IntroductionThere has been growing recognition of potential differences in disease course and presentation between men and women with MS. This study examined sex differences in MS using data collected at study entry in the Swiss Multiple Sclerosis Cohort (SMSC).MethodsA cross-sectional analysis of the data from 1541 SMSC participants (June 2012–February 2022) with persons with relapsing-remitting MS or Clinically Isolated Syndrome (named relapsing type) and progressive MS including persons with Primary Progressive Multiple Sclerosis (PPMS) and Secondary Progressive Multiple Sclerosis (SPMS) was performed. Sociodemographic and clinical characteristics, disease history, and severity indicators were examined, focusing on sex differences within progressive and relapsing MS types, and comparing these MS types. Statistical analyses included Mann-Whitney U tests and chi-squared tests for group comparisons. Multivariate linear regression models were constructed to examine the independent association of sex with Expanded Disability Status Scale (EDSS) scores, adjusting for age, disease duration, treatment category, recent relapse, and body mass index (BMI).ResultsWomen represented 65.8% of the cohort (1,014/1,541). BMI was significantly lower in women than in men in the relapsing type and SPMS (relapsing: p < 0.001; SPMS: p = 0.001; PPMS: p = 0.86). Age at first symptoms differed by sex depending on MS type: women were younger in the relapsing group (29.7 vs. 31.4 years, p = 0.036), while men were younger in PPMS (42.3 vs. 47.7 years, p < 0.001), with no difference in SPMS (p = 0.5). In univariate analysis, men showed a trend toward higher disability levels at study entry in the relapsing type (p = 0.058), but no significant sex differences in EDSS were observed in progressive forms. In multivariate analysis, female sex showed a trend toward lower EDSS scores in relapsing MS after adjusting for clinical factors (β = −0.13, 95% CI: −0.26 to 0.005, p = 0.059) but was not associated with EDSS in PPMS (β = −0.09, p = 0.802) or SPMS (β = + 0.09, p = 0.816).ConclusionThis study identified sex differences in disease distribution, BMI and EDSS at their entry in the SMSC. These findings underscore the complexity of sex differences in MS and highlight the importance of prospective longitudinal studies with standardized severity assessments to clarify sex-specific disease trajectories and inform personalized treatment strategies.

OBJECTIVE:Prior research, mostly from North America, suggests improved clinical outcomes for female patients treated by female physicians. Whether these findings apply in European healthcare systems and how underlying processes of care vary by sex remains unclear. This study aimed to assess whether in-hospital outcomes and processes of care differ by patient sex, physician sex or their interaction, in a European setting. DESIGN:Retrospective cohort study. SETTING:General internal medicine division of a Swiss tertiary teaching hospital. PARTICIPANTS:Adult inpatients (≥18 years) hospitalised between 2014 and 2024 and their primarily responsible physicians, classified by administrative sex (male vs female). The cohort included 20 094 hospitalisations (44.6% female patients) and 216 physicians (48.1% female). OUTCOME MEASURES:Outcomes included in-hospital mortality, 30-day mortality and 30-day readmission, as well as processes of care (resource use, advance care planning and cardiovascular low-value care). Multilevel mixed-effects regression models adjusted for patient and physician characteristics. RESULTS:Female patients had lower in-hospital mortality (OR 0.72, 95% CI 0.59 to 0.89) and 30-day mortality (OR 0.75, 95% CI 0.65 to 0.87), lower hospitalisation costs (-4.26%, 95% CI -6.08% to -2.41%), fewer diagnostic and therapeutic procedures (-6.44%, 95% CI -9.76% to -3.01%), fewer blood tests (-8.95%, 95% CI -12.98% to -4.73%) and were less likely to have resuscitation orders (OR 0.64, 95% CI 0.58 to 0.71) or intensive care unit transfer orders (OR 0.64, 95% CI 0.55 to 0.73). They were, however, more likely to receive non-indicated antihypertensive treatment (OR 1.86, 95% CI 1.38 to 2.51). No significant differences were observed by physician sex or patient-physician sex interaction. CONCLUSIONS:In a European tertiary teaching hospital with universal healthcare coverage, in-hospital outcomes and processes of care did not differ by physician sex or patient-physician sex interaction. Nevertheless, disparities by patient sex persisted, underscoring the need for sex-disaggregated quality monitoring and sex-sensitive medical training.

Multiple operational definitions of obesity have been proposed. We compared obesity prevalence and incidence according to World Health Organization (WHO), National Institute of Health (NIH), and European Association for the Study of Obesity (EASO) using the baseline survey and subsequent follow-ups of a population-based cohort (CoLaus|PsyCoLaus), in Lausanne, Switzerland. Sample included adults aged 35 to 75 years (n = 6733 at baseline). Obesity was defined by WHO (body mass index [BMI]), NIH (BMI and waist circumference), and EASO (BMI/waist-to-height ratio plus obesity-related complications such as hypertension, type 2 diabetes, cardiovascular disease, or chronic kidney disease). The joint prevalence of overweight and obesity did not change, but there was a twofold increase in obesity prevalence between WHO and NIH/EASO (average obesity prevalence combining all follow-ups: 17.4%, 33.9% and 37.5%, respectively), at the expense of the overweight category (average prevalence of 38.7%, 22.2% and 18.6%, respectively), with a particularly marked shift at older ages: obesity prevalence in age group +75 years old for follow-up 2 was 19.2%, 48.9% and 55.9% for WHO, NIH and EASO, respectively. Regarding the incidence analysis (n = 2334, 34.7% of the baseline cohort), after a median follow-up of 14.5 years, the incidence of obesity among participants without obesity at baseline was 5.8% (WHO), 16.8% (NIH), and 20.6% (EASO). For EASO definition, final prevalence of obesity (20.6%) exceeded overweight (18.3%). We conclude that broader definitions, notably EASO, identify more individuals at potential risk but substantially expand the obesity category, with implications for case classification, clinical management, and resource allocation.

Gender bias in medicine influences the diagnosis, treatment, and care provided to patients. Rooted in a lack of awareness of sex- and gender-specific needs and in stereotypes, it distorts the interpretation of symptoms and clinical and therapeutic decision-making. While some gender-related differences in patient management may be clinically justified on the basis of health equity, others reflect unjustified inequalities. Using concrete examples, this article examines their effects on the medical practice of care, while highlighting the need for appropriate training for healthcare professionals.

OBJECTIVE:To examine associations between physician-patient sex dyads and the prevalence, treatment, and control of dyslipidaemia and hypertension in primary care. METHODS:We analysed two Swiss population-based studies using mixed-effects logistic models to compare dyslipidaemia and hypertension management across four physician-patient sex dyads (male physician-male patient, male physician-female patient, female physician-male patient, female physician-female patient). Age-stratified analyses (≥50, ≥60 years) examined whether dyad-outcome associations differed by patient age. RESULTS:Among 8,635 participants (54.9% females; mean age 63 years in CoLaus study and 48 years in Bus Santé study), females had lower prevalences of dyslipidaemia and hypertension than males across both study samples, irrespective of physician sex. For dyslipidaemia, in CoLaus, females had higher odds of lipid-lowering therapy yet lower odds of LDL-C control, regardless of physician sex; in Bus Santé, females managed by male physicians had lower odds of lipid control (adjusted OR 0.52, 95% CI 0.28-0.95) compared to male physician-male patient dyads. For hypertension, in CoLaus, female physician-female patient dyads had lower odds of antihypertensive treatment (adjusted OR 0.62, 95% CI 0.42-0.92) than male physician-male patient dyads; in Bus Santé, treatment and control did not differ significantly by dyad. Most differences were more pronounced in patients aged 60 years or older. CONCLUSION:In primary care, patterns of risk-factor management were associated with both patient and physician sex, with dyad-related differences that may reflect patient-sex patterns but differ in magnitude across regions and age groups.

Abstract Background Despite growing awareness of the importance of integrating gender knowledge into medical education, gender stereotypes persist and may influence patient assessment and management. This study investigates gender inequalities in clinical reasoning among medical students to identify areas for improvement in medical education. Methods The study was conducted at the University of Lausanne in Spring 2021, using the Objective Structured Clinical Examination (OSCE) to assess fifth-year medical students. Students were evenly assigned to interactions with either a male or female standardised patient (SP) presenting with unintentional weight loss. Evaluation covered history taking, physical examination, and clinical management. A total of 105 students (57.1% female, 42.9% male) were assessed. Results Results indicate potential gender bias at various stages of clinical reasoning, with patterns depending on the gender of both the SP and the student. During history-taking, female students were less likely to ask female SPs about alcohol consumption than male SPs (56.3% vs. 78.6%, p = 0.07). Regarding occupational history, a compelling trend was also observed among male students, who asked female SPs less often (30.4% vs. 59.1%, p = 0.05), whereas female students showed more consistent rates. Additional compelling trends emerged during physical examinations: male students performed cardiac auscultation less often on female SPs (56.5% vs. 86.4%, p = 0.02). Although diagnostic hypotheses and differential diagnoses were similar, female SPs were more often prescribed laboratory tests (63.6% vs. 26.0%, p < 0.001). Conclusions Gender bias permeates multiple stages of clinical reasoning among medical students, leading to under-recognition of key health risk factors, differences in examination thoroughness, and increased prescription of laboratory tests in female patients. Addressing gender bias through sustained integration of gender into core medical education is essential for diagnostic accuracy and high-quality patient care. Specifically, systematic inquiry into occupational and alcohol histories in female patients, improved cardiovascular auscultation, and enhanced communication with male patients are needed.

In this article, we present eight studies published in the last 2 years that are likely to influence the practice of general practitioners in 2026. The key messages highlight the effectiveness of metformin for knee pain treatment, recent advances in the management of poorly controlled asthma, and the absence of contraindications to administering influenza and Covid-19 vaccines simultaneously. In addition, several articles describe the association between sleep duration and hypertension, blood pressure measurement protocols, the effects of vitamin K2 on nocturnal leg cramps, and the effects of intermittent fasting on weight loss. Finally, the Thrombosis Risk Prediction in Patients with Cast Immobilization Score can be used to assess whether therapeutic anticoagulation is indicated in cases of lower-limb immobilization.

The COVID 19 pandemic may have influenced smoking behaviours, including decisions to quit smoking. This study aimed to investigate smoking cessation following the first two waves of the COVID-19 pandemic in Switzerland and to assess whether cessation differed according to participants' SARS-CoV-2-related experiences. Data from SérocoViD, a Swiss repeated cross-sectional study comprising five surveys in the canton of Vaud, was used. A total of 2454 participants aged 15 years and older from the first (May-July 2020) and third (February 2021) surveys were included. Association between SARS-CoV-2 infection experiences and cigarette smoking cessation were analyzed using logistic regression; both factors were unadjusted and adjusted for age and gender. Overall, 21.2% of participants reported being ex-smokers, but only a small proportion of the entire study population (i.e., including both smokers and non-smokers) reported quitting during the pandemic (0.5% in the first sample, 1.5% in the second). Participants who were smokers before the pandemic and had undergone diagnostic testing for SARS-CoV-2 showed a trend toward smoking cessation during the pandemic (non-adjusted odds ratio = 2.15; 95% confidence interval: 0.79-5.87). No such trends were found with a positive diagnostic test or serological result, or with COVID-19-like symptoms. These findings suggest that individuals seeking testing may be more health-conscious, potentially contributing to smoking cessation. For these individuals, the pandemic may represent a critical opportunity to promote smoking cessation, which should be leveraged by healthcare professionals and public health policies.

Backround: The aim is to analyze whether sex and gender are associated with missed acute ischemic stroke (M-AIS). Methods: We performed a nested case-control study, using data collected from March 2003 to December 2020 from ASTRAL (Acute STroke Registry and Analysis of Lausanne). M-AIS were compared with a randomly selected control sample of acute ischmemic stroke (AIS). We extracted six gender-related socioeconomic variables. A gendered socioeconomic position (SEP) score was constructed reflecting the level of correspondence with feminine characteristics. Associations between M-AIS and the gender-related socioeconomic variables and the gendered SEP score were investigated using logistic regression. Results: Of the 6007 AIS, 182 (3%) were M-AIS. 80 (44%) were women. No association between administrative sex and M-AIS was found (OR 1.25, 95% CI 0.78–2.00). Differences were found for gender-related socioeconomic variables, women in the middle professional category had higher odds of an M-AIS compared to women in the lower professional category (OR 3.93, 95% CI 1.19–13.03). Men with higher education had lower odds of an M-AIS compared to men with lower education (OR 0.31, 95% CI 0.10–0.92). For women, a 20-unit increase in the gendered SEP score was associated with lower odds of an M-AIS (OR 0.66, 95% CI 0.46–0.94). For men, the same increase in the score tended to higher the odds of an M-AIS (OR 1.52, 95% CI 1.00–2.32). Conclusions: The interaction of administrative sex with gender-related socioeconomic variables revealed different associations with M-AIS for women and men. Correspondence to expected gender norms may have a protective effect against M-AIS.

En médecine, les biais de genre influencent le diagnostic, le traitement et la prise en charge des personnes qui consultent. Fondés à la fois sur une méconnaissance des besoins spécifiques liés au sexe et au genre, ainsi que sur des stéréotypes, ils faussent l’interprétation des symptômes de même que les décisions cliniques et thérapeutiques. Si certaines différences de prise en charge liées au sexe peuvent être cliniquement justifiées, car elles relèvent de l’équité en santé, d’autres traduisent des inégalités injustifiées. À partir d’exemples concrets, cet article examine leurs effets sur la pratique médicale et sur la qualité des soins, et souligne l’importance d’une formation adaptée des personnes exerçant dans le domaine de la santé.

Pharmacoepidemiology should represent and benefit populations equitably, embracing diversity and equity, and ensuring fairness. This article describes equity and fairness in pharmacoepidemiology, depicts key diversity domains, and provides an operational framework and call for action to implement diversity and fairness in pharmacoepidemiologic research. To ensure fairness, studies should address diversity and inclusion while providing equal opportunities and benefits for everyone in the target population. To implement and evaluate fairness in pharmacoepidemiology, we defined the following diversity domains: biological sex, socially constructed gender, age, life stages (e.g., pregnancy, menopause), ethnicity, race, migration, nationality, socioeconomic status, education, health literacy, and health status and capabilities. These are determinants of health, either through biological pathways or through social norms, discrimination, and barriers to healthcare or research participation. They are interlinked, their impact is study- and context-specific, and due to their sensitive and evolving nature, they should be handled with caution. Implementing diversity domains enables researchers to assess the generalizability of findings, identify and address health inequities, account for determinants of health, and ensure the fairness of algorithms, implementations, and recommendations. To successfully implement diversity domains and ensure fair pharmacoepidemiologic research, we recommend researchers to follow the Explore, Tailor, Implement, and Evaluate (ETIE) framework: Explore the role/implication of the diversity domains in the study, tailor their definitions to the study context, implement them appropriately and evaluate the study findings in their context. Increased availability of diversity data is needed, and support from stakeholders is essential. This manuscript was endorsed by the International Society for Pharmacoepidemiology (ISPE).

Background The association between patient and physician gender and suicide risk assessment is understudied, despite known differences in suicidal behaviors among genders.Aims To estimate the association between physicians’ sociodemographics and their rating of suicide risk and the need for hospitalization in men and women.Method In an anonymous online survey, physicians rated the suicide risk and the need for hospitalization of two clinical vignettes (one male and one female patient) and answered sociodemographic questions. Generalized estimating equations were used to estimate the associations between the vignettes’ gender and physician’s characteristics with the ratings of suicide risk and hospitalization needs.Results Of the 473 physicians who answered the survey, 407 were eligible for the study. Independently of other socio-demographics, (i) male physicians rated suicide risk and hospitalization need lower than their female counterparts, (ii) scores for female and male patients didn’t differ, and (iii) physicians rated higher hospitalization need for same-gender patients.Limitations We used a binary categorization for gender, which does not account for non-binary and other gender identities.Conclusion Physician gender impacts evaluations of suicide risk and the need for hospitalization. Future studies should explore how physician gender affects clinical practice and inform gender-sensitive medical training.

In Switzerland, smoking has slightly declined in recent years, while the use of new nicotine products such as electronic cigarettes and snus is increasing, especially among young people. All these products cause addiction, with some being potentially less harmful than conventional cigarettes, which remain the most widely used product. Nicotine replacement therapy and bupropion are currently the only approved medications for smoking cessation in Switzerland. Since varenicline was withdrawn, cytisine-an older drug with a similar mechanism of action-has seen renewed interest. Recent studies confirm its effectiveness and acceptability.