Olivier Duperrex

Introduction: Depression is common among people receiving haemodialysis and is associated with adverse outcomes, but the biological pathways underlying this relationship remain uncertain. We examined associations between depressive symptoms, mortality, immune–metabolic markers and stress-related transcriptional profiles, including potential sex differences in routine biomarkers. Methods: We studied 297 adults receiving maintenance haemodialysis across North and East London and Essex. Moderate/severe depressive symptoms were defined as a 17-item Hamilton Depression Rating Scale score >18. Cox regression examined all-cause mortality from enrolment until death or administrative censoring on 24 March 2026. Linear regression assessed associations between depressive-symptom severity and routinely measured immune–metabolic markers, overall and by sex. In a laboratory subset, inflammatory proteins and transcriptional profiles were examined overall only. Results: Moderate/severe depressive symptoms were associated with higher mortality in the adjusted model, although the association was attenuated after full adjustment (hazard ratio, 1.49; 95% confidence interval, 1.00–2.23; P=0.052). Higher white-cell count was associated with greater depressive-symptom severity before, but not after, adjustment for body mass index. Diastolic blood pressure was the only routine marker showing evidence that its association with depressive symptoms differed by sex (interaction P=0.022). Exploratory analyses did not provide convincing evidence that the measured biomarkers accounted for the depression–mortality association. In the laboratory subset, no inflammatory protein or transcriptional measure was significantly associated with depressive symptoms in fully adjusted analyses. Conclusion: Depression may identify a clinically relevant risk state among people receiving haemodialysis. The exploratory biological findings require validation in larger, prospectively sampled cohorts.

Background: The French-speaking Society for Smoking Cessation ( Société francophone de tabacologie , SFT), which promotes scientific knowledge and training on smoking cessation, asked us to identify and quantify consensual agreements among its members on the use of e-cigarette for smoking cessation. Methods: We used the fast-track Delphi process, starting with a modified version of the Nominal Group Technique where experts generated propositions to answer the target question: “What is the place and usefulness of vaping in the clinical care of people who smoke?”, followed by two Delphi surveys (e-questionnaires), in which they expressed their opinion on each statement (9-point Likert-scale) and commented. Consensual agreement is reached on a statement with a median ≥ 7 on the 1–9 Likert-scale (agreement) and an interquartile range (IQR) ≤ 3 scale points (consensus). Results: Over 40 days in autumn 2023, 87/163 (53%) experts reached consensual agreement on 26/33 (79%) statements, notably on the main outcome “According to current data, the e-cigarette is effective for smoking cessation (abstinence of 6 months or more)” (median 7, IQR 6.5–7.5). They considered that e-cigarette very likely reduces the risks compared to smoking (8, 7–9), and "can be used in association with nicotine replacement products" (9, 8–9). No consensual agreement was reached for adverse effects and potential benefits for subgroups (i.e. pregnancy, hospitalized). Conclusions: Participating experts agreed that e-cigarette can help to quit smoking. Agreeing on priority actions for smoking cessation is a base to develop clinical guidelines and trainings, and to tackle the industry-led tobacco epidemic.

Background: Scientists can play an important role in policymaking by providing evidence and consensual expert opinion on the state of scientific knowledge. Delphi surveys have been widely used to develop consensus on a topical issue, yet not compatible with public health crisis situations requiring rapid decisions. We developed a fast-track Delphi process, providing experts with a structured approach to rapidly develop and quantify consensus in support of informed policy decisions. Methods: We identified key elements of consensus-building techniques through a literature review and derived methodological procedures that served as the basis for the elaboration of the new process. Selected methodological experts provided advice on necessary adjustments. The process was pilot tested using a real-world public health issue. Results: The fast-track Delphi process is a hybrid approach between a conventional Delphi and the nominal group technique: one group session followed by two rounds of e-questionnaire, with predefined steps. We developed an ad hoc toolkit (REDCap templates, R code for analysis and production of reports, user guide) to overcome time constraints, which we pilot tested with experts. The feasibility test conducted in 18 days in the field of tobacco control demonstrated the applicability and usefulness of the process in real-world conditions. Conclusions: We strongly believe that this fast-track Delphi process has the potential to help inform policy decisions in various types of crises, including emerging diseases or novel potentially harmful products.

Background New onsets of chronic urticaria (CU) have been reported after repeated immunizations, mainly with the Moderna mRNA-1273 vaccine (Spikevax). This study aims to evaluate patients with CU after COVID-19 mRNA vaccination. The contribution of SARS-Cov2 infection, atopy and IgE against the vaccine was analyzed. Methods We monitored the features of patients who developed CU after vaccination through two surveys conducted in 2022 and 2023. Fifty individuals with CU underwent blood tests, and their results were compared with individuals without a history of urticaria (N = 135). The presence of anti-vaccine IgE was tested in 185 individuals with basophil activation tests (BAT). We assessed anti-SARS-Cov2 humoral response, and the presence of IgEs against common respiratory allergens (Phadiatop) as a surrogate for atopy. Results Post-vaccination CU occurs after a median interval of 10 days and significantly more after the Spikevax booster, affecting middle-aged individuals (median 41, 66% females). In 2023, CU was still active in 53% of the cases. Inducible forms of CU, primarily dermographism, are reported in 54% (2022) and 61% (2023) of the cases. BAT positivity is not specific to CU, anti-nucleocapsid positivity, or atopy but is significantly associated with higher anti-spike neutralizing activities and younger age. Four CU patients tolerate an additional dose of mRNA vaccine with no disease exacerbation/recurrence. Conclusions The spikevax booster induces anti-vaccine IgE independently of CU, the latter being not directly associated with COVID-19 infection nor atopy. The tolerance to a new booster in 4/4 patients suggests that the Spikevax vaccine indirectly triggers CU in predisposed individuals.

Background New onsets of chronic urticaria (CU) have been reported after repeated immunizations, mainly with the Moderna mRNA-1273 vaccine (Spikevax) Objective This study aims to evaluate patients with CU after COVID-19 mRNA vaccination. The contribution of SARS-Cov2 infection, atopy and IgE against the vaccine was analyzed. Methods We monitored the features of patients who developed CU after vaccination in the Canton of Vaud through two surveys conducted in 2022 and 2023. Fifty individuals with CU underwent blood tests, and their results were compared with individuals without a history of urticaria (N=135). The presence of anti-vaccine IgE was detected with basophil activation tests (BAT). We assessed anti-SARS-Cov2 humoral response, and the presence of IgEs against common respiratory allergens (Phadiatop) as a surrogate for atopy. Results Post-vaccination CU occurred after a median interval of 10 days and significantly more after the Spikevax booster, affecting middle-aged individuals (median 41, 66% females). In 2023, CU was still active in 53% of the cases. Inducible forms of CU, primarily dermographism, were reported in 54% (2022) and 61% (2023) of the cases. BAT positivity was not specific to CU, anti-nucleocapsid positivity, or atopy but was significantly associated with higher anti-spike neutralizing activities and younger age. Four CU patients tolerated an additional dose of mRNA vaccine with no disease exacerbation/recurrence. Conclusion The Spikevax booster induced anti-vaccine IgE independently of CU, the latter being not directly associated with COVID-19 infection nor atopy. The tolerance to a new booster in 4/4 patients suggests that the Spikevax vaccine indirectly triggered CU in predisposed individuals.

The measurement of an airborne concentration in Amosite fibers above 5035 F/m³ in a school prompted a retrospective quantitative health risk assessment. Dose estimates were built using air measurements, laboratory experiments, previous exposure data, and interviews. A dose response model was adapted for amosite-only exposure and adjusted for the life expectancy and lung cancer incidence in the Swiss population. The average yearly concentrations found were 52–320 F/m³. The high concentration previously observed was not representative of the average exposure in the building. Overall, the risk estimates for the different populations of the school were low and in the range of 2 × 10⁻⁶ to 3 × 10⁻⁵ for mesothelioma and 4 × 10⁻⁷ to 8 × 10⁻⁶ for lung cancer. The results evidenced however that children have to be considered at higher risk when exposed to asbestos, and that the current reference method and target values are of limited use for amphibole-only exposures. This study confirmed that quantitative health risk assessments and participatory approaches are powerful tools to support public decisions and build constructive communication between exposed people, experts, and policy-makers.

Questions under study: In view of the alarming trend in childhood obesity (O) and overweight (OW) observed in certain countries, the aim of the study is to measure the prevalence of O and OW in successive cohorts of elementary school children in Geneva. Methods: All 5–6-year-old children attending public schools in the Canton of Geneva were measured and weighed during a systematic health check at school from 2003 to 2008. BMI was calculated and plotted on standardised BMI for age tables, using Cole’s and Kromeyer’s references. Results: Using Cole’s references, the overall trend was a small non-significant decrease for OW 0.7 points (p = 0.33) and O 0.5 points (p = 0.23) over the 5-year period. For girls, OW decreased by 1.1 point (p = 0.47) and O decreased by 0.5 points (p = 0.61), whilst for boys OW decreased by 0.3 points (p = 0.54) and O decreased by 0.6 points (p = 0.23). A non-significant decrease or stabilisation in the prevalence of overweight and obesity was observed over the 5-year period in both boys and girls. Conclusion: These observations corroborate observations from Sweden and France, showing a levelling off in obesity and overweight in young children.

This study aims to examine changes in immunization coverage for diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella and hepatitis B during the academic calendars of 2003-2004 and 2007-2008 for students aged 13 to 14 years. Data were collected on an annual basis and systematically from the vaccination records 85% of adolescents enrolled in public institutions in Geneva. The immunization coverage increased for diphtheria, tetanus and polio by 2.3, 2.1 and 1.1 points respectively. Vaccination for pertussis (whooping cough) increased from 20.7% in 2003-2004 to 61% in 2007-2008. Vaccinations administered against measles, mumps and rubella increased by nearly 20 points. During this period, the coverage rate for hepatitis B increased by 10.3 points in 5 years. The recommended vaccination coverage rates are not being achieved for any of the vaccines currently being used in Switzerland, with the exception of those for diphtheria and polio.

To evaluate and compare the educational impact of the University of Geneva Faculty of Medicine (UGFM) emergency medicine clerkship training with that provided by the Swiss Army medical officer cadets school (ARMY). The assessment was designed to assess students' clinical knowledge and competency in major emergency situations, ACLS (Advanced Cardiac Life Support) and ATLS (Advanced Traumatic Life Support). Prospectively, 56 UGFM students were compared with 52 ARMY officer cadets by a multiformat pre- and post-training examination. The exam consisted of a multiple-choice questionnaire (MCQ), a standardised vignette-based oral exam (SOE) and a standardised practical cardio-pulmonary resuscitation (CPR) exercise. Overall, on the pre- and post-training testing, total scores improved significantly for the UGFM by 10% (from 63 to 73%) and for the ARMY by 9% (from 60 to 69%). Knowledge assessed on the MCQ improved for the UGFM by 8% (64 to 72%) but not significantly for the ARMY. Performance on the SOE improved by 10% for UGFM (54 to 64%) and the ARMY (47 to 57%) as well as performance on the CPR, which improved by 15% for UGFM (72 to 87%) and 19% for the ARMY (67 to 86%). Post-training performance indicated that, respectively, UGFM scored significantly higher than the ARMY on the MCQ (72 and 68%) and the SOE (64 and 57%) but not on the CPR. Internal reliability indexes for the MCQ, SOE and CPR were respectively 0.72, 0.86 and 0.92. Correlations between the MCQ, SOE and CPR varied between 0.07 to 0.19. In general, the multimethod assessment seemed to provide a complementary approach to evaluation of the trainees' competency in emergency training. Except for the ARMY MCQ performance, both training programmes seemed to be effective in improving trainees' overall knowledge and clinical performance. The trainees' performances are reviewed and discussed in terms of the specific skills assessed on the SOE, the context of the trainees' expected level of performance, the teaching and evaluation approaches, and implications in establishing the equivalence of the two programmes.