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Jahan R, Amin R, Arafat SMY. Practical challenges for mental health services among Rohingya refugee in Bangladesh. Asian J Psychiatr 2024; 97:104069. [PMID: 38788321 DOI: 10.1016/j.ajp.2024.104069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/26/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Rohingya Muslims have been forcefully displaced from their mother land, Rakhaine State, Myanmar to Bangladesh, a country with about 170 million population with a treatment gap of more than 90% for standard mental health care. Due to the experienced trauma and displacement, high prevalence of depression, anxiety and post-traumatic tress disorders has been identified among Rohingya refugees in addition to the enduring mental health burden of Bangladesh. Very little has been known regarding the practical challenges of mental health services among Rohingya refugees in Bangladesh. In this commentary, we aimed to highlight the practical challenges for mental health services in Rohingya camps in Bangladesh along with our speculative ways forward based on available evidence, work experience, and informal communications. We highlighted the available mental health services, several major challenges including awareness, perception and belief towards mental health, language and cultural barriers, dearth of skilled service providers, inadequate services for severe mental illness, dearth of mental health services for children, inadequate provision of supervision and 'Care for Caregivers' program, and privacy and confidentiality of the clients. Although significant improvements have been made in the mental health field in the emergency crisis sector in Cox's Bazar over the past years, concentrated efforts are urgently required to actualize proposed solutions in this paper.
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Affiliation(s)
- Rubina Jahan
- Head of Clinical Services, Mental Health Program, SAJIDA Foundation, Dhaka, Bangladesh.
| | - Rizwana Amin
- Department of Psychology, Effat University, Jeddah, Saudi Arabia.
| | - S M Yasir Arafat
- Department of Psychiatry, Bangladesh Specialized Hospital, Dhaka 1207, Bangladesh; Senior Research Fellow, Biomedical Research Foundation, Dhaka, Bangladesh.
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Jiang W, Yang Y, He Y, Liu Q, Deng X, Hua Y, Hayixibayi A, Ni Y, Guo L. Contribution of diversity of social participation on the mental health of humanitarian migrants during resettlement. Epidemiol Psychiatr Sci 2024; 33:e29. [PMID: 38779823 DOI: 10.1017/s2045796024000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
AIMS By the end of 2022, an estimated 108.4 million individuals worldwide experienced forced displacement. Identifying modifiable factors associated with the mental illness of refugees is crucial for promoting successful integration and developing effective health policies. This study aims to examine the associations between the changes in the diversity of social participation and psychological distress among refugees throughout the resettlement process, specifically focusing on gender differences. METHODS Utilizing data from three waves of a longitudinal, nationally representative cohort study conducted in Australia, this study involved 2399 refugees interviewed during Wave 1, 1894 individuals interviewed during Wave 3 and 1881 respondents during Wave 5. At each wave, we assessed psychological distress and 10 types of social participation across 3 distinct dimensions, including social activities, employment and education. The primary analysis employed mixed linear models and time-varying Cox models. Gender-stratified analyses and sensitivity analyses were performed. RESULTS Refugees engaging in one type or two or more types of social participation, compared with those not engaging in any, consistently had lower psychological distress scores (β = -0.62 [95% confidence interval (CI), -1.07 to -0.17] for one type of social participation; β = -0.57 [95% CI, -1.04 to -0.10] for two or more types of social participation) and a reduced risk of experiencing psychological distress (hazard ratio [HR] = 0.81 [95% CI, 0.65-0.99] for one type of social participation; HR = 0.77 [95% CI, 0.61-0.97] for two or more types of social participation) during the resettlement period. When stratifying the results by gender, these associations in the adjusted models only remained significant in male refugees. Moreover, three specific types of social participation, namely sporting activities, leisure activities and current employment status, were most prominently associated with a reduced risk of psychological distress. CONCLUSIONS The findings of this cohort study suggest that social participation was consistently associated with reduced risks of psychological distress among male refugees during resettlement. These findings highlight the significance of promoting meaningful social participation and interaction may be an effective strategy to improve the mental health of refugees and facilitate their successful integration into society, especially among male refugees.
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Affiliation(s)
- Weiqing Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yuwei Yang
- Institute of Infectious Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, People's Republic of China
| | - Yitong He
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Qianyu Liu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xueqing Deng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yilin Hua
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Alimila Hayixibayi
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Yanyan Ni
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
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Assaf SA, Nuwayhid I, Habib RR. A conceptual framework on pre- and post-displacement stressors: the case of Syrian refugees. Front Public Health 2024; 12:1372334. [PMID: 38737863 PMCID: PMC11082271 DOI: 10.3389/fpubh.2024.1372334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Researchers have documented multiple stressors and mental health problems along the journey of refugees as they are displaced to seek refuge in nearby and remote host countries. This article examines published research on Syrian refugees to propose a framework to conceptualize Syrian refugees' pre- and post-stressors and their collective impact on their mental health. The proposed framework provides a comprehensive understanding of the interconnected pathways between pre-displacement stressors, post-displacement stressors, and mental health outcomes for Syrian refugees. Pre-displacement stressors are best captured by the concept of trauma centrality and emotional suppression. Post-displacement stressors, categorized under financial, political, and social themes, have a direct impact on the mental health of the refugees, but could also play a partial mediating role on the impact of pre-displacement stressors on mental health. The framework suggests a direct pathway between the experience of war-related traumatic events and mental health and introduces the country of residence as a potential moderator of the severity of mental health. The latter is primarily influenced by local policies and the host communities' acceptance of refugees. We believe that the proposed framework can guide the work of researchers, policymakers, and practitioners concerned with the mental health and well-being of Syrian refugees. Additionally, although based on the experience of Syrian refugees, it presents a holistic perspective that could be adapted in other refugee settings.
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Affiliation(s)
- Sara A. Assaf
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Iman Nuwayhid
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima R. Habib
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Manafe N, Ismael-Mulungo H, Ponda F, Dos Santos PF, Mandlate F, Cumbe VFJ, Mocumbi AO, Oliveira Martins MR. Prevalence and associated factors of common mental disorders among internally displaced people by armed conflict in Cabo Delgado, Mozambique: a cross-sectional community-based study. Front Public Health 2024; 12:1371598. [PMID: 38689772 PMCID: PMC11058794 DOI: 10.3389/fpubh.2024.1371598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
Background Humanitarian emergencies are a major global health challenge with the potential to have a profound impact on people's mental and psychological health. Displacement is a traumatic event that disrupts families and affects physical and psychological health at all ages. A person may endure or witness a traumatic incident, such as being exposed to war, and, as a result, develop post-traumatic stress disorder (PTSD). There is a lack of information about post-traumatic stress disorder, depression, and anxiety disorder in low and middle-income countries in humanitarian emergency contexts such as Mozambique. This study aimed to assess the prevalence of PTSD, depression, and anxiety, and associated factors among armed conflict survivors in Cabo Delgado, north region of Mozambique in 2023. Methods A community-based cross-sectional study was conducted between January and April 2023 among 750 participants, who were selected by convenience. A face-to-face interview used the Primary Care Post-Traumatic Stress Disorder Checklist (PC-PTSD-5) to evaluate PTSD, the Generalized Anxiety Disorder Scale (GAD-7) to evaluate anxiety and the Patient Health Questionnaire - Mozambique (PHQ-9 MZ) to evaluate depression. The association between PTSD and demographic and psychosocial characteristics was analyzed using bivariate and multivariable binary logistic regression. We used a 5% significance level. Results The three mental disorders assessed were highly prevalent in our sample with 74.3% PTSD, 63.8% depression, and 40.0% anxiety. The chance of developing PTSD was higher in females (AOR = 2.30, 95% CI 1.50-3.51), in patients with depression symptoms (AOR = 8.27, 95% CI = 4.97-13.74) and anxiety symptoms (AOR = 1.45, 95% CI = 0.84-2.50). Conclusion This study reported that the prevalence of PTSD, depression, and anxiety were high. Patients having depressive symptoms, anxiety symptoms, and being female are more at risk of developing PTSD. There is a need to integrate screening for common mental disorders in the context of humanitarian emergencies and its adapted integration of psychosocial interventions.
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Affiliation(s)
- Naisa Manafe
- Instituto Nacional de Saúde, Maputo, Mozambique
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Fábio Ponda
- Instituto Nacional de Saúde, Maputo, Mozambique
| | | | - Flávio Mandlate
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Vasco F. J. Cumbe
- Mental Health Department, Ministry of Health, Provincial Health Directorate of Sofala, Beira, Mozambique
| | - Ana Olga Mocumbi
- Instituto Nacional de Saúde, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Maria R. Oliveira Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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Saadi A, Prabhu M, Snyder SA, Daboul L, Mateen F. Neurological Care of Refugees and Other Forcibly Displaced Persons. Semin Neurol 2024; 44:217-224. [PMID: 38499195 PMCID: PMC11177780 DOI: 10.1055/s-0044-1782495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
There are more than 100 million forcibly displaced persons (FDPs) in the world today, including a high number of people who experience neurologic symptoms and presentations. This review summarizes the conceptual frameworks for understanding neurological health risks and conditions across the migration journey (premigration, migration journey, and postmigration) and life span, including special attention to pediatric FDPs. The interaction with psychiatric illness is discussed, as well as the available published data on neurologic presentations in FDPs in the medical literature. A social determinant of health lens is used to provide ways in which forcible displacement can influence brain health and neurological outcomes. Priorities and future needs for the neurological care of refugees and other FDPs are suggested.
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Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Meha Prabhu
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Sara A. Snyder
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lynn Daboul
- Mass General Brigham Neurology Residency Program, Boston, MA
| | - Farrah Mateen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Hossain A. Provision of healthcare services for displaced individuals globally is a pressing concern. Front Public Health 2024; 12:1344984. [PMID: 38347932 PMCID: PMC10859449 DOI: 10.3389/fpubh.2024.1344984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Affiliation(s)
- Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Wells R, Acarturk C, Mozumder MK, Kurt G, Klein L, Lekkeh SA, Beetar A, Jahan S, Almeamari F, Faruk MO, McGrath M, Alam SF, Alokoud M, Dewan R, Vecih AE, El-Dardery H, Hadzi-Pavlovic D, Hammadi H, Hamoud MAS, Hasan MT, Joshi R, Kothaa S, Lamia FKC, Mastrogiovanni C, Najjar H, Nemorin S, Nicholson-Perry K, Prokrity TS, Said Yousef R, Tawakol M, Uygun E, Yasaki W, Wong S, Zarate A, Steel Z, Rosenbaum S. Testing the effectiveness and acceptability of online supportive supervision for mental health practitioners in humanitarian settings: a study protocol for the caring for carers project. BMC Psychiatry 2023; 23:884. [PMID: 38017407 PMCID: PMC10683137 DOI: 10.1186/s12888-023-05246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/01/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Local humanitarian workers in low and middle-income countries must often contend with potentially morally injurious situations, often with limited resources. This creates barriers to providing sustainable mental health and psychosocial support (MHPSS) to displaced individuals. Clinical supervision is an often neglected part of ensuring high-quality, sustainable care. The Caring for Carers (C4C) project aims to test the effectiveness and acceptability of online group-based supportive supervision on the well-being of MHPSS practitioners, as well as service-user-reported service satisfaction and quality when working with displaced communities in Türkiye, Syria, and Bangladesh. This protocol paper describes the aim, design, and methodology of the C4C project. METHOD A quasi-experimental, mixed-method, community-based participatory research study will be conducted to test the effectiveness of online group-based supportive clinical supervision provided to 50 Syrian and 50 Bangladeshi MHPSS practitioners working with Syrian and Rohingya displaced communities. Monthly data will be collected from the practitioners and their beneficiaries during the active control (six months) and supervision period (16 months over two terms). Outcomes are psychological distress (Kessler-6), burnout (the Copenhagen Burnout Inventory), compassion fatigue, compassion satisfaction, and secondary traumatic stress (Professional Quality of Life Scale), perceived injustice, clinical self-efficacy (Counseling Activity Self-Efficacy Scale), service satisfaction, and quality (Client Satisfaction Questionnaire and an 18-item measure developed in this project). A realist evaluation framework will be used to elucidate the contextual factors, mechanisms, and outcomes of the supervision intervention. DISCUSSION There is a scarcity of evidence on the role of clinical supervision in improving the well-being of MHPSS practitioners and the quality of service they provide to displaced people. By combining qualitative and quantitative data collection, the C4C project will address the long-standing question of the effectiveness and acceptability of clinical supervision in humanitarian settings.
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Affiliation(s)
- Ruth Wells
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia.
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Türkiye
| | | | - Gülşah Kurt
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Louis Klein
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | | | | | - Sabiha Jahan
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | | | - Md Omar Faruk
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | - Michael McGrath
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Syeda Fatema Alam
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | | | - Ranak Dewan
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | | | | | - Dusan Hadzi-Pavlovic
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | | | | | - M Tasdik Hasan
- Action Lab, Department of Human Centred Computing, Faculty of Information Technology, Monash University, Melbourne, Australia
| | - Rohina Joshi
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Sowmic Kothaa
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | | | - Chiara Mastrogiovanni
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | | | - Shaun Nemorin
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Australia
| | - Kathryn Nicholson-Perry
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, Australia
| | | | | | - Mamoun Tawakol
- Department of Psychology, Koc University, Istanbul, Türkiye
| | - Ersin Uygun
- Trauma and Disaster Mental Health, Bilgi University, Istanbul, Türkiye
| | - Wael Yasaki
- Hope Revival Organization, Gaziantep, Türkiye
| | - Scarlett Wong
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Ariel Zarate
- Suicide Prevention Subgroup, Cox's Bazar, Bangladesh
| | - Zachary Steel
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Simon Rosenbaum
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
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Koshe T, Jarso MH, Walde MT, Ebrahim J, Mamo A, Esmael A, Wedajo LF, Seife S, Mohammedhussein M, Nigatu D, Debele GR, Gezmu W. A post-traumatic stress disorder among internally displaced people in sub-Saharan Africa: a systematic review. Front Psychiatry 2023; 14:1261230. [PMID: 38025413 PMCID: PMC10655091 DOI: 10.3389/fpsyt.2023.1261230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Despite the prevalence of post-traumatic disorder in internally displaced persons, which is well established, and the fact that respective international organizations are working on the issues, little attention is given in the context of sub-Saharan Africa, This study aims to review the available data about the prevalence and determinants of post-traumatic stress disorders among internally displaced people in sub-Saharan Africa. Methods Studies published in the English language that have a clear outcome of interest and are available in full text were included. Six electronic databases were searched to identify published studies on the prevalence and determinants of posttraumatic stress disorder among IDPs in sub-Saharan Africa. This includes PubMed/MEDLINE, Scopus, EMBASE, PsychInfo, and the Web of Science. All relevant studies till June, 2023 were assessed. The review was done as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-2009) and registered on PROSPERO (CRD420222997111). Results Originally, 33,138 articles were found in six databases, and finally, eleven studies were reviewed. The prevalence of post-traumatic stress disorder in sub-Saharan African countries was disproportionately presented in this review, ranging from 12.3% in Central Sudan to 85.5% in Nigeria. From a total of 11 studies, eight of them reported more than 50% of the magnitude of post-traumatic stress disorder, pointing to a higher magnitude of the prevalence of post-traumatic stress disorders in the region. The study identified numerous factors that contributed to post-traumatic stress disorder among the internally displaced population. Female gender, depression, anxiety, stress, being single, low level of educational status, experiencing or witnessing traumatic events, and psychological trauma were evidenced for their association with post-traumatic stress disorder. Conclusion These results demonstrate a higher prevalence of post-traumatic stress disorder compared to other regions of the world. The participants' socio-demographic characteristics, including age, being single, being female, and a low level of education, were identified as factors contributing to PTSD. Moreover, the review identified that depression, anxiety, and experiencing or witnessing traumatic events were also influencing factors for PTSD among IDPs. The concerned bodies need to reinforce the monitoring and evaluation of the mental health programs of IDPs in the region. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299711, CRD42022299711.
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Affiliation(s)
- Tura Koshe
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashemene, Ethiopia
| | | | - Mandaras Tariku Walde
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Jemal Ebrahim
- Department of Psychiatry, College of Health Sciences, Madda Walabu University, Shashemene, Ethiopia
| | - Aman Mamo
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashemene, Ethiopia
| | - Adem Esmael
- Department of Psychiatry, College of Health Sciences, Madda Walabu University, Robe, Ethiopia
| | - Lema Fikadu Wedajo
- Department of Midwifery, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Solomon Seife
- Department of Midwifery, College of Health Sciences, Madda Walabu University, Shashemene, Ethiopia
| | - Mustefa Mohammedhussein
- Department of Psychiatry, College of Health Sciences, Madda Walabu University, Robe, Ethiopia
| | - Desalegn Nigatu
- Department of Nursing, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Wubishet Gezmu
- Department of Nursing, College of Health Sciences, Mattu University, Mattu, Ethiopia
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Nasar S, Nadim ASM, Raz S, Jabbar A, Hossain MR, Aktar B, Rahman MS, Rashid SF. Livelihood challenges of single female household heads in the Rohingya and host communities in Cox's Bazar, Bangladesh during the COVID-19 pandemic. BMC Public Health 2023; 23:2084. [PMID: 37875875 PMCID: PMC10599043 DOI: 10.1186/s12889-023-16964-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Following the mass influx of Rohingya refugees into Cox's Bazaar, Bangladesh in 2017, makeshift settlement camps in Ukhiya and Teknaf have been overburdened, leading to livelihood challenges for both Rohingya and host communities. The humanitarian crisis has had adverse effects on vulnerable populations, which include older people, persons with disabilities, adolescents, and single female household heads. Using a subset of a larger dataset on households with most vulnerable groups in both communities, we analysed the effect of the pandemic and lockdown on the livelihood of single female household (HH) heads. METHODS A cross-sectional household roster survey was designed to collect data from households with most vulnerable groups (MVGs) of host and Rohingya communities from December 2020 to March 2021; 11 host community villages and 10 Rohingya camps purposively selected as per the affiliated intervention of the project. The paper analysed quantitative and qualitative data from the sub-group of single female household heads without any income/low income. Participants were surveyed for their socio-demographic characteristics, COVID-19 experiences and knowledge, food security situation, social experiences and mental health using PHQ-2 test for depression. RESULTS We surveyed 432 single female HH heads. Support during the pandemic was reported to be low, with less than 50% of HHs reporting relief meeting their needs; only 36% and 15% of these HHs received rations in camps and host communities respectively. Loan facilities were mostly unavailable and there were reported insufficiencies in food consumption. Over 50% of respondents tested positive on the PHQ-2, a scale used to screen for depression. Further analyses indicates that having a chronic health issue (OR 2.2, 95% CI 1.33-3.66) was positively associated with the PHQ-2 score for Rohingya single females. For host single females, having an ill member in the HH (OR 1.46, 95% CI 1.02-2.08) and the inability to save before the pandemic (OR 1.57 95% CI 1.11-2.23) increased the odds of screening positive for depression. CONCLUSION Our study findings revealed insufficiencies with economic opportunities and food security for single female-headed households, as well as a high rate of positive screening for depression amongst this population. These findings call for a more in-depth understanding of the needs of this group.
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Affiliation(s)
- Sameen Nasar
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh.
| | | | - Saifa Raz
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
| | - Abdul Jabbar
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
| | - Muhammad Riaz Hossain
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
| | - Bachera Aktar
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Shafiqur Rahman
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
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Hossain A, Bartolucci A, Hirani SAA. Editorial: Conflicts and humanitarian crises on displaced people's health. Front Public Health 2023; 11:1234576. [PMID: 37497035 PMCID: PMC10368400 DOI: 10.3389/fpubh.2023.1234576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Affiliation(s)
- Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Andrea Bartolucci
- Institute of Security and Global Affairs (ISGA), Leiden University, Leiden, Netherlands
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Mateen FJ, Hanafi I, Birbeck GL, Saadi A, Schmutzhard E, Wilmshurst JM, Silsbee H, Jones LK. Neurologic Care of Forcibly Displaced Persons: Emerging Issues in Neurology. Neurology 2023; 100:962-969. [PMID: 36859408 PMCID: PMC10186241 DOI: 10.1212/wnl.0000000000206857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/07/2022] [Indexed: 03/03/2023] Open
Abstract
There is a growing number of forcibly displaced persons (FDPs) worldwide. With more than 100 million people forcibly displaced today, there is an urgent mandate to understand the neurologic care needs of this population and how neurologists and other health care workers can most effectively provide that care. In this Emerging Issues in Neurology article, we attempt to (1) define the scope of the problem of providing neurologic care to FDPs, (2) highlight commonly encountered clinical challenges related to neurologic care of FDPs, and (3) provide useful clinical information for neurologists and other clinicians who deliver care to FDPs with neurologic needs. We address the terminology of forcible displacement and how terms may differ across a person's migration journey. Common challenges encountered by FDPs with neurologic needs across settings include loss of support systems, loss of personal health information, language barriers and differing expression of symptoms, differing belief systems, epidemiologic patterns of disease unfamiliar to the clinician, and patients' fear and perceived risks of engaging with health systems. Practical approaches are shared for clinicians who encounter an FDP with a neurologic presentation. Finally, the article discusses many unmet neurologic needs of FDPs, which require significant investment. These include addressing lapses in neurologic care during displacement and understanding the effects of forcible displacement on people with chronic neurologic conditions. Future research and educational resources should focus on improving epidemiologic intelligence for neurologic conditions across geographies, developing curricula for optimizing the neurologic care of FDPs, and evaluating the most appropriate and effective uses of health technologies in humanitarian settings.
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Affiliation(s)
- Farrah J Mateen
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Ibrahem Hanafi
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Gretchen L Birbeck
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Altaf Saadi
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Erich Schmutzhard
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Jo M Wilmshurst
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
| | - Heather Silsbee
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN.
| | - Lyell K Jones
- From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Department of Neurology (I.H.), University Hospital of Würzburg, Germany; Department of Neurology (G.L.B.), University of Rochester Medical Center, NY; Department of Neurology (A.S.), Massachusetts General Hospital, Boston; Department of Neurology (E.S.), Medical University Innsbruck, Austria; Department of Paediatric Neurology (J.M.W.), University of Cape Town, South Africa; American Academy of Neurology (H.S.), Minneapolis, MN; and Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN
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Ritsema H, Armstrong-Hough M. Associations among past trauma, post-displacement stressors, and mental health outcomes in Rohingya refugees in Bangladesh: A secondary cross-sectional analysis. Front Public Health 2023; 10:1048649. [PMID: 36726616 PMCID: PMC9885485 DOI: 10.3389/fpubh.2022.1048649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Abstract
Objective The Rohingya endured intense trauma in Myanmar and continue to experience trauma related to displacement in Bangladesh. We aimed to evaluate the association of post-displacement stressors with mental health outcomes, adjusting for previously experienced trauma, in the Rohingya refugee population in Cox's Bazar, Bangladesh. Methods We analyzed data from the Cox's Bazar Panel Survey, a cross sectional survey consisting of 5,020 household interviews and 9,386 individual interviews completed in 2019. Using logistic regression, we tested the association between post-displacement stressors such as current exposure to crime and conflict and two mental health outcomes: depression and post-traumatic stress disorder (PTSD). In adjusted analyses, we controlled for past trauma, employment status, receiving an income, food security, and access to healthcare and stratified by gender. Results The prevalence of depressive symptoms was 30.0% (n = 1,357) and PTSD 4.9% (n = 218). Most (87.1%, n = 3,938) reported experiencing at least one traumatic event. Multiple post-displacement stressors, such as current exposure to crime and conflict (for men: OR = 2.23, 95% CI = 1.52-3.28, p < 0.001; for women: OR = 1.92, 95% CI = 1.44-2.56, p < 0.001), were associated with higher odds of depressive symptoms in multivariable models. Trauma (OR = 4.98, 95% CI = 2.20-11.31, p < 0.001) was associated with increased odds of PTSD. Living in a household that received income was associated with decreased odds of PTSD (OR = 0.74, 95% CI = 0.55-1.00, p = 0.05). Conclusion Prevalence of depressive symptoms was high among Rohingya refugees living in Cox's Bazar. Adjusting for past trauma and other risk factors, exposure to post-displacement stressors was associated with increased odds of depressive symptoms. There is a need to address social determinants of health that continue to shape mental health post-displacement and increase mental healthcare access for displaced Rohingya.
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Affiliation(s)
- Haley Ritsema
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States,*Correspondence: Haley Ritsema ✉
| | - Mari Armstrong-Hough
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States,Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, United States
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Rofo S, Gelyana L, Moramarco S, Alhanabadi LHH, Basa FB, Dellagiulia A, Emberti Gialloreti L. Prevalence and risk factors of posttraumatic stress symptoms among Internally Displaced Christian couples in Erbil, Iraq. Front Public Health 2023; 11:1129031. [PMID: 37033064 PMCID: PMC10076725 DOI: 10.3389/fpubh.2023.1129031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Background Research about the impact of war and displacement experiences on the mental health of Internally Displaced People (IDPs) has recently grown. However, a limited number of studies focus on minorities. The objective of the present preliminary study was to estimate the prevalence of posttraumatic stress symptoms (PTSSs) among IDPs who live outside camps and belong to the Christian minority in Iraq, and to identify possible predictors. Methods Overall, 108 internally displaced Christians (54 married couples) participated in the study. Traumatic events and PTSSs were assessed using the Harvard Trauma Questionnaire. Multivariable linear regression models were used to investigate possible predictors of PTSSs. Multivariable logistic regression models have been developed to estimate the odds of presenting PTSSs. Results Results demonstrated high rates of trauma exposure, with all participants having experienced at least three traumatic events. The estimated prevalence of PTSSs was 20.3%. A low economic status, the number of traumatic events, and a second experience of displacement were associated with increased PTSSs. Five traumatic events were identified as the main predictors of PTSSs. Conclusion Findings from the current preliminary study indicated the impact of war-related traumatic events on IDPs' mental health and the negative effects of post-displacement experiences. These findings may have important implications for setting up psychosocial interventions, as well as for further promoting physical and mental health services among these populations.
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Affiliation(s)
- Sana Rofo
- Department of Psychology, Salesian University of Rome, Rome, Italy
| | - Lina Gelyana
- Department of Psychology, Salesian University of Rome, Rome, Italy
| | - Stefania Moramarco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Luma H. H. Alhanabadi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Primary Health Care, Preventive Health Affairs Directorate, Duhok, Iraq
| | - Faiq B. Basa
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Internal Medicine Department, Rizgary Teaching Hospital, Erbil, Iraq
| | | | - Leonardo Emberti Gialloreti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- *Correspondence: Leonardo Emberti Gialloreti
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Duffey MM, Patel T, Koukaz Y, Sepulveda T, Barbour K, Fredricks K, Weatherhead JE. The impact of neglected tropical diseases on women and girl refugees: A call for increased awareness and strategic intervention. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.1095174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
As the number of forcibly displaced women and girls increases, it becomes ever important to recognize the negative health impacts of being displaced. Women and girl refugees are disproportionately affected by sexual and gender-based violence and mental health concerns. In addition to these health concerns in women, crowding and lack of clean water in refugee camps leads to the spread of infectious diseases in general. Neglected tropical diseases (NTDs) are infectious diseases of poverty found in tropical areas, and longstanding infections lead to significant morbidity. Particularly for women, these diseases can impact fertility, chronic disease in pregnancy, and social stigma. Despite being a high-risk group, there are minimal data on the impact of NTDs on the health of Women and girl refugees. Diseases such as schistosomiasis, soil-transmitted helminth infections, strongyloidiasis, and leishmaniasis have all been shown to affect Women and girl refugees, but the majority of these data describe NTDs in this population only after resettlement. Access to medical care with providers that are knowledgeable about NTDs while in situations of displacement as well as after third-country resettlement is crucial to their timely diagnosis and treatment to prevent longstanding sequalae. More studies in this at-risk population are needed to understand the extent of this issue and begin to work towards lasting, equitable healthcare.
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Rivara FP, Haneuse SJPA, Morris AM, Fihn SD. Call for Papers on the Effects of War on Health and Health Care Delivery, Access, and Equity. JAMA Netw Open 2022; 5:e2217872. [PMID: 35622371 DOI: 10.1001/jamanetworkopen.2022.17872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Frederick P Rivara
- Department of Pediatrics, University of Washington, Seattle
- Editor, JAMA Network Open
| | - Sebastien J P A Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Statistical Editor, JAMA Network Open
| | - Arden M Morris
- Department of Surgery, Stanford University School of Medicine, Stanford, California
- Associated Editor, JAMA Network Open
| | - Stephan D Fihn
- Department of Medicine, University of Washington, Seattle
- Deputy Editor, JAMA Network Open
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Al-Rousan T, AlHeresh R, Saadi A, El-Sabrout H, Young M, Benmarhnia T, Han BH, Alshawabkeh L. Epidemiology of cardiovascular disease and its risk factors among refugees and asylum seekers: Systematic review and meta-analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION 2022; 12:200126. [PMID: 35199106 PMCID: PMC8851152 DOI: 10.1016/j.ijcrp.2022.200126] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/31/2021] [Accepted: 01/28/2022] [Indexed: 01/10/2023]
Abstract
Background Methods and results Conclusions
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Affiliation(s)
- Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Corresponding author. Herbert Wertheim School of Public Health, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - Rawan AlHeresh
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hannah El-Sabrout
- University of California San Francisco Medical School, San Francisco, CA, USA
| | - Megan Young
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Benjamin H. Han
- Division of Geriatrics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Laith Alshawabkeh
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA
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Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity, University of California, San Diego
| | - Rawan AlHeresh
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts
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