When nightclub security agents assault clients

In 2006, a medico-legal consultation service devoted to adult victims of interpersonal violence was set up at the Lausanne University Hospital Centre, Switzerland: the Violence Medical Unit. Most patients are referred to the consultation by the Emergency Department. They are received by forensic nurses for support, forensic examination (in order to establish medical report) and community orientation. Between 2007 and 2009, among community violence, aggressions by security agents of nightclubs on clients have increased from 6% to 10%. Most of the victims are young men who had drunk alcohol before the assault. 25.7% presented one or several fractures, all of them in the head area. These findings raise questions about the ability of security agents of nightclubs to deal adequately with obviously risky situations and ensure client security.

A satisfaction survey conducted on patients of a medico-legal consultation

In 2006, a medico-legal consultation service devoted to adult victims of interpersonal violence was set up at the Lausanne University Hospital Centre, Switzerland: the Violence Medical Unit. Patients are received by forensic nurses for support, forensic examination (in order to establish medical report) and community orientation. In 2008, a telephone survey was conducted on patients. The objectives of the survey were to estimate the degree of patients' satisfaction and to document the use of the medical report by six questions. Among the 476 patients admitted to the VMU in 2007, 132 were interviewed. Their overall satisfaction was high with an average mark of 8.7/10. The medical report was used extensively by the interviewed victims (81%) for its primary function - to be produced as evidence. As the consultations are financed by public funds, these results were of interest for advocacy of long-lasting financial support.

[Community immersion in Lausanne: a different approach to teaching public health?]

Teaching community medicine represents a significant challenge for medical schools, which tend to struggle to promote interest in the issue among students. In 2009, the Lausanne medical school introduced a "community immersion" module specifically designed to address the issue. The new module requires students working in small groups under the supervision of a tutor to investigate a health question of their choice. The investigation involves conducting interviews with stakeholders (health professionals, patients, politicians, etc.), carrying out a survey, and presenting the results of the investigation in a "congress". An external evaluation showed that the objectives of the initiative had been largely achieved, with an increase of interest in community medicine for over 50% of students (based on a total cohort of 150 students) and a high level of satisfaction for over 90% of students and tutors. This paper presents the results of the initiative and its use for promoting community-oriented medicine.

[Partner violence: women trust health professionals]

In 2008, the department of gynaecology and obstetrics of a university hospital centre implemented a program addressing interpersonal partner violence (screening, prevention and care of the patient victims). A qualitative survey was conducted to identify the needs and feelings of patients. The results show that patients are in favour of being actively and directly questioned about violence during the consultation and that they trust medical doctors and nurses to help and support them.

Characteristics of victims of violence admitted to a specialized medico-legal unit in Switzerland

To improve care and services to victims of interpersonal violence, a medico-legal consultation unit was set up at the Lausanne University Hospital, Switzerland in 2006. Adult victims of violence are referred to the consultation by the emergency department. Patients are received by forensic nurses for support, forensic examination and community orientation. A descriptive study of medical reports filled for the 2006 population was conducted in 2007 with the aim to explore characteristics of this specific population and to better orient prevention. Among the 422 patients in 2006, 57% were men and 43% women, with a median age of 31 years old. Violent episodes took place in a public place for 90% of male victims and at home for 70% of female victims. The perpetrators were mostly unknown to male victims (62% of all men victims) and mostly known (usually the partner or a former partner) to female victims (90% of all women victims). For 80% of the women and 47% of the men, the violent event which brought them to the consultation, was not the first one. Because 90% of all patients under study were victimized by men., not only is it necessary to target prevention program to match the potential victims, prevention messages must also focus on potential offenders, especially on young men.

["Bientraitance": conceptual exploration and an example of its application in public health. An experience from Fribourg, Switzerland]

Since the year 2000, the concept of "bientraitance" (for which no equivalent term has yet emerged in either the English or German language) has gained widespread credence among educators, sociologists and health professionals in France and Belgium. This concept emphasizes a constructive approach to care and education rather than merely one of prevention of disasters. Applied in public health, and in particular to mental health promotion, the use of the concept of "bientraitance" can help promote both effectiveness and meaning in the design and planning of community interventions. The article presents an example of an intervention for children and adolescents in Fribourg, Switzerland. The underpinning hypothesis is that the children and youth groups (such as sports clubs, artistic and cultural associations, scouts and guides) represent largely untapped, or under-tapped, informal health resources with a favourable cost-effectiveness profile. "Bientraitance" criteria are used in selecting certain associations offering structured extracurricular group educational activities and collective out-of-school (or after school) programmes. Support is provided to the organisations selected for recruiting new members, in particular those with potentially lower levels of access, for example disabled children or new migrants. The results will be evaluated for the impact of participation in various out-of-school activities on health and health determinants from a prospective and comparative perspective. This paper shows how the concept of "bientraitance" can be useful in the development of a public health intervention.

Research involving biological material from forensic autopsies: legal and ethical issues

Recommendations and laws do not always contain specific and clear provisions on the use of cadaveric material in research, and even more rarely do they address explicitly the ethical issues related to research on material obtained during forensic autopsy. In this article we analyse existing legal frameworks in Europe by comparing the legal provisions in 2 European Countries which are member states of the Council of Europe, the UK and Switzerland. They were chosen because they have distinct legal frameworks that make comparisons interesting. In addition, the detailed laws of the UK and a specific law project and national ethical recommendations in Switzerland permit us to define more clearly the legal range of options for researchers using cadaveric material obtained during forensic investigations. The Human Tissue Act 2004 in England, Wales and Northern Ireland, its Scottish equivalent with the same title (2006) and the national ethical guidelines in Switzerland all require consent from the deceased person, an appropriate relative or a person with power of attorney for healthcare decisions before cadaveric biological material can be obtained and used for research. However, if the purpose of the autopsy is purely forensic, no such authorization will be sought to carry out the autopsy and related analyses, which might include genetic testing. In order to be allowed to carry out future research projects, families need to be approached for informed consent, unless the deceased person had left written directives including permission to use his or her tissues for research.

[Prevalence of violence reported by patients consulting an emergency service]

Violence and their consequences on health is increasingly part of the daily activities of health professionals. A large proportion of victims of violence do use emergency services according to the literature. Those services are often the first contact in the health care system for victims of violence. This potential opportunity to follow the victims, make necessary to improve the quality of the screening, thus because persons concerned by violence will not easily reveal their past or current history of violence. This delicate problem leads often to under diagnosis. This paper presents the research protocol developed to assess the prevalence of violence in an emergency unit in a University hospital. We obtained a high participation rate of 77% and a high proportion of violence (11.40%) confirming the public health importance of this health problem.

[Local resources in management of adult victims of violence and abuse: a method of presentation and diffusion]

Always more health problems require integrated care. So professionals needs to be aware of local and regional network resources (social, legal, home care, etc.) and specific offers of each individual institution. This article present a method used for creating a register of institutions involved in adults violence and elder abuse, for health professionals. Dates collected by interviewing professionals permitted to class institutions by intervention domain and offer. Five utility indicators (POUCE method) were selected for the register. A score has been attributed to each institution according to their problematic-related offers. Professional in charge of each institution validated information. This map, available in paper or CDrom, affords general practitioneer a quick and targeted access to a large number of dates, according to patient needs. This method could be useful for other health problems requiring exhaustive and targeted information about local and regional community resources (alcoholism, addiction, palliatives care, etc.)

[Training of field professionals in Switzerland health prevention projects]

Following various difficulties during prevention programs, an interdisciplinary training course in project management was set up for professionals working in the field. Sessions devoted to theoretical aspects alternated with workshops aimed at problem-solving strategies. The intention of the course was to equip the participants with relevant operational tools. The twenty-seven participants came from twelve different professional backgrounds. Fourty-two hours of training were given over a period of nine months. Two physicians specialized in public health accompanied the course throughout, seven invited speakers joined the group for occasional sessions. The evaluation was positive for the teaching methods used and the variety of subjects covered. The analysis of practical experiences has proved to be a powerful learning tool and a vehicle for interdisciplinary exchanges. The course has highlighted the isolation of the professionals in the field, the absence of common points of reference and the resulting difficulties in communication and collaboration. This experience has clearly shown the need for a well-defined standard model in project management and for intensive training of the professionals in the field.

[Data on the community health education of social workers at the Ecole d'études sociales et pédagogiques]

Social workers may be an essential link between health professionals and patients. Their possibilities of action in health education and prevention could be used more systematically. From this viewpoint, the various functions they carry out are an absolute advantage. They are confronted with countless relevant matters of social and preventive medicine and often resort to "original" intervention models. This article presents a programme of training in social and preventive health developed in the Social and Educational School of Lausanne for future social workers and health promoters. The critical analysis of this programme shows the numerous difficulties which are linked to this training, but also the necessity of such a training for the social workers who are more and more involved in interventions where health problems are in the front rank.