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Mohammadi M, Jafari H, Etemadi M, Dalugoda Y, Mohtady Ali H, Phung H, Ahmadvand A, Dwirahmadi F, Barnes P, Chu C. Health Problems of Increasing Man-Made and Climate-Related Disasters on Forcibly Displaced populations: A Scoping Review on Global Evidence. Disaster Med Public Health Prep 2023; 17:e537. [PMID: 37994107 DOI: 10.1017/dmp.2023.159] [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] [Indexed: 11/24/2023]
Abstract
Forcibly displaced populations are among the most vulnerable groups in disasters. They experience poorer health conditions compared with nondisplaced individuals. However, a clear picture is lacking regarding the overall health problems encountered by disaster-induced mid- to long-term displaced people. This study investigated these disorders prevalence and identified their correlates among long-settled displaced populations worldwide. The current scoping review follows the PRISMA-ScR guidelines; a systematic search was conducted on PubMed, Web of Science, and CINAHL and included original peer-reviewed studies, commentary, reviews, and grey literature published in English between January 1990 to June 2022. In the thematic and content analysis, the authors applied the narrative review approach to identify themes and sub-themes. Forty-eight documents were identified as fully relevant to this study. The largest number of published papers were from Asia, followed by the Middle East, the United States, and Europe. IDPs in developed countries were the most researched populations. Human-made disasters were addressed by 89% of the included studies. The four main thematic categories included were "physical health," "mental health," "inadequate facilities," and "lack of healthy behaviour." The worsening of noncommunicable diseases had the highest prevalence, followed by communicable diseases. Due to their condition, forcibly displaced migrants face a triple burden of communicable diseases and noncommunicable diseases such as mental health issues. Health-related research and policy need to consider the links among disasters, health problems, and forced migration as a determinant of health in the new era of climate change-driven displacements.
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Affiliation(s)
- Mahan Mohammadi
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Hamid Jafari
- Department of Medical Emergencies, School of Medical Sciences, Sirjan, Iran
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Manal Etemadi
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Yohani Dalugoda
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Heba Mohtady Ali
- Cities Research Institute & School of Engineering and Built Environment, Griffith University, Gold Coast, Australia
| | - Hai Phung
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Alireza Ahmadvand
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Febi Dwirahmadi
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Paul Barnes
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Cordia Chu
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
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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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Mateen FJ. Progress towards the 2030 sustainable development goals: direct and indirect impacts on neurological disorders. J Neurol 2022; 269:4623-4634. [PMID: 35583660 DOI: 10.1007/s00415-022-11180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
The United Nations' Sustainable Development Goals (SDGs) were set forth in 2015 as a blueprint for all nations to create a more sustainable future together. These 17 social, environmental, and economic goals have established targets to meet globally by the year 2030, with a focus on pro-poor initiatives, gender equality, and ending hunger. The relationship of the SDGs with neurological disorders and how the achievement of the SDGs intersects with the future of neurological practice have not been comprehensively examined. However, the incidence of neurological disorders, the outcomes of people living with neurological disorders, and the training of future neurologists can be interlinked, directly or indirectly, with programming for the SDGs and their eventual achievement. Each SDG is reviewed in the context of neurology. This lens can inform programming and policy, enhance research and training, and improve inter-sectoral action for neurological disorders worldwide.
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Affiliation(s)
- Farrah J Mateen
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, 165 Cambridge Street, #627, Boston, MA, 02114, USA.
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4
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Rezaei S, Sakadi F, Hiew FL, Rodriguez-Leyva I, Kruja J, Wasay M, Seidi OA, Abdel-Aziz S, Nafissi S, Mateen F. Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach. Gates Open Res 2022; 5:178. [PMID: 35299829 PMCID: PMC8901583 DOI: 10.12688/gatesopenres.13447.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person's country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.
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Affiliation(s)
- Shawheen Rezaei
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, 02114, USA
| | | | - Fu-Liong Hiew
- Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Ildefonso Rodriguez-Leyva
- Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
- Neurology, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
| | - Jera Kruja
- Neurology, University of Medicine, Tirana, Tirana, Albania
- Neurology, University Hospital Center Mother Teresa, Tirana, Albania
| | - Mohammad Wasay
- Neurology, Aga Khan University Hospital, Karachi, Pakistan
| | - Osheik AbuAsha Seidi
- University of Khartoum, Khartoum, Sudan
- Neurology, Soba University Hospital, Khartoum, Sudan
| | | | - Shahriar Nafissi
- Neurology, Tehran University of Medical Sciences, Tehran, Iran
- Neurology, Shariati Hospital, Tehran, Iran
| | - Farrah Mateen
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, 02114, USA
- Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Global Working Group for Refugees with Neurological Needs
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, 02114, USA
- General Hospital of National Reference, N'Djamena, Chad
- Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
- Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
- Neurology, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology, University of Medicine, Tirana, Tirana, Albania
- Neurology, University Hospital Center Mother Teresa, Tirana, Albania
- Neurology, Aga Khan University Hospital, Karachi, Pakistan
- University of Khartoum, Khartoum, Sudan
- Neurology, Soba University Hospital, Khartoum, Sudan
- Médecins Sans Frontières, Amman, Jordan
- Neurology, Tehran University of Medical Sciences, Tehran, Iran
- Neurology, Shariati Hospital, Tehran, Iran
- Harvard Medical School, Boston, Massachusetts, 02115, USA
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5
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Rezaei S, Sakadi F, Hiew FL, Rodriguez-Leyva I, Kruja J, Wasay M, Seidi OA, Abdel-Aziz S, Nafissi S, Mateen F. Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach. Gates Open Res 2021; 5:178. [PMID: 35299829 PMCID: PMC8901583 DOI: 10.12688/gatesopenres.13447.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 08/26/2024] Open
Abstract
Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person's country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.
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Affiliation(s)
- Shawheen Rezaei
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, 02114, USA
| | | | - Fu-Liong Hiew
- Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Ildefonso Rodriguez-Leyva
- Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
- Neurology, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
| | - Jera Kruja
- Neurology, University of Medicine, Tirana, Tirana, Albania
- Neurology, University Hospital Center Mother Teresa, Tirana, Albania
| | - Mohammad Wasay
- Neurology, Aga Khan University Hospital, Karachi, Pakistan
| | - Osheik AbuAsha Seidi
- University of Khartoum, Khartoum, Sudan
- Neurology, Soba University Hospital, Khartoum, Sudan
| | | | - Shahriar Nafissi
- Neurology, Tehran University of Medical Sciences, Tehran, Iran
- Neurology, Shariati Hospital, Tehran, Iran
| | - Farrah Mateen
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, 02114, USA
- Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Global Working Group for Refugees with Neurological Needs
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, 02114, USA
- General Hospital of National Reference, N'Djamena, Chad
- Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
- Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
- Neurology, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
- Neurology, University of Medicine, Tirana, Tirana, Albania
- Neurology, University Hospital Center Mother Teresa, Tirana, Albania
- Neurology, Aga Khan University Hospital, Karachi, Pakistan
- University of Khartoum, Khartoum, Sudan
- Neurology, Soba University Hospital, Khartoum, Sudan
- Médecins Sans Frontières, Amman, Jordan
- Neurology, Tehran University of Medical Sciences, Tehran, Iran
- Neurology, Shariati Hospital, Tehran, Iran
- Harvard Medical School, Boston, Massachusetts, 02115, USA
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6
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Amiri M, Peinkhofer C, Othman MH, De Vecchi T, Nersesjan V, Kondziella D. Global warming and neurological practice: systematic review. PeerJ 2021; 9:e11941. [PMID: 34430087 PMCID: PMC8349167 DOI: 10.7717/peerj.11941] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background Climate change, including global warming, will cause poorer global health and rising numbers of environmental refugees. As neurological disorders account for a major share of morbidity and mortality worldwide, global warming is also destined to alter neurological practice; however, to what extent and by which mechanisms is unknown. We aimed to collect information about the effects of ambient temperatures and human migration on the epidemiology and clinical manifestations of neurological disorders. Methods We searched PubMed and Scopus from 01/2000 to 12/2020 for human studies addressing the influence of ambient temperatures and human migration on Alzheimer’s and non-Alzheimer’s dementia, epilepsy, headache/migraine, multiple sclerosis, Parkinson’s disease, stroke, and tick-borne encephalitis (a model disease for neuroinfections). The protocol was pre-registered with PROSPERO (2020 CRD42020147543). Results Ninety-three studies met inclusion criteria, 84 of which reported on ambient temperatures and nine on migration. Overall, most temperature studies suggested a relationship between increasing temperatures and higher mortality and/or morbidity, whereas results were more ambiguous for migration studies. However, we were unable to identify a single adequately designed study addressing how global warming and human migration will change neurological practice. Still, extracted data indicated multiple ways by which these aspects might alter neurological morbidity and mortality soon. Conclusion Significant heterogeneity exists across studies with respect to methodology, outcome measures, confounders and study design, including lack of data from low-income countries, but the evidence so far suggests that climate change will affect the practice of all major neurological disorders in the near future. Adequately designed studies to address this issue are urgently needed, requiring concerted efforts from the entire neurological community.
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Affiliation(s)
- Moshgan Amiri
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Costanza Peinkhofer
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Medical Faculty, University of Trieste, Trieste, Italy
| | - Marwan H Othman
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Teodoro De Vecchi
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Medical Faculty, University of Trieste, Trieste, Italy
| | - Vardan Nersesjan
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Garry S, Checchi F. Armed conflict and public health: into the 21st century. J Public Health (Oxf) 2021; 42:e287-e298. [PMID: 31822891 DOI: 10.1093/pubmed/fdz095] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/10/2019] [Accepted: 07/21/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Many people worldwide are affected by conflict, and countries affected are less likely to meet the UN Sustainable Development Goals. This review outlines the effects of conflict on health and focuses on areas requiring more attention. METHODS We completed a search of the literature using Medline, Embase and Global Health. RESULTS Health effects of conflict include trauma; mental health; non-communicable diseases (NCDs); child health; sexual, reproductive and maternal health; and infectious diseases. Conflict damages health directly through fighting, and indirectly through wider socioeconomic effects. Health outcomes are influenced by pre-existing population health and demographics, and access to appropriate healthcare. Vulnerable populations (the elderly, children, neonates and women) are especially at risk. CONCLUSION Several areas pose key challenges including: tactics of war as a public health problem; a lack of focus on neonatal care and NCDs; the long-term consequences of conflict across a life-course and into future generations; and the need to focus on wellbeing beyond standard health parameters. Clear decisions about prioritisation need to be made. The effects on civilians must be documented and recorded. Further research is required to understand chronic health needs and effects on future generations, to support fair and equitable resource prioritisation to best meet the needs of conflict-affected populations.
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Affiliation(s)
- S Garry
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.,Chatham House, London SW1Y 4LE, UK
| | - F Checchi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.,Chatham House, London SW1Y 4LE, UK
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8
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Mateen FJ. Toward Minimum Standards Guidelines for the Delivery of Neurological Care in Complex Humanitarian Settings. JAMA Neurol 2019; 76:394-395. [PMID: 30688970 DOI: 10.1001/jamaneurol.2018.4596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Farrah J Mateen
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston
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9
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Brinckmann MP, van Noort BM, Leithner C, Ploner CJ. Neurological Emergencies in Refugees. Front Neurol 2018; 9:1088. [PMID: 30643500 PMCID: PMC6298418 DOI: 10.3389/fneur.2018.01088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/28/2018] [Indexed: 01/14/2023] Open
Abstract
Objective: Health care personnel in Europe is increasingly involved in care of displaced persons from non-European countries; we investigated the spectrum of neurological disorders and medical management in refugees presenting to the emergency room (ER) of a German university hospital. Methods: We retrospectively studied ER-patients with refugee status (R-patients) during the peak of the European refugee crisis between July 2015 and February 2016 (N = 100). Complaints on admission, medical management and diagnoses at discharge were compared to matched groups of German residents with migrational background (M-patients; N = 96) and to native Germans (N-patients; N = 95). Results: R-patients were mostly male young adults (75% male; mean age 33.2 years). Headache was the most frequent complaint in all groups (R-patients 38%; M-patients 43%; N-patients 24%). R-patients, however, presented much more often with possible or definite seizures (R-patients 27%; M-patients 9%; N-patients 15%). Initial triage, length of medical history and examination records, utilization of laboratory tests and cranial imaging did not differ between groups. However, time to diagnosis was considerably longer in R-patients (220 min; M-patients 151 min, N-patients 123 min). While strokes and other life-threatening emergencies were rare final diagnoses in R-patients, a substantial proportion was discharged with a diagnosis of non-epileptic seizures or a psychiatric disorder (20%; M-patients 6%; N-patients 7%). Conclusions: Refugee patients present with a spectrum of neurological disorders that not solely results from cultural differences but rather reflects the consequences of forced displacement. ER management of refugees requires more time, language skills and critically depends on psychosomatic/psychiatric expertise.
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Affiliation(s)
- Marie P Brinckmann
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Betteke M van Noort
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Leithner
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph J Ploner
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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10
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The Role of Oral Health in Complex Emergencies and Disaster Rehabilitation Medicine. Disaster Med Public Health Prep 2018; 12:772-777. [PMID: 29463334 DOI: 10.1017/dmp.2018.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper presents an overview of the importance of oral health in complex emergencies. It highlights the importance of maintaining general and oral health in the acute, intermediate and long-term phases of such events which are increasing in frequency. The importance of oral health as an early warning sign for systemic disease and deprivation is also explored along with the crucial role of oral health in maintaining quality of life through adequate nutrition and speech. The overview of oral health in these situations identifies the need for training dental personnel as members of rehabilitation teams that set out to manage these disasters. They can quickly help in improving quality of life for victims by extracting carious and painful teeth as necessary, and also form part of an oral health education program for aid agencies. They can also be the first to identify systemic diseases like HIV and may also play a role in identifying victims of abuse, as non-accidental injuries can frequently present in the oro-facial region. The oral health overview concludes by describing the contents of innovative oral health packs that are tailored to prevention of dental diseases and that can be readily incorporated as part of food packs distributed by aid agencies. (Disaster Med Public Health Prepardness. 2018;12:772-777).
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11
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Saadi A, Mateen FJ. International Issues: Teleneurology in humanitarian crises: Lessons from the Médecins Sans Frontières experience. Neurology 2017; 89:e16-e19. [PMID: 28716879 DOI: 10.1212/wnl.0000000000004114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Humanitarian emergencies defined by armed conflict, political strife, famine, or natural disaster can devastate populations rapidly. Neurologic disorders accompany these complex humanitarian emergencies but often go unheeded, exacerbated by a scarcity of neurologists. Teleneurology offers the promise of neurologic care remotely in the face of this inadequate local clinician supply. We describe our experiences as voluntary neurology teleconsultants with Médecins Sans Frontières in order to highlight both the promises and challenges of teleneurology in humanitarian contexts. We identified the major advantages of this service as (1) minimal resources and incurred costs while (2) changing a patient's clinical course favorably, and (3) creating a community for the field referrer and neurology specialist. Current challenges include (1) limited diagnostic resources and difficult diagnostic and therapeutic decision-making, (2) need for greater continuity and familiarity between the field site and neurologist, (3) gaps in the US neurology curriculum to provide expertise for all sites, (4) lack of follow-up and feedback from the field to advise future cases, and (5) low frequency of consultations. Growth opportunities include eventual expansion to the development of a community of neurologists who can provide context-specific care and maximize use of multimedia at low Internet bandwidth. Lessons from our experience may help optimize teleneurology's effect and reduce disparities in neurologic care, particularly in humanitarian crises.
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Affiliation(s)
- Altaf Saadi
- From Partners Neurology Residency (A.S.), Massachusetts General Hospital (F.J.M.) and Brigham and Woman's Hospital; and Harvard Medical School (F.J.M.), Boston, MA.
| | - Farrah J Mateen
- From Partners Neurology Residency (A.S.), Massachusetts General Hospital (F.J.M.) and Brigham and Woman's Hospital; and Harvard Medical School (F.J.M.), Boston, MA
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Measuring functioning and disability after a disaster: results from the typhoon Haiyan/Yolanda-affected areas of the Philippines. Int J Rehabil Res 2016; 39:267-71. [DOI: 10.1097/mrr.0000000000000181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Etienne M, Alessi AG. Disaster neurology: A new practice opportunity and challenge for the neurologist. Neurol Clin Pract 2013; 3:493-500. [PMID: 30107026 DOI: 10.1212/01.cpj.0000436212.11132.c7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Headlines are filled with stories of the physical disability and loss of life that results from both natural and man-made disasters. The role of a neurologist as part of the response to these tragedies has moved from a supportive role to the front line. Recent earthquakes in Haiti and Japan as well as military conflicts in Iraq and Afghanistan have demonstrated an increased need for nonsurgical neurologic care. Disaster neurology has become attractive to neurologists at many stages of their careers. Employed, academic, and private practice neurologists all have the potential to embrace this opportunity to apply their clinical skills to help others in need of care. Neurologists interested in engaging in disaster relief efforts should have the ability to respond to a situation quickly with the flexibility of devoting several weeks to the response effort.
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Affiliation(s)
- Mill Etienne
- New York Medical College (ME), Bon Secours Charity Health System, Suffern; and the Departments of Neurology and Kinesiology (AGA), The William W. Backus Hospital, University of Connecticut, Norwich
| | - Anthony G Alessi
- New York Medical College (ME), Bon Secours Charity Health System, Suffern; and the Departments of Neurology and Kinesiology (AGA), The William W. Backus Hospital, University of Connecticut, Norwich
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Rosewell A, Clark G, Mabong P, Ropa B, Posanai E, Man NWY, Dutta SR, Wickramasinghe W, Qi L, Ng JC, Mola G, Zwi AB, MacIntyre CR. Concurrent outbreaks of cholera and peripheral neuropathy associated with high mortality among persons internally displaced by a volcanic eruption. PLoS One 2013; 8:e72566. [PMID: 24023752 PMCID: PMC3759368 DOI: 10.1371/journal.pone.0072566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 07/10/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In October 2004, Manam Island volcano in Papua New Guinea erupted, causing over 10 000 villagers to flee to internally displaced person (IDP) camps, including 550 from Dugulaba village. Following violence over land access in March 2010, the IDPs fled the camps, and four months later concurrent outbreaks of acute watery diarrhea and unusual neurological complaints were reported in this population. MATERIALS AND METHODS A retrospective case-control study was conducted to identify the risk factors for peripheral neuropathy. Rectal swabs were collected from cases of acute watery diarrhea. Hair and serum metals and metalloids were analyzed by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). RESULTS There were 17 deaths among the 550 village inhabitants during the outbreak period at a crude mortality rate 21-fold that of a humanitarian crisis. Vibrio cholerae O1 El Tor Ogawa was confirmed among the population. Access to community-level rehydration was crucial to mortality. Peripheral neuropathy was diagnosed among cases with neurological symptoms. A balanced diet was significantly protective against neuropathy. A dose-response relationship was seen between peripheral neuropathy and a decreasing number of micronutrient- rich foods in the diet. Deficiencies in copper, iron, selenium and zinc were identified among the cases of peripheral neuropathy. CONCLUSIONS Cholera likely caused the mostly preventable excess mortality. Peripheral neuropathy was not caused by cholera, but cholera may worsen existing nutritional deficiencies. The peripheral neuropathy was likely caused by complex micronutrient deficiencies linked to non-diversified diets that potentially increased the vulnerability of this population, however a new zinc-associated neuropathy could not be ruled out. Reoccurrence can be prevented by addressing the root cause of displacement and ensuring access to arable land and timely resettlement.
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Affiliation(s)
- Alexander Rosewell
- World Health Organization, Port Moresby, National Capital District (NCD), Papua New Guinea
- School of Public Health and Community Medicine, The University of New South Wales, New South Wales, Sydney, NSW, Australia
- * E-mail:
| | - Geoff Clark
- World Health Organization, Port Moresby, National Capital District (NCD), Papua New Guinea
| | - Paul Mabong
- Provincial Health Office, Madang, Madang Province, Papua New Guinea
| | - Berry Ropa
- National Department of Health, Port Moresby, NCD, Papua New Guinea
| | - Enoch Posanai
- National Department of Health, Port Moresby, NCD, Papua New Guinea
| | - Nicola W. Y. Man
- School of Public Health and Community Medicine, The University of New South Wales, New South Wales, Sydney, NSW, Australia
| | - Samir R. Dutta
- Pathology Department, Port Moresby General Hospital, Port Moresby, NCD, Papua New Guinea
| | - Wasa Wickramasinghe
- The University of Queensland, National Research Centre for Environmental Toxicology, Coopers Plains, Queensland, Australia
| | - Lixia Qi
- The University of Queensland, National Research Centre for Environmental Toxicology, Coopers Plains, Queensland, Australia
| | - Jack C. Ng
- The University of Queensland, National Research Centre for Environmental Toxicology, Coopers Plains, Queensland, Australia
| | - Glen Mola
- University of Papua New Guinea, Port Moresby, NCD, Papua New Guinea
| | - Anthony B. Zwi
- School of Public Health and Community Medicine, The University of New South Wales, New South Wales, Sydney, NSW, Australia
| | - C. Raina MacIntyre
- School of Public Health and Community Medicine, The University of New South Wales, New South Wales, Sydney, NSW, Australia
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Rathore FA, Gosney JE, Reinhardt JD, Haig AJ, Li J, DeLisa JA. Medical rehabilitation after natural disasters: why, when, and how? Arch Phys Med Rehabil 2012; 93:1875-81. [PMID: 22676904 DOI: 10.1016/j.apmr.2012.05.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
Abstract
Natural disasters can cause significant numbers of severe, disabling injuries, resulting in a public health emergency and requiring foreign assistance. However, since medical rehabilitation services are often poorly developed in disaster-affected regions and not highly prioritized by responding teams, physical and rehabilitation medicine (PRM) has historically been underemphasized in global disaster planning and response. Recent development of the specialties of "disaster medicine" and "disaster rehabilitation" has raised awareness of the critical importance of rehabilitation intervention during the immediate postdisaster emergency response. The World Health Organization Liaison Sub-Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine has authored this report to assess the role of emergency rehabilitation intervention after natural disasters based on current scientific evidence and subject matter expert accounts. Major disabling injury types are identified, and spinal cord injury, limb amputation, and traumatic brain injury are used as case studies to exemplify the challenges to effective management of disabling injuries after disasters. Evidence on the effectiveness of disaster rehabilitation interventions is presented. The authors then summarize the current state of disaster-related research, as well as lessons learned from PRM emergency rehabilitation response in recent disasters. Resulting recommendations for greater integration of PRM services into the immediate emergency disaster response are provided. This report aims to stimulate development of research and practice in the emerging discipline of disaster rehabilitation within organizations that provide medical rehabilitation services during the postdisaster emergency response.
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Affiliation(s)
- Farooq A Rathore
- International Society of Physical and Rehabilitation Medicine, Rehabilitation Disaster Relief Committee, Geneva, Switzerland.
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Mateen FJ, Carone M, Nyce S, Ghosn J, Mutuerandu T, Al-Saedy H, Lowenstein DH, Burnham G. Neurological disorders in Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System. J Neurol 2011; 259:694-701. [PMID: 21952870 DOI: 10.1007/s00415-011-6248-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 09/05/2011] [Accepted: 09/08/2011] [Indexed: 10/17/2022]
Abstract
The United Nations High Commissioner for Refugees (UNHCR) recognizes 43.7 million forcibly displaced persons and asylum seekers due to conflict and persecution worldwide. Neurological disorders have rarely been described in displaced persons but likely pose a significant burden of disease. We describe the disease spectrum and health service utilization of Iraqi refugees and asylum seekers with neurological disorders using an information system developed by the UNHCR. Neurological disorders were actively monitored among the 7,642 UNHCR-registered Iraqi refugees and asylum seekers who received health and humanitarian assistance using a pilot, centralized, database called the Refugee Assistance Information System (RAIS) in the Kingdom of Jordan in 2010. There were 122 neurological diagnoses reported in 1,328 refugees (mean age 41 years, 49% female, 10% disabled, 43% with pending resettlement applications) in 2,659 health visits, accounting for 17% of all refugees who sought health assistance in RAIS. Referral to a neurologist occurred in 178 cases (13.4%). The most frequent ICD-10 neurological diagnoses were dorsalgia (back pain) (29.7% of individuals with neurological disorders), headache (13.1%), and epilepsy (12.6%). Approximately 1 in 20 Iraqi refugees with a neurological diagnosis self-reported a history of torture, which was higher than Iraqi refugees without a history of torture [66/1,328 versus 196/6,314, odds ratio (OR) = 1.63, 95% confidence interval (CI) 1.21-2.18]. Neurological disease affects a high proportion of Iraqi refugees, including victims of torture and the disabled. Refugees require dedicated care for treatment of neurological disease with a focus on pain disorders and epilepsy.
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Affiliation(s)
- Farrah J Mateen
- Department of International Health, The Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA.
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