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Pronounced changes in patterns of health take place in adolescence and young adulthood, but the effects on mortality patterns worldwide have not been reported. We analysed worldwide rates and patterns of mortality between early adolescence and young adulthood. We obtained data from the 2004 Global Burden of Disease Study, and used all-cause mortality estimates developed for the 2006 World Health Report, with adjustments for revisions in death from HIV/AIDS and from war and natural disasters. Data for cause of death were derived from national vital registration when available; for other countries we used sample registration data, verbal autopsy, and disease surveillance data to model causes of death. Worldwide rates and patterns of mortality were investigated by WHO region, income status, and cause in age-groups of 10–14 years, 15–19 years, and 20–24 years. 2·6 million deaths occurred in people aged 10–24 years in 2004. 2·56 million (97%) of these deaths were in low-income and middle-income countries, and almost two thirds (1·67 million) were in sub-Saharan Africa and southeast Asia. Pronounced rises in mortality rates were recorded from early adolescence (10–14 years) to young adulthood (20–24 years), but reasons varied by region and sex. Maternal conditions were a leading cause of female deaths at 15%. HIV/AIDS and tuberculosis contributed to 11% of deaths. Traffic accidents were the largest cause and accounted for 14% of male and 5% of female deaths. Other prominent causes included violence (12% of male deaths) and suicide (6% of all deaths). Present global priorities for adolescent health policy, which focus on HIV/AIDS and maternal mortality, are an important but insufficient response to prevent mortality in an age-group in which more than two in five deaths are due to intentional and unintentional injuries. WHO and National Health and Medical Research Council.

ABSTRACT BACKGROUND Increasing the attractiveness of primary care careers is a key step in addressing the growing shortage of primary care physicians. The purpose of this review was to (1) identify interventions aimed at increasing the proportion of undergraduate medical students choosing a primary care specialty, (2) describe the characteristics of these interventions, (3) assess the quality of the studies, and (4) compare the findings to those of a previous literature review within a global context. METHODS We searched MEDLINE, EMBASE, ERIC, CINAHL, PsycINFO, The Cochrane Library, and Dissertations & Theses A&I for articles published between 1993 and February 20, 2015. We included quantitative and qualitative studies reporting on primary care specialty choice outcomes of interventions in the undergraduate medical curriculum, without geographic restrictions. Data extracted included study characteristics, intervention details, and relevant outcomes. Studies were assessed for quality and strength of findings using a five-point scale. RESULTS The review included 72 articles reporting on 66 different interventions. Longitudinal programs were the only intervention consistently associated with an increased proportion of students choosing primary care. Successful interventions were characterized by diverse teaching formats, student selection, and good-quality teaching. Study quality had not improved since recommendations were published in 1995. Many studies used cross-sectional designs and non-validated surveys, did not include control groups, and were not based on a theory or conceptual framework. DISCUSSION Our review supports the value of longitudinal, multifaceted, primary care programs to increase the proportion of students choosing primary care specialties. Isolated modules or clerkships did not appear to be effective. Our results are in line with the conclusions from previous reviews and add an international perspective, but the evidence is limited by the overall low methodological quality of the included studies. Future research should use more rigorous evaluation methods and include long-term outcomes.

Identifying essential competencies in end-of-life care, as well as general practitioners' (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain. To determine which competencies in end-of-life care are considered important by GPs, to assess GPs' confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist. Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014. Survey development was informed by a previous qualitative exploration of relevant end-of-life GP competencies. Main outcome measures were GPs' assessment of the importance of and confidence in 18 attributes of end-of-life care competencies, and reasons for transferring care of terminally-ill patients to a specialist. GP characteristics associated with main outcome measures were tested using multivariate regression models. The response rate was 31%. Ninety-nine percent of GPs considered the recognition and treatment of pain as important, 86% felt confident about it. Few GPs felt confident in cultural (16%), spiritual (38%) and legal end-of-life competencies such as responding to patients seeking assisted suicide (35%) although more than half of the respondents regarded these competencies as important. Most frequent reasons to refer terminally ill patients to a specialist were lack of time (30%), better training of specialists (23%) and end-of-life care being incompatible with other duties (19%). In multiple regression analyses, confidence in end-of-life care was positively associated with GPs' age, practice size, home visits and palliative training. GPs considered non-somatic competencies (such as spiritual, cultural, ethical and legal aspects) nearly as important as pain and symptom control. Yet, few GPs felt confident in these non-somatic competencies. These findings should inform training and quality improvement efforts in this domain, in particular for younger, less experienced GPs.

To assess and compare the self-perceived Health Related Quality of Life (HRQoL) of multimorbid patients and the general population using health utilities (HU) and visual analogue scale (VAS) methods. We analyzed data (n = 888) from a national, cross-sectional Swiss study of multimorbid patients recruited in primary care settings. Self-perceived HRQoL was assessed using the EQ-5D-3L instrument, composed of 1) a questionnaire on the five dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression (EQ-5D dimensions), and 2) a 0-100 (0 = worst- and 100 = best-imaginable health status) VAS. We described the EQ-5D dimensions and VAS and computed HU using a standard pan-European value set. HU and VAS are the two components of the overall HRQoL assessment. We examined the proportions of multimorbid patients reporting problems (moderate/severe) in each EQ-5D dimension, corresponding proportions without problems, and mean HU and VAS values across patient characteristics. To test differences between subgroups, we used chi-square tests for dichotomous outcomes and T-tests (ANOVA if more than two groups) for continuous outcomes. Finally, we compared observed and predicted HU and VAS values. All 888 participants answered every EQ-5D item. Mean (SD) HU and VAS values were 0.70 (0.18) and 63.2 (19.2), respectively. HU and VAS were considerably and significantly lower in multimorbid patients than in the general population and were also lower in multimorbid patients below 60 years old and in women. Differences between observed and predicted means (SD) were -0.07 (0.18) for HU and -11.8 (20.3) for VAS. Self-perceived HRQoL is considerably and significantly affected by multimorbidity. More attention should be given to developing interventions that improve the HRQoL of multimorbid patients, particularly women and those aged below 60 years old.

For developmental as well as epidemiological reasons, young people need youth-friendly models of primary care. Over the past two decades, much has been written about barriers faced by young people in accessing health care. Worldwide, initiatives are emerging that attempt to remove these barriers and help reach young people with the health services they need. In this paper, we present key models of youth-friendly health provision and review the evidence for the effect of such models on young people's health. Unfortunately, little evidence is available, since many of these initiatives have not been appropriately assessed. Appropriate controlled assessments of the effect of youth-friendly health-service models on young people's health outcomes should be the focus of future research agendas. Enough is known to recommend that a priority for the future is to ensure that each country, state, and locality has a policy and support to encourage provision of innovative and well assessed youth-friendly services.

Clinical placements significantly impact medical students' career choices. Primary care physicians supervising these placements can influence students' career decisions through role modelling and by creating supportive learning environments. This qualitative study aimed to identify factors contributing to role modelling and students' sense of integration during placements and their influence on career decisions, with a focus on primary care. Semi-structured interviews were conducted with postgraduate trainees selected based on interest in primary care, exploring their experiences during undergraduate clinical placements and factors influencing career choices. Data were thematically analysed to identify key themes related to student integration, well-being, and supervisor role modelling. Analysis revealed four key domains where primary care physicians can positively influence students' career interest: onboarding students effectively, fostering positive and inclusive team dynamics, involving students in patient care, and providing high-quality supervision and feedback. Students reported that feeling valued and socially included contributed to their well-being and professional self-efficacy, which in turn impacted their career choices. Supportive and inclusive learning environments during placements are critical to fostering students' professional growth. While relevant across clinical settings, this study's findings hold particular significance for primary care due to the challenge of balancing clinical and practice management duties and teaching. Implementing structured onboarding, team integration, and effective supervision can enhance students' experiences and promote interest in primary care. Future research should extend these findings beyond primary care. The proposed roadmap could both spark interest in primary care and promote future collaboration between primary and secondary care.

Background Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late. The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life. Methods Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues. 3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis. Results Eight PCPs were trained. Patient recruitment was a challenge for PCPs who feared to impose additional loads on their patients. PCPs became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life. Conclusions While the intervention was acceptable to PCPs, recruitment was a challenge and a follow up trial was not deemed feasible using the current design but PCPs reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life. Trial registration The ethics committee of the canton of Geneva approved the study (2018–00077 Pilot Study) in accordance with the Declaration of Helsinki.

The early identification of patients suffering from SARS-CoV-2 infection in primary care is of outmost importance in the current pandemic. The objective of this study was to describe the clinical characteristics of primary care patients who tested positive for SARS-CoV-2. We conducted a cross-sectional study between March 24 and May 7, 2020, involving consecutive patients undergoing RT-PCR testing in two community-based laboratories in Lyon (France) for a suspicion of COVID-19. We examined the association between symptoms and a positive test using univariable and multivariable logistic regression, adjusted for clustering within laboratories, and calculated the diagnostic performance of these symptoms. Of the 1561 patients tested, 1543 patients (99%) agreed to participate. Among them, 253 were positive for SARS-CoV-2 (16%). The three most frequently reported ‘ear-nose-throat’ and non-‘ear-nose-throat’ symptoms in patients who tested positive were dry throat (42%), loss of smell (36%) and loss of taste (31%), respectively fever (58%), cough (52%) and headache (45%). In multivariable analyses, loss of taste (OR 3.8 [95% CI 3.3–4.4], p-value < 0.001), loss of smell (OR 3.0 [95% CI 1.9–4.8], p < 0.001), muscle pain (OR 1.6 [95% CI 1.2–2.0], p = 0.001) and dry nose (OR 1.3 [95% CI 1.1–1.6], p = 0.01) were significantly associated with a positive result. In contrast, sore throat (OR 0.6 [95% CI 0.4–0.8], p = 0.003), stuffy nose (OR 0.6 [95% CI 0.6–0.7], p < 0.001), diarrhea (OR 0.6 [95% CI 0.5–0.6], p < 0.001) and dyspnea (OR 0.5 [95% CI 0.3–0.7], p < 0.001) were inversely associated with a positive test. The combination of loss of taste or smell had the highest diagnostic performance (OR 6.7 [95% CI 5.9–7.5], sensitivity 44.7% [95% CI 38.4–51.0], specificity 90.8% [95% CI 89.1–92.3]). No other combination of symptoms had a higher performance. Our data could contribute to the triage and early identification of new clusters of cases.

IntroductionUnaccompanied asylum-seeking minors (UASMs) represent a population group with complex healthcare needs. Initial and ongoing healthcare is challenging for host countries but considered essential. This publication describes the protocol concerning a large cohort of UASMs settled in Switzerland in 2015–2016. Our aim is to assess their health status and examine their trajectories of healthcare services utilisation during the 3-year period after their initial health control.Methods and analysisWe will retrospectively analyse data of all newly arrived UASMs aged 12–18 years who benefited from a first health assessment at the Youth Clinic of Geneva University Hospitals between 1 January 2015 and 31 December 2016. Source of data will be electronic medical records. Main outcomes include the determination of their health status (acute and chronic conditions) and the utilisation of different care sectors (ambulatory primary care and subspecialty clinics, emergency room and inpatient wards). A secondary outcome will be the identification of patients at risk for high use of services as well as those with limited access to care. We will extract the following data: demographic characteristics (age, gender and country of origin), social determinants (place of residence, the presence of family in Geneva, school performance and asylum status), clinical information (reason for attending service, anthropometric measurements and medical diagnosis at discharge) and laboratory parameters (complete blood count, ferritin level, 25-hydroxyvitamin D level, hepatitis B antigen and antibodies, tetanus antibodies, QuantiFERON and stool and serology tests for intestinal parasites). We will collect data from first health assessment and during a follow-up period of 3 years for each patient.Ethics and disseminationIn accordance with the Swiss clinical research law, this protocol has been approved by the local ethics committee (project ID: 2021–01260). Our findings will provide important information for the development of quality healthcare services focusing to UASMs. We intend to disseminate our results through publication in peer-reviewed journals.