This study aimed to systematically identify, synthesize, and evaluate measurement properties of patient-reported outcome measures (PROMs) of eHL in adult populations. A systematic review was conducted, considering studies reporting the development or validation of eHL instruments for adult populations. Four databases and grey literature were searched from January 2000 to 2024, with additional website searches up to 2022. Quality assessment, data analysis and synthesis followed the COSMIN methodology and findings were reported according to PRISMA 2020 guidelines. The GRADE framework was used to assess evidence quality. A total of 8558 citations were identified. Seven instruments, 89 articles and 3 reports were included in this review. The HL19-DIGI, DHLI, TeHLI, eHLQ, eHLA, and Lisane demonstrated sufficient ratings for aspects of content validity, albeit with varying levels of evidence, ranging from very low to high. Five instruments showed sufficient ratings for structural validity and internal consistency, but evidence on their reliability was insufficient. No information on responsiveness was mentioned in articles. The HL19-DIGI, DHLI, eHEALS, and eHLQ were the most frequently investigated instruments. This review identified 17 eHL instruments, of which seven demonstrated adequate content validity. However, insufficient evidence exists regarding psychometric properties for widespread implementation. It is strongly recommended that the content of these instruments be updated to reflect patients’ evolving use of eHealth services, and that further psychometrics evaluations be conducted systematically. PROSPERO CRD42021232765.

BACKGROUND:Frailty is a major public health concern in aging populations. Socioeconomic disadvantage increases the risk of frailty, yet the mechanisms underlying this association remain unclear. OBJECTIVES:To examine the mediating role of chronic diseases in the longitudinal association between socioeconomic disadvantage and frailty. DESIGN:Population-based cohort study. SETTING:Lausanne, Switzerland. PARTICIPANTS:4731 community-dwelling adults aged 65-70 years at recruitment (2004, 2010, and 2014), followed for up to 16 years, as part of the Lausanne Cohort 65+. INTERVENTION:None. MEASUREMENTS:Socioeconomic disadvantage was assessed using indicators of education, occupation, income, health insurance subsidy, and financial strain. Frailty was measured using the Fried phenotype (unintentional weight loss, exhaustion, low physical activity, weakness, and slow walking speed). Chronic conditions (obesity, diabetes, hypertension, cardiovascular and respiratory disease, and multimorbidity [≥2 conditions]) were assessed at baseline using standardized self-reported physician diagnoses. Counterfactual mediation using Cox proportional hazards models estimated the proportion of the socioeconomic disadvantage-frailty association mediated by each condition. RESULTS:Socioeconomic disadvantage was associated with a 1.5-2.5-fold higher risk of incident frailty. Obesity mediated 13-55% of this association, diabetes 11-22%, and multimorbidity 21-39%, whereas hypertension, cardiovascular, and respiratory disease showed minimal or no mediation. CONCLUSIONS:Chronic diseases-particularly obesity and diabetes-partly explain the long-term impact of socioeconomic disadvantage on frailty, underscoring stark inequities in healthy aging. Early detection and management of these conditions in socioeconomically vulnerable older adults, alongside population-level prevention and efforts to address adverse socioeconomic conditions as root causes, could help reduce these inequalities.

Objectives:Migrants and refugees face a high burden of infections caused by multidrug-resistant bacteria but frequently encounter structural barriers to healthcare and appropriate antibiotic treatment. This multicountry study applied a structured Delphi process to develop a standardized survey that systematically assesses healthcare access and barriers to appropriate antibiotic use among migrant and refugee populations in Europe. Methods:A multicountry Delphi consensus study was conducted with two different panels of experts including 64 experts from 12 European countries, from academia, clinical practice, nongovernmental organization, and migrant communities, to design and validate a survey on healthcare access and antibiotic use. Content validity was assessed using Item- and Scale-level Content Validity Indices (I-CVI and S-CVI/Ave) and the interquartile range. The finalized questionnaire was pilot-tested among 183 migrants, evaluating internal consistency (Cronbach's α; KR-20), temporal stability (intraclass correlation coefficient), inter-rater reliability (κ), and construct validity via exploratory factor analysis. Results:Fifteen of 16 experts (94%) completed both Delphi rounds. The S-CVI/Ave improved from 0.94 to 0.95, and the mean interquartile range decreased from 0.38 to 0.02, indicating strengthened content validity and consensus. External validation confirmed excellent agreement (S-CVI/Ave = 0.96). Psychometric testing demonstrated good reliability (Cronbach's α = 0.82-0.91; KR-20 = 0.79), substantial inter-rater agreement (κ = 0.72), and robust construct validity (KMO = 0.84; Bartlett's test p <0.001). Conclusions:The AdMiRE questionnaire is a reliable and methodologically robust tool for assessing healthcare access and antibiotic use among migrants and refugees in Europe. This validated instrument provides a standardized framework for generating comparable data to inform policies, strengthen antimicrobial stewardship, and promote equitable access to care across migrants.

INTRODUCTION:Lesbian, gay, bisexual, transgender or non-binary and intersex (LGBTI) populations experience persistent health inequities, including poorer mental and physical health outcomes and higher unmet healthcare needs compared with non-LGBTI populations. These inequities are partly attributable to insufficient training of primary care physicians (PCPs) in LGBTI health. However, evidence on effective and scalable training interventions for PCPs remains limited, particularly outside North America. This study evaluates the effectiveness of a self-directed e-learning programme-Improving Care and Access for Rainbow Equity (I-CARE)-designed to improve PCPs' knowledge, attitudes, skills and behaviours related to LGBTI health. METHODS AND ANALYSIS:We will conduct a type I effectiveness-implementation hybrid, two-arm, parallel-group, superiority randomised controlled trial among PCPs practising in French-speaking Switzerland. Eligible physicians will be randomly assigned (1:1) to either the I-CARE programme (intervention) or an e-learning programme on motivational interviewing (control) matched for format and duration. Outcomes will be measured at baseline, immediately postintervention and at the 3-month follow-up. The primary outcomes are knowledge and attitudes towards LGBTI patients assessed at the postintervention time point using validated scales. Superiority will be declared if the intervention group is statistically significantly superior to the control group on at least one primary outcome and statistically significantly inferior on neither primary outcome. Secondary outcomes include skills, self-reported behaviours and the presence of LGBTI-inclusive environmental cues. Effectiveness will be analysed using generalised estimating equations. Implementation outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. ETHICS AND DISSEMINATION:Participants will provide electronic informed consent. All study data will be managed and stored on secure servers hosted by the Lausanne University Hospital (CHUV). All information will be handled in strict accordance with the Swiss Federal Act on Data Protection. The project was approved by the Central Ethics Commission of the University of Lausanne on 7 July 2025 (C_Services centraux_052025_00018). Study findings will be disseminated through peer-reviewed scientific publications and lay summaries intended for the public, Swiss PCPs and LGBTI communities. TRIAL REGISTRATION NUMBER:ISRCTN93781961 (11 March 2026, updated 14 July 2026).

BACKGROUND:The mental health of medical students has been widely discussed, with studies reporting a high prevalence of mental health issues, including depression, anxiety, suicidal ideation and burnout. Yet, few have explored the relationship between material, social and health deprivation and these outcomes in medical students, despite the higher risk of psychological disorders when exposed to precarious living conditions. OBJECTIVE:Our study aimed to explore longitudinal associations between experiencing deprivation and mental health outcomes among Swiss medical students while adjusting for protective factors. DESIGN:Data were collected from hour-long online surveys at two time points (November-December 2022 and November-December 2023) of an open cohort study of medical students from the University of Lausanne, Switzerland (UNIL). Data were analysed using hierarchical multiple regression models. SETTING:This study was carried out by Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois (CHUV)) and the Centre for Primary Care and Public Health, UNIL. PARTICIPANTS:Our sample included medical students enrolled in any year of medical school studies, excluding those enrolled as part of an exchange programme. At time points T3 and T4, there were, respectively, 1941 and 1267 eligible students for participation; the final sample consisted of 631 medical students having participated at both time points (67.5% female, mean age 22.11). PRIMARY OUTCOME MEASURES:Deprivation was evaluated with the Deprivation in Primary Care Questionnaire (DIPCare-Q) index. Mental health variables included depression symptoms, anxiety symptoms, suicidal ideations and burnout symptoms (emotional exhaustion, cynicism, academic efficacy). Protective factors included coping skills (emotion-focused, problem-focused and help-seeking) and social support (practical and emotional support). RESULTS:In our final regression model, controlling for demographics (ie, age, gender, year of study and mother tongue), protective factors and baseline mental health scores, a higher overall baseline deprivation index was predictive of increased depression (β=0.14, p<0.001) and anxiety (β=0.06, p=0.046) symptoms over time, but not for suicidal ideation or burnout symptoms. CONCLUSION:Results demonstrated a significant association between deprivation and mental health longitudinally. Findings suggested that social support was protective from an increase in suicidal ideations over time. The implementation of interventions that provide material and social support may help promote improved mental health and health equity among medical students.

Background and objectives : Longitudinal evidence on mental health among refugee families across migration policy contexts remains limited. This exploratory longitudinal study describes probable psychiatric disorder prevalence, mental health-related quality of life (MHQoL), and family functioning among Syrian forced migrant families in Switzerland, comparing trajectories between families admitted through the Swiss Resettlement Program (SRP) and those entering through the standard asylum process (non-SRP). Methods: The study followed 115 participants from 34 Syrian families between 2019 and 2023. Participants completed repeated assessments of probable psychiatric disorders and MHQoL, including the SF-12 Mental Component Summary (SF-12 MCS). Family function-ing was assessed with the Family Assessment Device. Hierarchical linear models were used as secondary exploratory analyses to examine changes over time by migration pathway and family role while accounting for repeated observations within families. Results: Adults showed a higher prevalence of probable psychiatric disorders than children. Hierarchical linear models suggested that MHQoL trajectories differed by migration pathway over time, although these findings were attenuated in sensitivity analyses. Family functioning was not independently associated with MHQoL trajectories after adjustment. Mothers consistently reported lower SF-12 MCS scores than children across all adjusted models and sensitivity analyses, whereas fathers also reported lower scores, although to a lesser extent. Conclusion: Mental health patterns among Syrian forced migrant families were dynamic and heterogeneous. Differences in MHQoL trajectories by migration pathway and consistently lower MHQoL among mothers highlight the need for sustained, culturally responsive family-centered support. Larger longitudinal studies are needed to confirm these findings and clarify underlying mechanisms.

The specific health issues faced by lesbian, bisexual, pansexual, and queer (LBPQ) individuals remain poorly understood, and these individuals are often marginalized in healthcare settings. A lack of training among healthcare professionals, the persistence of heteronormative and cisnormative standards, and an absence of specific data often contribute to inadequate care. This is particularly true regarding sexual and mental health, the identification and management of violence and discrimination, as well as appropriate preventive recommendations. Recognizing these issues can enable professionals to promote inclusive, respectful, and equitable care practices.

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.

Social and environmental determinants of health (SEDH) strongly influence health outcomes, morbidity, and access to care. Considering them represents a key challenge in family medicine, but teaching them remains complex. This article presents a reflection on the teaching of SEDH at the Faculty of Biology and Medicine of the University of Lausanne, particularly in the context of family medicine. Through various educational approaches combining contextualized clinical vignettes and team-based learning, students are encouraged to analyze situations illustrating the impact of life trajectories, socioeconomic vulnerability, and environmental factors on care pathways. These teaching strategies promote critical thinking, relational skill development, and SEDH integration into clinical reasoning.

ObjectivesIncarcerated people carry many health problems. While prisons provide structured healthcare and meals, micronutrient status remains unclear. We assessed plasma zinc, selenium, and copper status in incarcerated men in Vaud (French-speaking canton in Switzerland) and explored prevention-relevant patterns.MethodsCross-sectional study (May-September 2023) of incarcerated men in three prisons. Participants (n = 206) completed a health-related questionnaire and provided venous blood. Plasma trace elements were measured by inductively coupled-plasma-mass spectrometry. Associations with individual characteristics were examined and differences between-prisons were assessed. Micronutrient concentrations were compared with community-men, adjusting for age and body mass index.ResultsPrevalence of men with micronutrient plasma level below the normal range did not differ between incarcerated and community men. Adjusted means showed modestly lower selenium and higher zinc and copper in men experiencing incarceration. Within prisons, lower selenium was associated with older age, lower pre-incarceration income, and smoking. Zinc was lower with age and in one facility.ConclusionOverall micronutrient status was reassuring, yet the heterogeneity, possibly reflecting individual vulnerabilities and institutional conditions, supports continued, facility-aware monitoring to identify at-risk groups and protect health.

In this article, we present eight studies published in the past two years that are likely to influence general practice in 2025. The key messages highlight the importance of physical activity in reducing cardiovascular risk, the effectiveness of aripiprazole for treatment-resistant depression, and the positive impact of guidelines on antibiotic use for acute cystitis. Furthermore, teleconsultation is more effective when supported by a pre-existing therapeutic relationship, extended leave reduces physician burnout, electronic cigarettes aid smoking cessation, and AI improves the management of electronic communications. Finally, community screening enhances the management of undiagnosed respiratory conditions.