IntroductionVaccine hesitancy is a complex public health issue referring to concerns about the safety, efficacy or need for vaccination. Relatively little is known about vaccine hesitancy in Switzerland. This ongoing study (2017–2021) focuses on biomedical and complementary and alternative medicine (CAM) providers and their patients since healthcare professionals play important roles in vaccination decision-making. This national research programme seeks to assess the sociocultural determinants of vaccine hesitancy regarding childhood and human papillomavirus vaccines in Switzerland. We aim to provide a detailed characterisation of vaccine hesitancy, including CAM and biomedical perspectives, patient–provider interactions, and sociocultural factors, to establish the mediating effects of vaccine hesitancy on underimmunisation, and to design an intervention to improve vaccination communication and counselling among physicians, parents and adolescents.Methods and analysisOur transdisciplinary team employs a sequential exploratory mixed-methods study design. We have established a network of more than 150 medical providers across Switzerland, including more than 40 CAM practitioners. For the qualitative component, we conduct interviews with parents, youth, and biomedical and CAM providers and observations of vaccination consultations and school vaccination information sessions. For the quantitative component, a sample of 1350 parents of young children and 722 young adults (15–26 years) and their medical providers respond to questionnaires. We measure vaccine hesitancy with the Parent Attitudes about Childhood Vaccines 15-item survey and review vaccination certificates to assess vaccination status. We administer additional questions based on findings from qualitative research, addressing communication with medical providers, vaccine information sources and perceptions of risk control vis-à-vis vaccine-preventable diseases. The questionnaires capture sociodemographics, political views, religion and spirituality, and moral foundations.Ethics and disseminationThe study was approved by the local ethics committee. The results will be published in peer-reviewed journals and disseminated to healthcare professionals, researchers and the public via conferences and public presentations.
Prayer marks are asymptomatic callosities resulting from repeated, extended pressure, and friction exerted on bony prominences when praying on hard ground.A 41-year-old woman with ulcerative colitis treated with infliximab was referred to our clinic due to skin changes on her feet that were suspected to be drug eruptions.The patient presented several asymptomatic, hyperpigmented, and hyperkeratotic plaques over the lateral malleoli suggesting that the lesions had a mechanical cause.Further exploration revealed that the patient, a practicing Muslim, prays in a sitting position called "Julus" several times a day. After color marking, the lesions over the lateral feet left a precise imprint on the underlay when the patient was asked to imitate the praying posture-thus proving the origin of the skin lesions. We searched the database on July 31, 2019 using the terms «prayer marks» OR «prayer nodules» OR "prayer callosities." Only electronically available publications were reviewed. Recognition of prayer marks is important to avoid misdiagnosis, performance of unnecessary diagnostic procedures, and to enhance the intercultural competence of clinicians who practice in multicultural societies.
K E Y W O R D Scomorbidities, Muslim, prayer marks, religious
La mononucléose infectieuse aiguë est un problème fréquent en médecine de ville. Dans 90% des cas, la mononucléose est due au virus Epstein-Barr (EBV) -pour de nombreux médecins, «EBV» et «mononucléose» sont synonymes. Le diagnostic n'est pas toujours facile, et certaines personnes atteintes ne présentent pas d'autres symptômes que la fatigue. La rupture de la rate est une complication redoutée mais rare. La fatigue prolongée, le diagnostic différentiel avec -rarement -une maladie grave dont le lymphome sont autant de défis à surmonter.
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