ABSTRACT
Background: Understanding the factors influencing SARS-CoV-2 transmission in asylum seekers and refugees living in centres is crucial to determine targeted public health policies protecting these populations fairly and efficiently. In response, this study was designed to explore the pandemic's spread into asylum centres during the first wave of the pandemic in Switzerland. Specifically, it aimed to identify the risk factors associated with a positive anti-SARS-CoV-2 seroprevalence test after the first semi-confinement period (16 March to 27 April 2020) amongst asylum seekers and refugees living in centres. Methods: This research is part of SérocoVID, a seroepidemiologic study of SARS-CoV-2 infection conducted in the canton of Vaud, Switzerland. Migrants living in two asylum centres, one known to have had an epidemic outbreak, were invited to participate in this study. Anti-SARS-CoV-2 IgG and IgA antibodies targeting the spike viral protein were measured in all participants using a Luminex immunoassay. Each participant also completed a questionnaire measuring socio-demographic characteristics, medical history (comorbidities, smoking status, BMI, flu-like symptoms), health literacy, public health recommendations (wearing a masque in a public area, social distancing and hands cleaning), behaviours and exposures (daily life activities, number of contacts weekly). The association of these independent variables with the serologic test result were estimated using a multivariable logistic regression model. Findings: A total of 124 participants from the two asylum centres took part in the study (Centre 1, n = 82; Centre 2, n = 42). The mean participation rate was 36.7%. The seroprevalence in Centres 1 and 2 were 13% [95% CI 0.03, 0.14] and 50% [0.34, 0.65], respectively. Next, 40.63% of SARS-CoV-2 positive people never developed symptoms (asymptomatic cases), and no one had severe forms of the Covid-19 disease requiring hospitalisation. Participants report high compliance with public health measures, especially hygiene rules (96.3% of positive answers) and social distancing (88.7%). However, only 11.3% said they always wore a masque in public. After adjusting for individual characteristics, infection risk was lower amongst people with high health literacy (aOR 0.16, p = 0.007 [0.04, 0.60]) and smokers (aOR 0.20, p = 0.013 [0.06, 0.69]). Conclusion: Despite the lack of severe complications of Covid-19 disease in this study, findings suggest that developing targeted public health measures, especially for the low health literacy population, would be necessary to limit the risk of outbreaks in asylum centres and improve this population's safety. Further investigations and qualitative approach are required to understand more finely how living conditions, risks and behaviours such as tobacco consumption, and the adoption of protective measures impact SARS-CoV-2 infection.
ABSTRACT
In this article, we report abstracts of eight interviews, showing how clinicians use their interest in gender in their everyday practice. Clinicians report that being acquainted with a person interested by the question of gender raises their own awareness about the subject. In practice, they notice biased acquisition of knowledge due to non-inclusion of gender in research on one hand, and influence of gender stereotypes on clinical care on the other hand. Gender also influenced carriers. Some interviewed clinicians expressed they wished for more training, to reduce inequalities attributable to gender.
Dans cet article, nous rapportons de brefs extraits de 8 entrevues avec des clinicien·ne·s sensibilisé·e·s au genre, dans le but d'illustrer comment un intérêt pour ce domaine peut influencer la pratique quotidienne. Les personnes interrogées expliquent que le fait d'avoir un·e proche intéressé·e au genre les a rendues attentives à ce sujet. Dans leur pratique, elles disent avoir conscience de biais liés, d'une part, à l'acquisition des connaissances médicales ne tenant pas compte du genre et, d'autre part, à des stéréotypes de genre menant à une pratique médicale inégalitaire. Le genre a aussi un effet sur leurs carrières. Certaines personnes interrogées souhaiteraient bénéficier de plus de formation afin de diminuer les inégalités dues au genre.
Subject(s)
Medicine , Humans , NarrationABSTRACT
Since a decade, the medical school of Lausanne, Switzerland, develops via the Gender and Medicine Unit a gender integration project in the pregraduate curricula through gender specific lessons and a transversal integration in pertinent disciplines. This article aims to present its progresses and to elaborate some future prospects.
Depuis une dizaine d'années, l'École de médecine de Lausanne développe un projet d'intégration du genre dans le cursus prégradué. L'Unité médecine et genre guide la création de cours spécifiques ainsi qu'une intégration transversale du genre dans les disciplines médicales pertinentes. Cet article a pour but de présenter l'avancée du projet et d'élaborer quelques perspectives d'avenir.
Subject(s)
Education, Medical, Undergraduate , Medicine , Curriculum , Humans , Schools, Medical , SwitzerlandABSTRACT
EVIVO is a well-established chronic disease self-management program, having been successfully implemented during the last decade in Switzerland. The program has shown positive results in facilitation of self-management competences for patients living with chronic diseases and their relatives. EVIVO was designed to run for 6 weeks with weekly sessions of 2 and a half hour each. We tested the effectiveness of a shortened version of EVIVO, running it over five half days in order to make it more focused for patients who are challenged by managing their chronic illness within the context of their professional life. Participants in the five-session version showed comparable self-efficacy levels compared with those who had attended the standard six-week six-session courses. Overall, the five-session version was well accepted, considered very useful, met the participants' needs and changed their perception of their own expectations towards self-management of their illness.
Le cours EVIVO «â Devenir acteur de sa santé avec une maladie chroniqueâ ¼ a été implémenté en Suisse et s'est montré utile pour aider les personnes concernées et/ou leurs proches à renforcer leurs capacités à gérer la maladie et vivre le quotidien de manière plus positive. Structuré sur 6 semaines à raison d'une session de 2 h 30 par semaine, il a été reformaté sur 5 demi-journées afin d'être implémenté dans le monde du travail. L'évaluation d'EVIVO sur 5 sessions montre des résultats comparables dans l'évolution du sentiment d'autoefficacité comparable au cours sur 6 sessions. De plus, la version en 5 sessions ciblant les enjeux liés au travail s'est globalement révélée acceptable, utile et répondant aux besoins des participant·e·s qui ont exprimé avoir changé leurs attentes envers l'autogestion de leur maladie.
Subject(s)
Chronic Disease , Humans , SwitzerlandABSTRACT
In 2010 the canton of Vaud has innovated by launching the Cantonal Diabetes Program (PcD) aimed at reducing the impact of diabetes on the population. The evaluation after 7 years shows that some clinical examinations are performed more regularly and lower limb amputations tend to decrease. The contributions and interprofessional collaborations resulting from the PcD provide concrete guidelines for the implementation of a more comprehensive strategy of prevention and management of non-communicable diseases. It should be developed according to a chronicity model integrating social vulnerability.
Les autorités sanitaires du canton de Vaud ont innové en lançant en 2010 le Programme cantonal Diabète (PcD) dans le but de diminuer l'impact du diabète sur la population vaudoise. Le bilan réalisé après sept ans montre une amélioration de certains contrôles systématiques et une diminution des amputations des membres inférieurs. Les contributions et les collaborations interprofessionnelles résultant du programme fournissent des pistes concrètes pour la mise en Åuvre d'une stratégie plus globale de prévention et prise en charge des maladies non transmissibles. Elle devrait se développer selon un modèle de chronicité intersectoriel intégrant notamment la vulnérabilité sociale.
