Health assessment of newly arrived refugees to the Municipality of Copenhagen, Denmark

Background

Research data on the health status of newly arrived refugees is sparse. Newly arrived refugees and family reunified in The Municipality of Copenhagen has since 2016 been offered a general health assessment. These assessments are conducted by clinicians with expertise in refugee and migrant health from the Section of Immigrant Health. This study describes the sociodemographic characteristics and the burden of disease in this population.

Methods

In this cross-sectional study the population consists of adult patients examined January 2017 to February 2019. Clinicians performed the health assessment including a questionnaire regarding sociodemographics, medical history, symptoms, traumatic events during/before migration, a clinical examination and blood samples.

Results

The population had an equal presentation of males (N = 81) and females (N = 79) primarily from Syria (33%) and Iran (29%). The median age was 31,5 years (SD = 10,9). 67% had ≥8 years of schooling, while 11% had a maximum of 2 years. More than half had experienced war and 50% persecution. 76% suffered from Vitamin D deficiency, 31% of B12 deficiency and 12% of anemia. Few suffered from infectious and somatic diseases, yet many experiences symptoms such as pain (53%) and headaches (54%). 33% presented with symptoms of PTSD.

Conclusions

A high frequency of micronutrition deficiency was prevalent in the refugee group. Furthermore, many suffered from physical symptoms while very few had serious somatic issues. Numerous traumatic experiences were reported and 33% presented with symptoms of PTSD. The data is presumably a reflection of the healthy migrant bias.

Key messages

Despite refugees presumably being tested pre-entry and at holding level, they still suffer several health issues when granted asylum. Many newly arrived refugees suffer from micronutrition deficiency. These conditions are easily treated and could enhance the overall health of the individual.

NTCP model validation method for DAHANCA patient selection of protons versus photons in head and neck cancer radiotherapy

Introduction: Prediction models using logistic regression may perform poorly in external patient cohorts. However, there is a need to standardize and validate models for clinical use. The purpose of this project was to describe a method for validation of external NTCP models used for patient selection in the randomized trial of protons versus photons in head and neck cancer radiotherapy, DAHANCA 35. Material and methods: Organs at risk of 588 patients treated primarily with IMRT in the randomized controlled DAHANCA19 trial were retrospectively contoured according to recent international recommendations. Dose metrics were extracted using MatLab and all clinical parameters were retrieved from the DAHANCA database. The model proposed by Christianen et al. to predict physician-rated dysphagia was validated through the closed testing, where change of the model intercept, slope and individual beta's were tested for significant prediction improvements. Results: Six months prevalence of dysphagia in the validation cohort was 33%. The closed testing procedure for physician-rated dysphagia showed that the Christianen et al. model needed an intercept refitting for the best match for the Danish patients. The intercept update increased the risk of dysphagia for the validation cohort by 7.9 ± 2.5% point. For the raw model performance, the Brier score (mean squared residual) was 0.467, which improved significantly with a new intercept to 0.415. Conclusions: The previously published Dutch dysphagia model needed an intercept update to match the Danish patient cohort. The implementation of a closed testing procedure on the current validation cohort allows quick and efficient validation of external NTCP models for patient selection in the future.

Life-Cycle Assessment as a decision-support tool for early phases of urban planning: evaluating applicability through a comparative approach

While ambitious environmental objectives are being set for new constructions in Switzerland, the assessment of urban-scale projects and comparison of their performance to national targets are made possible by a growing number of life-cycle assessment (LCA) tools. However, previous research emphasizes the lack of existing tools to support the decision-making process at the early design stage, characterized by a low level of project details. This paper presents a comparison between three LCA tools. The first, stemming from a research and development project (SETUP), is an exploration tool relying on a database of urban-level scenarios and their environmental performance, able to convert district targets (e.g. 2000-Watt society objectives) into specific sub-targets at the building or component levels. The other two are online LCA tools currently available to practitioners (Sméo and Calculation tool for 2000-Watt-society-sites RH II ), that allow assessing the project and verifying its compliance with a given target. Each tool was applied to a low-carbon case study, the blueFactory district in Fribourg (Switzerland), in two hypothetical contexts corresponding to the schematic and detailed project development phases, characterized by different levels of details. When used for the assessment of a project at a more advanced development stage with a high resolution of detail, findings indicate that Smeo and RH II provide similar environmental performance results. However, in early planning stages, SETUP shows better abilities to support decision-making by providing ranges of results and highlighting uncertainties and the influence of design parameters that have not yet been fixed.

General practitioners' and nurses' views on medication reviews and potentially inappropriate medicines in elderly patients - a qualitative study of reports by educating pharmacists

OBJECTIVE

The aim with this study was to understand more about how general practitioners (GPs) and nurses in primary care experience their work with medication reviews in elderly patients.

DESIGN

This qualitative study was nested within a cluster randomised trial and analysed narrative and unstructured diaries written by two pharmacists who performed academic detailing, i.e. educational outreach visits in primary care. The educational sessions dealt with potentially inappropriate medicines, and stimulated interprofessional dialogue in relation to medication reviews. The purpose of the diaries was to document and structure the pedagogical process of academic detailing and contained quotes from 194 GP and 113 nurse participants in the sessions, and the pharmacists' reflections. The data was explored using thematic analysis.

SETTING

Thirty-three primary care practices in Stockholm, Sweden.

SUBJECTS

GPs and nurses working in primary care.

MAIN OUTCOME MEASURES

Thematic descriptions of academic detailing by pharmacists.

RESULTS

Five themes were identified: 1) Complexity in 3 'P': patients, pharmacotherapy, and primary care; 2) What, when, who? Clash between GPs' and nurses' experiences and guidelines; 3) Real-world problems and less-than-ideal solutions; 4) Eureka? Experiences with different steps during a medication review; and 5) Threats to GP autonomy.

CONCLUSION

GPs and nurses should participate in the construction and release of guidelines in order to increase their usability in clinical practice. Future research should analyse if alternative strategies such as condensed medical reviews and feedback on prescribing are easier to implement in primary care. Key points Complex medication reviews have been introduced on a large scale in Swedish primary care, but knowledge on GPs' and nurses' views on such reviews is lacking. In the context of primary care alternative strategies such as condensed medication reviews and feedback on prescribing may be more applicable than medication reviews according to guidelines. GPs and nurses should make contributions to the development of guidelines on medication reviews in order to increase their usability in clinical practice.

Mitochondria, glycogen, and lipid droplets in skeletal muscle during testosterone treatment and strength training: a randomized, double-blinded, placebo-controlled trial

Low testosterone levels in aging men are associated with insulin resistance. Mitochondrial dysfunction, changes in glycogen metabolism, and lipid accumulation are linked to insulin resistance in skeletal muscle. In this randomized, double-blinded, placebo-controlled study, we investigated the effects of six-month testosterone replacement therapy (TRT) and strength training (ST) on mitochondrial, glycogen, and lipid droplet (LD) content in skeletal muscle of aging men with subnormal bioavailable testosterone (BioT) levels. Mitochondrial, glycogen, and LD volume fractions in muscle biopsies were estimated by transmission electron microscopy. Insulin sensitivity (insulin-stimulated Rd) and body composition were assessed by euglycemic-hyperinsulinemic clamp and dual X-ray absorptiometry, respectively. TRT significantly increased total testosterone levels, BioT, and lean body mass (LBM) (p < 0.05), whereas percent body fat decreased (p < 0.05), and insulin sensitivity was unchanged. Baseline mitochondrial volume fraction correlated inversely with percent body fat (ρ = -0.43; p = 0.003). Δ-mitochondrial fraction correlated positively with Δ-total testosterone (ρ = 0.70; p = 0.02), and Δ-glycogen fraction correlated inversely with Δ-LBM (ρ = -0.83; p = 0.002) during six-month TRT, but no significant changes were observed in mitochondrial, glycogen, and LD volume fractions during TRT and ST. In conclusion, in this exploratory small-scale study, the beneficial effects of six-month TRT on total testosterone, LBM, and percent body fat were not followed by significant changes in fractions of mitochondria, glycogen, or lipid in skeletal muscle of aging men with lowered testosterone levels. Six-month ST or combined three-month ST+TRT did not change intramyocellular mitochondria, glycogen, and LD fractions compared to placebo. However, further studies with a larger sample size are needed.