. The registry has already been used in several publications focusing on symptoms and long COVID-19, infection fatality rate and re-infection.Future plansThe data of this large real-world registry provides a valuable resource for various types of research, such as clinical research, epidemiological research or policy assessment as it illustrates the impact of public health policies and overall disease burden of COVID-19.

The outpatient management of patients who are victims of harassment can be a challenge for primary care physicians. Focusing on the psychosocial environment in which the events develop can help to highlight the conditions that allow the phenomenon to exist and to detect people who could be of valuable help to the victim. The aim of this article is to provide a more comprehensive view of the phenomenon of harassment, emphasizing the role played by the context and the social group, in order to give caregivers additional tools for the support and treatment of victims.La prise en charge ambulatoire des patientes et des patients victimes de harcèlement peut mettre en difficulté les médecins de premier recours. S’intéresser à l’environnement psychosocial dans lequel les événements se développent peut aider à la mise en évidence des conditions qui permettent l’existence du phénomène et à la détection des personnes qui pourraient apporter une aide précieuse à la victime. L’objectif de cet article est d’apporter une vision plus globale du phénomène du harcèlement, en mettant l’accent sur le rôle joué par le contexte et le groupe social, afin de donner aux soignant·e·s des outils supplémentaires pour l’accompagnement et le traitement d’un patient ou d’une patiente qui en est victime.

PurposeThe Actionable Register of Geneva Out- and inpatients with SARS-CoV-2 (ARGOS) is an ongoing prospective cohort created by the Geneva Directorate of Health (GDH). It consists of an operational database compiling all SARS-CoV-2 test results conducted in the Geneva area since late February 2020. This article aims at presenting this comprehensive cohort, in light of some of the varying public health measures in Geneva, Switzerland, since March 2020.ParticipantsAs of June 1st, 2021, the database included 356’868 patients, among which 65’475 had at least one positive test result for SARS-CoV-2. Among all positive patients, 37.6% were contacted only once, 10.6 % had one follow-up call, 8.5% had two, and 27.7% had 3 or more follow-up calls. Participation rate among positive patients is 94%. Data collection is ongoing.Findings to dateARGOS data illustrates the magnitude of COVID-19 pandemic in Geneva, Switzerland, and details a variety of population factors and outcomes. The content of the cohort includes demographic data, comorbidities and risk factors for poor clinical outcome, self-reported COVID-19 symptoms, environmental and socio-economic factors, prospective and retrospective contact tracing data, travel quarantine data, and deaths. The registry has already been used in several publications focusing on symptoms and long COVID, infection fatality rate, and re-infection.Future plansThe data of this large real-world registry provides a valuable resource for various types of research, such as clinical research, epidemiological research or policy assessment as it illustrates the impact of public health policies and overall disease burden of COVID-19.STRENGTHS AND LIMITATIONS OF THIS STUDYARGOS’ main strength consists of its large number of cases, representative of all diagnosed cases on a regional level with the primary aim of assessing all cases.ARGOS involves every individual who performed a SARS-CoV-2 test (PCR or antigenic) and is not limited to hospitalized patients, thus providing a valuable resource to assess the overall disease burden of COVID-19 in a geographically defined population.To mitigate confounding effects and improve data analysis and interpretation, we present the data according to four policy periods.This cohort is multicentric as it includes all tests performed in Geneva’s hospitals (both public and private), private practices and medical centers.Due to operational needs, symptoms and comorbidities are self-reported, which may lead to measurement error or misclassification.

BackgroundThere is growing awareness that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can include long-term neuropsychological deficits, even in its mild or moderate respiratory forms.MethodsStandardized neuropsychological, psychiatric, neurological and olfactory tests were administered to 45 patients (categorized according to the severity of their respiratory symptoms during the acute phase) 236.51 ± 22.54 days post-discharge following SARS-CoV-2 infection.ResultsDeficits were found in all the domains of cognition and the prevalence of psychiatric symptoms was also high in the three groups. The severe performed more poorly on long-term episodic memory and exhibited greater anosognosia. The moderate had poorer emotion recognition, which was positively correlated with persistent olfactory dysfunction. The mild were more stressed, anxious and depressed.ConclusionThe data support the hypothesis that the virus targets the central nervous system (and notably the limbic system), and support the notion of different neuropsychological phenotypes.

Integrative medicine proposes a coordinated approach to conventional medicine and complementary treatments. This approach is of particular interest in the field of prevention and in comprehensive primary care. This article presents some key studies published in 2020, which highlight the potential benefits of an integrative approach in primary care medicine.La médecine intégrative permet de coordonner médecine conventionnelle et traitements complémentaires. Cette approche est particulièrement intéressante dans le domaine de la prévention et dans la prise en charge globale en médecine de premier recours. Cet article présente quelques études clés, publiées en 2020, qui mettent en lumière les bénéfices potentiels d’une approche intégrative en médecine de premier recours.

La médecine intégrative permet de coordonner médecine con­ventionnelle et traitements complémentaires. Cette approche est particulièrement intéressante dans le domaine de la préven­tion et dans la prise en charge globale en médecine de premier recours. Cet article présente quelques études clés, publiées en 2020, qui mettent en lumière les bénéfices potentiels d'une approche intégrative en médecine de premier recours.

Assisted teleconsultation, one of the components of telemedicine, is a form of medical practice set to further develop in the coming years. Interprofessional relationships are being adapted, and the triad patient-care provider-physician is experiencing new challenges. In this article we focus on the competencies and skills required and suggest some clinical practice guidelines for this new form of medical practice based on the pilot phase of our project.La téléconsultation assistée, une des composantes de la télémédecine, est un type de pratique médicale amené à se développer dans les prochaines années. Dans cette nouvelle forme de relation interprofessionnelle, la triade patient-soignant-médecin connaît de nouveaux enjeux. À travers cet article, nous nous intéressons aux compétences requises pour cette nouvelle pratique et tentons de proposer quelques bonnes pratiques à partir de notre expérience pilote.

During the COVID-19 crisis, telemedicine was at the center of the health management systems in the canton of Geneva. Telemedicine contributed to the triage and follow-up of patients with a suspected or confirmed diagnosis of COVID-19, as well as to the coordination of different healthcare actors in the patient's trajectory. New partnerships and reinforcement of coordination in the Geneva healthcare and social care networks with an unprecedented use of telemedicine tools were able to ensure patient care while preserving frontline healthcare providers. Telemedicine has benefited during this time from a temporary relaxation of measures and regulations governing its practice, encouraging its deployment in a crisis situation. However, for these tools to be effective, they need to become an integral part of our healthcare systems.Durant la crise

General internal medicine is particularly concerned by the shift from stationary to ambulatory care, a shift that unfortunately is more often discussed from an economic perspective than from the angle of evidence. This article presents the results of studies and reviews published in 2019 that investigated the effectiveness of ambulatory instead of stationary care.La médecine interne générale est particulièrement concernée par le virage ambulatoire, virage malheureusement plus souvent discuté sous l’angle économique que sous l’angle des évidences. Cet article présente les résultats d’études et de revues publiées en 2019 et ayant investigué l’efficacité de prises en charge ambulatoires en complément ou en remplacement de prises en charge stationnaires.

Suite à la résurgence mondiale de la rougeole en 2018–2019, l'OMS a déclaré en 2019 la vaccino-hésitation comme l'une des 10 premières menaces de la santé dans le monde. La métacognition, science cognitive qui étudie la pensée humaine, peut aider les professionnels de santé à mieux comprendre et appréhender l'hésitation des ­patients. Nous proposons une démarche de communication avec les patients vaccino-hésitants basée sur les techniques de l'entretien motivationnel. Cette approche relationnelle centrée sur le patient comprend plusieurs étapes: explorer son avis et ses connaissances sur les vaccins tout en faisant preuve d'empathie, développer chez lui des divergences et susciter un discours de changement, lui donner de l'information tout en évitant la confrontation et enfin cultiver le sentiment d'efficacité personnelle.

The potential of information and communication technologies has quickly been identified for health and in particular to promote weight loss. Several types of technologies exist with varying degrees of efficiency. These include programs on the Internet, using text messages, smartphone applications or portable devices. All these technologies are based on a set of weight loss strategies known to be effective, such as self-monitoring, feedback and social support. Despite promising results, several important limitations must be addressed such as the quality of the information being disseminated, the risk of promoting eating disorders, the place of these tools in patient follow-up, as well as data confidentiality issues.Le potentiel des technologies de l’information et de la communication a rapidement été identifié dans le domaine de la santé et en particulier dans la promotion de la perte de poids. Des programmes sur internet, l’utilisation de SMS, des applications sur smartphone ou encore des appareils portables connectés existent, avec des degrés variables d’efficacité. Toutes ces technologies reposent sur un ensemble de stratégies connues pour faciliter la perte de poids telles que l’autosurveillance, le feedback et le soutien social. Malgré des résultats prometteurs, plusieurs questions se posent, sur le plan de la fiabilité de ces outils, la qualité des messages diffusés, le risque de favoriser des troubles du comportement alimentaire, la place de ces outils dans le suivi ou encore les problèmes de confidentialité des données.

Traditionally, the doctor has focused his efforts on mastering medical knowledge. Given the challenges facing him, the medical institutions and the society, it becomes clear that his concern must also be about how this medical knowledge hits the patients and the general population. Knowing how to deliver our care is now as important as having the medical knowledge ! In this article, we present new models of healthcare delivery that we implemented or plan to implement in Geneva, Switzerland.Traditionnellement, le médecin a concentré ses efforts sur la maîtrise de la connaissance médicale. Face aux enjeux qui se présentent à lui, aux institutions et à la société, il devient évident que sa préoccupation doit également se porter sur la façon dont cette connaissance médicale atteint les patients et la population en général. Savoir délivrer nos soins est désormais aussi important que d’avoir les connaissances médicales ! Dans cet article, nous présentons des nouveaux modèles de soins de santé que nous avons mis en œuvre ou prévoyons de mettre en œuvre à Genève, en Suisse.

Background Literature provides mixed results regarding the influence of large-scale sporting events on emergency department attendance. To contribute to the research on the subject, we sought to evaluate whether the broadcasting of major tennis tournaments, one of the most popular sports in Switzerland, has an impact on patient admission rates in emergency units in Geneva including 1) type of match 2) the role of a Swiss player, 3) degree of triage, 4) reason of attendance and 5) age of patients. Methods Admission rates between periods with tennis matches regarding the semi-finals and finals of 3 major tennis tournaments were compared to equivalent periods without matches from May 2013 to August 2017. Patient admission data was retrieved retrospectively from administrative databases of two Outpatient Emergency Units in Geneva. Patients’ admission rates in periods with and without a tennis match were investigated using a negative binomial regression model with mixed effects. Results We observed a statistically significant decrease (− 10%, 95% CI -17 to − 2, p = 0.015) in admission rates in periods with a tennis match compared to periods without a tennis match, more pronounced during finals (− 15%, 95% CI -26 to − 3, p = 0.017) than during semi-finals (− 7%, − 16 to 2, p = 0.13). In addition, this effect was more pronounced in patients aged between 26 to 64 years of age, a category representing professionnally active people. No modification in the admission rates was detected in the hours preceding and following the matches, nor in type of consultations (traumatology vs non traumatology related admissions). Conclusion Although modest, the results support the hypothesis that the broadcasting of large-scale sporting events such as tennis matches decreases admission rates in emergency units. Further research is required to explore for a potential causal relationship. Electronic supplementary material The online version of this article (10.1186/s12873-018-0209-y) contains supplementary material, which is available to authorized users.

Ideally, our clinical practices and decisions should be based on evidence derived from randomized clinical trials. Yet, we often have to determine the potential side effects (including interactions) of drugs that we prescribed using other level of evidence; clinical trials being obviously not appropriate for such situations. Results from observational studies published in 2016 should be of interest to primary care physicians. In this review, we present six of them. Once the limitations of these non-interventional studies acknowledged, primary care physicians should consider these results and be particularly attentive when prescribing these drugs.Dans l’idéal, nos pratiques et décisions sont guidées sur la base d’évidences issues d’études cliniques randomisées. Cependant, nous devons fréquemment juger des possibles effets indésirables (y inclus interactions) des médicaments que nous prescrivons sur la base d’autres types d’informations, les essais cliniques n’étant pour des raisons évidentes pas réalisables. Les résultats de plusieurs études observationnelles publiées en 2016 dans ce domaine devraient attirer notre attention. Nous présentons ici six d’entre elles. Une fois les limites inhérentes à ce type d’étude considérées, ces résultats nous invitent à être particulièrement vigilants lors de nos prescriptions.

Introduction:Therapeutic patient education (TPE) is a patient-centered approach that requires proper training of healthcare professionals. This study aims to explore representative situations encountered by physicians in their practice where TPE training was useful, which can provide insights for the conception of TPE training programs.Methods:A qualitative approach with both focus groups (FG) and individual interviews with physicians trained in TPE in activity at the Geneva University Hospitals (GUH) was carried out. The data was analyzed using inductive thematic analysis.Results:Two FG of 9 doctors were conducted. Six representative situations emerged from our analysis: non-compliance, maintaining a comprehensive vision for overall care of the patient, the partner patient, matching the patient request to the underlying need, co-constructing the therapeutic action plan, and confronting powerlessness.Discussion:Training in TPE allowed physicians to develop skills to better identify and address these situations. It also favored a change in the posture of the physician, from a posture of teaching and expertise to one of co-construction and learning.Conclusion:These situations show how much the care of complex patients is present in the medical practice and TPE training a valuable skill to deal with this complexity. TPE training targeted at these activities could have a positive impact on the practice of physicians and patient care.

Monica Varcher,1 Sofia Zisimopoulou,1 Olivia Braillard,1 Bernard Favrat,2 Noëlle Junod Perron1 1Department of Community, Primary and Emergency Care, Division of Primary Care, Geneva University Hospitals, Geneva, 2Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland Background: Iron deficiency is a common problem in primary care and is usually treated with oral iron substitution. With the recent simplification of intravenous (IV) iron administration (ferric carboxymaltose) and its approval in many countries for iron deficiency, physicians may be inclined to overutilize it as a first-line substitution.Objective: The aim of this study was to evaluate iron deficiency management and substitution practices in an academic primary care division 5 years after ferric carboxymaltose was approved for treatment of iron deficiency in Switzerland.Methods: All patients treated for iron deficiency during March and April 2012 at the Geneva University Division of Primary Care were identified. Their medical files were analyzed for information, including initial ferritin value, reasons for the investigation of iron levels, suspected etiology, type of treatment initiated, and clinical and biological follow-up. Findings were assessed using an algorithm for iron deficiency management based on a literature review.Results: Out of 1,671 patients, 93 were treated for iron deficiency. Median patients’ age was 40 years and 92.5% (n=86) were female. The average ferritin value was 17.2 μg/L (standard deviation 13.3 μg/L). The reasons for the investigation of iron levels were documented in 82% and the suspected etiology for iron deficiency was reported in 67%. Seventy percent of the patients received oral treatment, 14% IV treatment, and 16% both. The reasons for IV treatment as first- and second-line treatment were reported in 57% and 95%, respectively. Clinical and biological follow-up was planned in less than two-thirds of the cases.Conclusion: There was no clear overutilization of IV iron substitution. However, several steps of the iron deficiency management were not optimally documented, suggesting shortcuts in clinical reasoning. Keywords: iron deficiency, iron substitution, general practice, quality of care, cross-sectional design

Chronic non cancerous pain considerably limits the patients' quality of life. Yet, chronic non cancerous pain has a prevalence as high as 25% to 35%, Therapeutic education allows to work on the knowledge and know-how about the disease, the treatment, the management of health resources and health behaviors. E-learning uses new technologies of communication to improve the quality of learning by facilitating access to the resources and favoring the interactivity. It is attractive by its wide accessibility and its limited logistic needs. The level of proof of its efficacy is weak, mainly because of methodological limitations. Some good quality studies are promising, with a positive effect of e-learning programs on pain intensity, disability, autonomy and medication misuse.

This article provides an overview of 10 important articles published in year 2013 in the field of ambulatory general internal medicine. The newest guidelines about glaucoma screening are detailed. In the midst of the lung cancer screening controversy, an article summarizes new guidelines for the management of solitary pulmonary nodules. Cohort studies are detailed, which have shown association between high calcium intake and cardiovascular mortality, grade 2 or 3 obesity and mortality, aspirin use and lower melanoma incidence, and a reduction of the prevalence of dementia in last 20 years. Finally, 2 publications clarify the optimal length of corticoid treatment for COPD exacerbations and the most appropriate treatment regimen for Helicobacter Pylori eradication.