Did you say vulnerable populations?

The current new coronavirus pandemic has highlighted the importance of taking into consideration population groups particularly at risk of contracting Covid-19 disease or developing severe forms of the disease. The medical literature, the press and the authorities have thus stepped up the use of the expression <<vulnerable populations>> in recent weeks to refer to it. However, behind this general expression there are diverse but often interdependent realities whose specific consideration and understanding seem essential for the effective management of the epidemic and its health and socioeconomic consequences.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

2020 scientific breakthroughs in ambulatory general internal medicine

Functional weakness of the limbs has an uncertain prognosis and little chance of recovery. Obese people in precarious situations may succeed in losing weight through an intensive lifestyle-based weight loss program. In patients with gonarthrosis, physiotherapy may decrease pain and disability when compared to injected corticosteroids. Patients suffering from an alcohol dependence syndrome can reduce their consumption with short-term consultations conducted by general practitioners. Fatigue and dyspnea are two frequent symptoms that may persist after the acute phase of the SARS-CoV-2 infection. PCR analysis for the detection of SARS-CoV-2 could be performed with the same degree of sensitivity on a nasopharyngeal or salivary swab.

Did you say vulnerable populations?

The current new coronavirus pandemic has highlighted the importance of taking into consideration population groups particularly at risk of contracting Covid-19 disease or developing severe forms of the disease. The medical literature, the press and the authorities have thus stepped up the use of the expression «vulnerable populations» in recent weeks to refer to it. However, behind this general expression there are diverse but often interdependent realities whose specific consideration and understanding seem essential for the effective management of the epidemic and its health and socioeconomic consequences.

Left behind populations, COVID-19 and risks of health inequities: a guide of the local social-health network (Vaud, Switzerland)

Since the emergence of the COVID-19 pandemic, the Confederation has referred to «vulnerable populations» 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.

Frequent users of ED’s perspectives about a case management intervention in Western Switzerland

Background Management of frequent users of the emergency department (FUED;≥5 visits/year) is a known challenge. Studies show that case management (CM) improves FUEDs' quality of life while reducing their number of emergency department visits and associated costs. However, little is known about FUEDs' own perspectives on CM. Methods This qualitative study was part of a larger study aiming to implement CM for FUED in French-speaking Switzerland. Participants were FUEDs included in the parent study, who had either completed the CM intervention or were still enrolled. Semi-structured qualitative interviews were conducted with 20 participants (75% female;mean age=40.55, SD = 12.84), randomly drawn from the parent study sample. Content analysis was performed by two researchers to assess participants' perceptions on the CM intervention. Results Most participants endorsed general positive perceptions of CM. CM differed from their usual treatment by two characteristics: its holistic approach and the quality of the relationship with the case manager. Also, moral support was perceived as a main benefit. FUEDs perceived four outcomes: an increase in motivation (e.g., day-to-day life or health-related), better orientation in and interaction with the healthcare system and improved health literacy. Finally, FUEDs identified two negative aspects to the CM: few perceived benefits (e.g., not enough concrete outcomes) and negative consequences (e.g., feeling ashamed to come back to ED). Three obstacles were identified: case manager's lack of time, COVID-19's influence (e.g., less personal contact) and uncertainty around the program (e.g., organization, aims). The personal relationship with their case manager was perceived as the main driver to positive outcomes. Conclusions FUED perceived the program as useful and considered the relationship with the case manager as key for positive outcomes. Our findings also suggest ways to improve CM, such as clarifying its organization and aims. Key messages In FUEDs’ opinion, the CM intervention had many positive outcomes, often relying on the relationship with the case manager. However, the CM intervention had also some negatives.

[Asylum seekers : collaboration between nurses and medical students during the COVID-19 epidemic]

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 Unisante. 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.

Compassion fatigue: an inevitable reality in the context of a pandemic crisis ?

The pandemic attributed to the SARS-CoV-2 virus has been responsible since 2019 for the extreme strains put on health and social assistance services across the globe. While factors such as the contagiousness of the virus, the lack of immunity in the general population and the uncertain trajectory of the pandemic contribute to the rise of general anxiety among these professionals, the morbidity and mortality attributed to the virus, the scarcity of material and personnel resources are at high risk of leading to their exhaustion, both physically and mentally. The admirable surge of solidarity, resilience and self-sacrifice shown on a daily basis by these professionals and many others should not obscure the awareness of the mental «cost» of caring. La pandémie liée au virus SARS-CoV-2 est responsable depuis 2019 de la mise sous tension globale et extrême des systèmes de santé et d’assistance sociale. Dans ce contexte, des facteurs tels que la contagiosité du virus, l’absence d’immunité dans la population générale et la trajectoire incertaine de la pandémie contribuent à l’élévation du niveau d’anxiété générale de professionnels de la santé et du social. La morbidité et la mortalité liées au virus, les ressources insuffisantes en matériel et en personnel sont, quant à elles, à risque élevé de conduire à un épuisement, tant sur le plan physique que psychique, du personnel soignant. L’élan de solidarité, la résilience et l’abnégation admirables dont font preuve au quotidien ces corps professionnels et bien d’autres ne devraient pas occulter la prise de conscience des « coûts » psychiques liés aux soins prodigués à autrui.