[Assessment of families in situations of forced migration: Transcultural approaches to identifying and supporting psychological suffering]. / Évaluation des familles en situation de migration forcée: Approches transculturelles pour repérer et accompagner la souffrance psychologique.

With current migratory movements, the population is becoming increasingly mixed, and consultations are receiving more migrants. The paediatrician or general practitioner is often the front-line health professional who has to assess how to welcome a newcomer family, investigate their life history, discuss mental health with them and sometimes overcome the negative prejudices that some cultures and people may have about psychiatry. Identifying worrying symptoms is an important first step in the overall assessment. It is then essential to support these families while working on protective factors and offering support for parenthood. Finally, working with the network will be key to ensuring continuity of care and the most appropriate support for the migrant's needs.

Avec les mouvements migratoires actuels, la population devient de plus en plus métissée et les consultations accueillent davantage de migrants. Le pédiatre ou le généraliste est souvent le professionnel de santé en première ligne qui doit évaluer la façon d'accueillir une famille primo-arrivante, d'investiguer leur histoire de vie, de parler de santé mentale avec eux et parfois de contourner les préjugés négatifs que certaines cultures et personnes pourraient avoir sur la psychiatrie. Le repérage des symptômes inquiétants est une première étape importante lors de l'évaluation globale. Il est fondamental ensuite d'accompagner ces familles tout en travaillant sur les facteurs protecteurs et en proposant un soutien à la parentalité. Enfin, le travail avec le réseau sera déterminant pour assurer la continuité des soins et un accompagnement le plus adapté au besoin du migrant.

Asylum Seekers' Responses to Government COVID-19 Recommendations: A Cross-sectional Survey in a Swiss Canton.

Asylum seekers face multiple language, cultural and administrative barriers that could result in the inappropriate implementation of COVID-19 measures. This study aimed to explore their knowledge and attitudes to recommendations about COVID-19. We conducted a cross-sectional survey among asylum seekers living in the canton of Vaud, Switzerland. We used logistic regressions to analyze associations between knowledge about health recommendations, the experience of the pandemic and belief to rumors, and participant sociodemographic characteristics. In total, 242 people participated in the survey, with 63% of men (n = 150) and a median age of 30 years old (IQR 23-40). Low knowledge was associated with linguistic barriers (aOR 0.36, 95% CI 0.14-0.94, p = 0.028) and living in a community center (aOR 0.43, 95% CI 0.22-0.85, p = 0.014). Rejected asylum seekers were more likely to believe COVID-19 rumors (aOR 2.81, 95% CI 1.24-6.36, p = 0.013). This survey underlines the importance of tailoring health recommendations and interventions to reach asylum seekers, particularly those living in community centers or facing language barriers.

Detecting and describing heterogeneity in health care cost trajectories among asylum seekers.

BACKGROUND: The mechanism underlying the health care cost trajectories among asylum seekers is not well understood. In the canton of Vaud in Switzerland, a nurse-led health care and medical Network for Migrant Health ("Réseau santé et migration" RESAMI) has established a health care model focusing on the first year after arrival of asylum seekers, called the "community health phase". This model aims to provide tailored care and facilitate integration into the Swiss health care system. The aim of this study is to explore different health care cost trajectories among asylum seekers during this phase and identify the associated factors. METHODS: We detected different patterns of health care cost trajectories using time-series clustering of longitudinal data of asylum seekers in the canton of Vaud in Switzerland. These data included all adult asylum seekers and recipients of emergency aid who entered the canton between 2012 and 2015 and were followed until 2018. The different clusters of health care cost trajectories were then described using a multinomial logistic regression model. RESULTS: We identified a concave, an upward trending, and a downward trending cluster of health care cost trajectories with different characteristics being associated with each cluster. The likelihood of being in the concave cluster is positively associated with coming from the Eastern Mediterranean region or Africa rather than Europe and with a higher share of consultations with an interpreter. The likelihood of being in the upward trending cluster, which accrued the highest costs, is positively associated with 20-24-year-olds rather than older individuals, coming from Europe than any other region and having a mental disorder. In contrast to the other two clusters, the likelihood of being in the downward trending cluster is positively associated with having contacted the RESAMI network within the first month after arrival, which might indicate the potential of early intervention. It is also positively associated with older age and living in a group lodge. CONCLUSIONS: Asylum seekers are heterogeneous in terms of health care cost trajectories. Exploring these differences can help point to possible ways to improve the care and supporting services provided to asylum seekers. Our findings could indicate that early and patient-centered interventions might be well-suited to this aim.

[The health equity issues of an emergency department fee]. / Instauration d'une taxe aux urgences : enjeux d'équité en santé.

In June 2021, the Swiss parliament accepted a legislative proposal calling for the introduction of a fee to fight emergency department (ED) overcrowding. Although this issue remains a major challenge for health policies, the introduction of such a fee raises many questions, notably regarding health equity. However, other more equitable solutions exist: improving the case management of ED frequent users and improving coordination between ED and primary care.

En juin 2021, le Parlement fédéral a accepté une proposition législative demandant l'instauration d'une taxe aux urgences pour lutter contre leur surfréquentation. Bien que cette problématique demeure un enjeu majeur des politiques de santé, l'instauration d'une telle taxe pose de nombreuses questions, notamment d'équité en santé. Pourtant, d'autres solutions existent, en améliorant la prise en charge des usager-ère-s fréquent-e-s des urgences, ainsi que la coordination entre soins primaires et services d'urgences.

[Gabapentinoids : misuses and addictions]. / Gabapentinoïdes : mésusages et addictions.

Cases of addictions and misuses on gabapentinoids are increasingly reported. But the underlying pharmacological mechanism is not completely understood. Here is an uptodate of the current knowledges on this dependence and its management.

Des cas de mésusages et d'addictions aux gabapentinoïdes sont de plus en plus fréquemment rapportés, sans que le mécanisme pharmacologique sous-jacent ne soit complètement compris. Nous faisons un état des lieux des connaissances sur cette dépendance et sa prise en charge.

[Recommendations for management of misuses and addictions to benzodiazepines]. / Recommandations de prise en charge des mésusages et addictions aux benzodiazepines.

The management of patients who have become dependent on benzodiazepines and analogues is a problem frequently encountered in both somatic and psychiatric medicine. No pharmacological treatment is currently recognized as effective in the management of these addictions, apart from a gradual reduction of doses. We propose practical strategies for the implementation of gradual dose reduction and choice of molecules while promoting individual adaptation to the withdrawal symptoms presented by the patient.

La prise en charge de patients ayant développé une dépendance aux benzodiazépines et analogues est une problématique rencontrée fréquemment tant en médecine somatique que psychiatrique. Aucun traitement pharmacologique n'est actuellement reconnu comme efficace dans la prise en charge de ces dépendances, en dehors d'une réduction progressive des doses. Nous proposons des stratégies pratiques de mise en œuvre de réduction progressive des doses et de choix de molécules tout en favorisant une adaptation individuelle aux symptômes de sevrage présentés par le patient.

[Asylum seekers : collaboration between nurses and medical students during the COVID-19 epidemic]. / Patients issus de l'asile : collaboration infirmiers-étudiants en médecine durant l'épidémie de Covid-19.

The exceptional health challenges generated by the COVID-19 pandemic have sparked a wave of mobilization among medical students. We were four students to provide support to the Migrant Care Units of the Vulnerability and Social Medicine Department of Unisanté. This two-month experience, very different from the academic framework we were used to during our studies, allowed us to discover a clinic grappling with social and cross-cultural issues, and taught us the mutual benefits of an interprofessional collaboration with experienced nurses. Through a few clinical vignettes, we would like to share the challenges of the care we have seen, as well as the significant lessons we have learned from them.

Les défis sanitaires exceptionnels générés par la pandémie de Covid-19 ont donné lieu à une vague de mobilisation parmi les étudiant·e·s en médecine. Nous avons été quatre étudiant·e·s à apporter notre soutien aux Unités de soins aux migrants du Département Vulnérabilités et médecine sociale d'Unisanté. Cette expérience de deux mois, bien différente du cadre académique dont nous avons eu l'habitude au cours de nos études, nous a permis de découvrir une clinique en prise avec des problématiques sociales et transculturelles, et nous a appris les bénéfices mutuels d'une collaboration interprofessionnelle avec des infirmier·ère·s expérimenté·e·s. Au travers de quelques vignettes cliniques, nous souhaitons ainsi partager les enjeux des prises en soins auxquelles nous avons assisté, ainsi que les enseignements marquants que nous en avons retirés.

[Mobilization of Medical Students, UNIL, during the COVID-19 Pandemic]. / Mobilisation d'étudiants en médecine de l'UNIL en période de pandémie du Covid-19.

Medical students from the University of Lausanne volunteered rapidly and in great number to bolster health facilities across Switzerland in response to the COVID-19 pandemic. At Unisanté, Center for general practice and public health, University of Lausanne, students recruited as interns discovered the different aspects of primary care. This extraordinary period naturally involves considerable challenges but represents also a precious learning opportunity for future doctors.

Les étudiants en médecine de l'Université de Lausanne se sont rapidement et massivement portés volontaires pour soutenir les institutions de soins en Suisse face à la pandémie du Covid-19. À Unisanté, Centre universitaire de médecine générale et santé publique de Lausanne, les étudiants engagés comme médecins stagiaires ont pu découvrir les différentes facettes de la médecine de premier recours. Cette situation extraordinaire comporte naturellement ses défis, mais représente également une opportunité précieuse d'apprentissage pour les futurs médecins.

[Racism and the practice of medicine†: elements for a required learning]. / Racisme et pratique de la médecine†: éléments pour un apprentissage nécessaire.

The new catalogue of objectives for medical education at Swiss universities (PROFILES) underlines the importance of teaching the impact of ethnic, cultural, spiritual and religious differences and the socio-economic determinants of health and illness on health and care. At the same time, the social reality of the moment reminds us that racism is still present in our societies. Therefore, education for medical students is necessary. This should include basic knowledge but also, and above all, an understanding of the underlying mechanisms that will enable them to grasp the notions of prejudice, stereotypes and discrimination. Finally, introspection, the acquisition of cross-cultural skills and cultural humility will help to deal with this other epidemic.

Le nouveau catalogue des objectifs d'enseignement de la médecine dans les universités suisses (PROFILES) souligne l'importance de l'enseignement de l'impact sur la santé et les soins des différences ethniques, culturelles, spirituelles, religieuses, et des déterminants socio-économiques de la santé et de la maladie. Parallèlement, la réalité sociale du moment nous rappelle que le racisme est toujours présent dans nos sociétés. Dès lors, un enseignement aux étudiant·e·s de médecine est nécessaire. Celui-ci devra intégrer des connaissances de base mais aussi et surtout la compréhension des mécanismes sous-jacents qui permettra d'appréhender les notions de préjugés, stéréotypes et discriminations. Enfin, l'introspection, l'acquisition de compétences transculturelles et d'humilité culturelle permettront de faire face à cette autre épidémie.

[Left behind populations, COVID-19 and risks of health inequities†: a guide of the local social-health network (Vaud, Switzerland)]. / Populations précarisées, COVID-19 et risques d'iniquités en santé†: guide du réseau socio-sanitaire vaudois.

Since the emergence of the COVID-19 pandemic, the Confederation has referred to «â€…vulnerable populations ¼ over the age of 65 and/or with co-morbidities as potentially at risk. This group should not overshadow other highly vulnerable populations such as forced migrants, people deprived of their liberty, and the homeless. In the context of the current pandemic, there is a risk of increasing inequities in care among these populations. In this practical article, we list the marginalized and disadvantaged left behind populations in the canton of Vaud and the issues of inequities in care in the context of the pandemic; we also present the implementation of procedures sometimes original, always inter-professional and interdisciplinary, specifying who the partners are and what the resources are for front-line caregivers.

Depuis l'apparition de la pandémie du COVID-19, la Confédération évoque comme potentiellement à risque les «â€…populations vulnérables ¼ de plus de 65 ans et/ou présentant des comorbidités. Ce groupe ne doit pas «â€…éclipser ¼ d'autres populations en situation de grande vulnérabilité telles que les personnes issues de la migration forcée, celles privées de liberté, ainsi que les sans domicile fixe. Dans cet article qui se veut pratique, nous énumérons différentes populations marginalisées du canton de Vaud et les enjeux d'iniquités dans les soins dans le cadre de la pandémie ; nous présentons également l'implémentation de procédures, parfois originales, toujours interprofessionnelles et interdisciplinaires, en précisant qui sont les partenaires et quelles sont les ressources pour les soignants de première ligne.

Protocol of a longitudinal study on the specific needs of Syrian refugee families in Switzerland.

BACKGROUND: The ongoing Syrian civil war has led to massive population displacements, leading to the reorganization of the asylum policies of several countries. Accordingly, like other European countries, the Swiss government has recently chosen to implement a specific resettlement program. This program is characterized by the fact that the whole nuclear family is granted a work and residence permit upon arrival, and benefits from enhanced integration services. The aim of the present project is to evaluate the effects of the Swiss resettlement program, with a special focus on mental health, while adopting a family perspective. METHODS: The outcomes of 15 Syrian families taking part in this program will be compared to those of 15 Syrian families that came to Switzerland through other means (i.e., following the usual asylum procedure, which is much more stressful and time consuming). Each family member above 8 years old will be invited to participate to a 3-wave longitudinal survey concerning the resettlement process: upon arrival in the collective shelters, six and 12 months later. Questionnaires will be used for the evaluation of participants' mental health, risk behaviors, general health, romantic relationship, parent-child relationship, family functioning, parentification, social support, and social identities related to group belongingness. DISCUSSION: The findings of the present project will provide longitudinal information on Syrian refugees. A comprehensive approach will be adopted by screening potential difficulties that the sample may be faced with and potential strengths that participants may rely on. Accordingly, physical and mental health, as well as the quality of family functioning, the feeling of support and of belongingness to different groups will be evaluated. We will also compare the results of families who had the chance to immigrate through the Swiss resettlement program, to the results of families that did not. This comparison will allow the elaboration of hypotheses regarding adjusted asylum policies. Furthermore, it will enhance our knowledge regarding the impact of displacement on the family system. Indeed, although the role of the family for the well-being of adults and children has been established, surprisingly few studies have adopted this focus in the asylum field.