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Birtan D, Akpinar A. Ethical challenges in organ transplants for refugees in a healthcare system. Nurs Ethics 2024:9697330241230528. [PMID: 38321969 DOI: 10.1177/09697330241230528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Several ethical issues are associated with providing living organ transplantation services, and there is limited information on these issues faced by the teams providing service to refugees or asylum seekers. AIM To determine the challenges healthcare professionals face in organ transplant centers providing services to Syrians under temporary protection status and discern whether these difficulties align with ethical issues in living organ transplantation. RESEARCH DESIGN This study employed a qualitative design and conducted individual semi-structured, in-depth interviews with 18 transplant team members in Istanbul between September and November 2022. Data analysis was based on Braun and Clarke's thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT The participants comprised 18 healthcare professionals, including 6 physicians and 12 nurses working in organ transplant teams in Istanbul. ETHICAL CONSIDERATIONS The University's Ethics Committee provided approval. Participants were informed regarding confidentiality and signed an informed consent form. RESULTS Three themes emerged from the data on ethical issues faced by organ transplantation services to Syrians: (a) beneficence or double equipoise, (b) autonomy, and (c) justice. Transplant teams experience problems related to preserving double equipoise in the provision of living donor organ transplantation because of language barriers, poor socioeconomic conditions, and cultural factors, which increases transplant teams' individual and indirect social burden. Although problems arise from the language barrier when obtaining informed consent in the autonomy theme, institutional and national policies in preventing donor abuse have a comforting effect. Health workers had the least problems with the justice theme, wherein national health policies are determined. CONCLUSION Fewer issues related to autonomy and justice were reported in providing organ transplantation services to Syrians, with the most intense reported issues being maintaining double equipoise. The results revealed the need to develop institutional, national, and international policies with individual solutions to prevent difficulties healthcare professionals face in this process.
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Affiliation(s)
- Deniz Birtan
- Kocaeli University
- İstanbul University-Cerrahpaşa
| | - Aslihan Akpinar
- Department of History of Medicine and Ethics, School of Medicine, Kocaeli University, Kocaeli
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Scales SE, Park JW, Nixon R, Guha-Sapir D, Horney JA. Chickenpox Outbreaks in Three Refugee Camps on Mainland Greece, 2016-2017: A Retrospective Study. Prehosp Disaster Med 2024; 39:3-12. [PMID: 38108128 PMCID: PMC10882556 DOI: 10.1017/s1049023x23006702] [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: 12/19/2023]
Abstract
INTRODUCTION Displaced populations face disproportionately high risk of communicable disease outbreaks given the strains of travel, health care circumstances in their country of origin, and limited access to health care in receiving countries. STUDY OBJECTIVE Understanding the role of demographic characteristics in outbreaks is important for timely and efficient control measures. Accordingly, this study assesses chickenpox outbreaks in three large refugee camps on mainland Greece from 2016 - 2017, using clinical line-list data from Médecins du Monde (MdM) clinics. METHODS Clinical line-list data from MdM clinics operating in Elliniko, Malakasa, and Raidestos camps in mainland Greece were used to characterize chickenpox outbreaks in these camps. Logistic regression was used to compare the odds of chickenpox by sex, camp, and yearly increase in age. Incidences were calculated for age categories and for sex for each camp outbreak. RESULTS Across camps, the median age was 19 years (IQR: 7.00 - 30.00 years) for all individuals and five years (IQR: 2.00 - 8.00 years) for cases. Males were 55.94% of the total population and 51.32% of all cases. There were four outbreaks of chickenpox across Elliniko (n = 1), Malakasa (n = 2), and Raidestos (n = 1) camps. The odds of chickenpox when controlling for age and sex was lower for Malakasa (OR = 0.46; 95% CI, 0.38 - 0.78) and Raidestos (OR = 0.36; 95% CI, 0.24 - 0.56) when compared Elliniko. Odds of chickenpox were comparable between Malakasa and Raidestos (OR = 1.49; 95% CI, 0.92 - 2.42). Across all camps, the highest incidence was among children zero-to-five years of age. The sex-specific incidence chickenpox was higher for males than females in Elliniko and Malakasa, while the incidence was higher among females in Raidestos. CONCLUSION As expected, individuals five years of age and under made up the majority of chickenpox cases. However, 12% of cases were teenagers or older, highlighting the need to consider atypical age groups in vaccination strategies and control measures. To support both host and displaced populations, it is important to consider risk-reduction needs for both groups. Including host communities in vaccination campaigns and activities can help reduce the population burden of disease for both communities.
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Affiliation(s)
| | - Jee Won Park
- Epidemiology Program, University of Delaware, Newark, Delaware, USA
| | - Rebecca Nixon
- Department of Geography and Spatial Sciences, University of Delaware, Newark, Delaware, USA
| | - Debarati Guha-Sapir
- Division of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ibrahim N, Zein M, Abdel Sater AH, El Khatib O, Tayyara L. Syrian Refugees Seeking Hospital Care in Beirut: A Cross-Sectional Study of Reasons for Hospital Admissions. Cureus 2023; 15:e42276. [PMID: 37605675 PMCID: PMC10440193 DOI: 10.7759/cureus.42276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Lebanon has the highest Syrian refugee density worldwide. The influx of Syrian refugees has had various impacts on Lebanon, with one of the most significant effects observed in the already exhausted healthcare system. This study aimed to determine the reasons for hospitalization among registered Syrian refugees in Beirut who were admitted to Rafik Hariri University Hospital (RHUH) between December 2017 and June 2020. METHODS Data from 7,480 diagnosed cases were collected from the RHUH archives between December 2017 and June 2020 and were analyzed using SPSS (IBM Corp., Armonk, NY, USA). The collected data included information related to demographics, admission date, primary diagnosis, and other related medical problems. Variations and correlations were then tested. RESULTS Of the cases, 73.4% were females; the mean age was 28 ± 16.23 years. Fifty-seven percent of the admitted cases were solely due to pregnancy, childbirth, and puerperium reasons, and 91.14% of the deliveries were single deliveries by cesarean section. Common reasons for hospitalization were injuries (5.8%) and diseases of the digestive system (6.8%), circulatory system (4.7%), and respiratory system (4.4%). Non-communicable diseases (NCDs) constituted 61% of all hospital admissions, while only 6.6% belonged to communicable diseases. Reasons for hospitalization and the type of diagnosed diseases were associated with gender and age groups (p-values <0.001). CONCLUSION The major reasons for hospitalization among Syrian refugees were related to pregnancies and NCDs. The burden of the Syrian refugee influx on the Lebanese healthcare system can be alleviated by improving community health education, public health services, and conditions for refugees.
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Affiliation(s)
- Nour Ibrahim
- Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Marwan Zein
- Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Ali H Abdel Sater
- Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Omar El Khatib
- Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Loubna Tayyara
- Pulmonology, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
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Khadra MM, Suradi HH, Amarin JZ, El-Bassel N, Kaushal N, Jaber RM, Al-Qutob R, Dasgupta A. Risk factors for miscarriage in Syrian refugee women living in non-camp settings in Jordan: results from the Women ASPIRE cross-sectional study. Confl Health 2022; 16:32. [PMID: 35672855 PMCID: PMC9171994 DOI: 10.1186/s13031-022-00464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background Syrian refugee women face health care disparities and experience worse pregnancy outcomes, including miscarriage. We investigated risk factors for miscarriage in Syrian refugee women living in non-camp settings in Jordan to identify targets for interventions. Methods We analyzed data from Women ASPIRE, a cross-sectional study of gendered physical and mental health concerns of 507 Syrian refugee women (≥ 18 years old) living in non-camp settings in Jordan. We recruited women using systematic clinic-based sampling from four clinics. We limited our analyses to women who had a history of pregnancy and whose most recent pregnancy was single, took place in Jordan, and ended in term live birth or miscarriage (N = 307). We grouped the women by the primary outcome (term live birth or miscarriage) and compared the sociodemographic and clinical characteristics of the two groups. We used Pearson’s χ2 test or the Mann–Whitney U test to obtain unadjusted estimates and multivariable binomial logistic regression to obtain adjusted estimates. Results The most recent pregnancies of 262 women (85%) ended in term live birth and another 45 (15%) ended in miscarriage. Since crossing into Jordan, 11 women (4%) had not received reproductive health services. Of 35 women who were ≥ 35 years old, not pregnant, and did not want a (or another) child, nine (26%) did not use contraception. Of nine women who were ≥ 35 years old and pregnant, seven (78%) did not plan the pregnancy. The adjusted odds of miscarriage were higher in women who had been diagnosed with thyroid disease (aOR, 5.54; 95% CI, 1.56–19.07), had been of advanced maternal age (aOR, 5.83; 95% CI, 2.02–16.91), and had not received prenatal care (aOR, 36.33; 95% CI, 12.04–129.71). Each additional previous miscarriage predicted an increase in the adjusted odds of miscarriage by a factor of 1.94 (1.22–3.09). Conclusions We identified several risk factors for miscarriage in Syrian refugee women living in non-camp settings in Jordan. The risk factors may be amenable to preconception and prenatal care.
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Affiliation(s)
- Maysa M Khadra
- Department of Obstetrics and Gynecology, The University of Jordan School of Medicine, Queen Rania Street, Amman, 11942, Jordan.
| | - Haya H Suradi
- The University of Jordan School of Medicine, Amman, Jordan
| | | | - Nabila El-Bassel
- Columbia University School of Social Work, New York City, NY, USA
| | - Neeraj Kaushal
- Columbia University School of Social Work, New York City, NY, USA
| | - Ruba M Jaber
- Department of Family and Community Medicine, The University of Jordan School of Medicine, Amman, Jordan
| | - Raeda Al-Qutob
- Department of Family and Community Medicine, The University of Jordan School of Medicine, Amman, Jordan
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Lima Junior LPD, Lima KCOD, Bertolozzi MR, França FODS. Vulnerabilities of Arab refugees in primary health care: a scoping review. Rev Saude Publica 2022; 56:15. [PMID: 35384999 PMCID: PMC8963749 DOI: 10.11606/s1518-8787.2022056003691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To map and analyze the vulnerabilities of Arab refugees in the context of primary health care. METHOD Scoping review in which studies published in English, Spanish and Portuguese languages from 2011 onwards were reviewed. The following databases were surveyed: Cochrane, Scopus, Health System Evidence, MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science, SciELO, NYAM Grey Literature, BVS, Capes Thesis and Dissertation Database, Refworld and Journal of Refugee Studies. Data were analyzed in light of the concept of vulnerability. RESULTS Of the 854 studies identified, 40 articles were held for analysis and extraction of vulnerability indicators in the individual, social and programmatic dimensions. Regarding the individual dimension, the main indicators identified were unemployment, unstable and overcrowded housing, lack of sanitation and access to water, mental disorders, communicable and chronic noncommunicable diseases, etc. In the programmatic dimension, were identified, mainly, health teams with work overload, lack of preparation to deal with cultural and linguistic barriers, and delays in providing care. In relation to the social dimension, lack of access to schools, to information about health programs in the host countries, and to rights, among others, were found. CONCLUSION Vulnerabilities found highlight the disadvantage of refugees regarding health programs, services and system in host countries, in addition to highlighting the deep inequalities that affect this group. It is pointed out the need for programs and policies that promote actions, within the scope of primary health care, which recognize and respond to the health needs of refugees.
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Affiliation(s)
- Luiz Paulo de Lima Junior
- Universidade de São Paulo . Faculdade de Saúde Pública . Programa de Pós-Graduação em Saúde Global e Sustentabilidade . São Paulo , SP , Brasil
| | - Kayte Chaves Oliveira de Lima
- Universidade de São Paulo . Escola de Enfermagem . Programa de Pós-Graduação em Enfermagem . São Paulo , SP , Brasil
| | - Maria Rita Bertolozzi
- Universidade de São Paulo . Escola de Enfermagem . Departamento de Enfermagem em Saúde Coletiva . São Paulo , SP , Brasil
| | - Francisco Oscar de Siqueira França
- Universidade de São Paulo . Faculdade de Medicina . Departamento de Moléstias Infecciosas e Parasitárias . Núcleo de Medicina Tropical. São Paulo , SP , Brasil
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Korri R, Froeschl G, Ivanova O. A Cross-Sectional Quantitative Study on Sexual and Reproductive Health Knowledge and Access to Services of Arab and Kurdish Syrian Refugee Young Women Living in an Urban Setting in Lebanon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9586. [PMID: 34574511 PMCID: PMC8471977 DOI: 10.3390/ijerph18189586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 01/19/2023]
Abstract
Since data on the sexual and reproductive health (SRH) of young refugee women living in urban settings in Lebanon are particularly scarce, we aim through this exploratory study to assess the SRH knowledge and access to services of Arab and Kurdish Syrian refugee young women living in Bourj Hammoud. From January to March 2020, a cross-sectional survey was conducted among 297 Syrian Arab and Kurdish participants and aged 18-30 years old. It was found that participants coming from Syrian urban areas or who completed an education above secondary level have higher overall knowledge on SRH issues. Only a total of 148 out of the 297 participants (49.8%) knew a health facility in Bourj Hammoud that provides SRH services and among them 36.4% did not know which type of services are available there. The Syrian refugee young women's access to SRH services is inadequate due to different obstacles. The overall knowledge level on different SRH topics is limited. The context of multiple crises in Lebanon should be taken into consideration when delivering future SRH services.
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Affiliation(s)
- Rayan Korri
- Munich Medical Research School (MMRS), Medical Faculty of the University of Munich (LMU), 80336 Munich, Germany
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (G.F.); (O.I.)
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
| | - Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (G.F.); (O.I.)
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
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Sürmeli A, Yasin Y, Umay Tolunay T, User I, Topsever P. Practicing in exile: Syrian healthcare professionals working in informal outpatient clinics in Istanbul. INTERNATIONAL MIGRATION 2021. [DOI: 10.1111/imig.12906] [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: 11/27/2022]
Affiliation(s)
- Aral Sürmeli
- Department of Public Health Acibadem Mehmet Ali Aydinlar University School of Medicine Atasehir Istanbul Turkey
| | - Yesim Yasin
- Department of Public Health Acibadem Mehmet Ali Aydinlar University School of Medicine Atasehir Istanbul Turkey
| | - Tuana Umay Tolunay
- National Institutes of Health National Cancer Institute West Bethesda, MD USA
| | - Inci User
- Department of Sociology Acibadem Mehmet Ali Aydinlar University School of Arts and Sciences Atasehir Istanbul Turkey
| | - Pinar Topsever
- Deparment of Family Medicine Acibadem Mehmet Ali Aydinlar University School of Medicine Atasehir Istanbul Turkey
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Tran VM, Fozouni L, Denkinger JK, Rometsch C, Junne F, Vinck P, Pham P. Factors influencing utilization and perception of health care: a qualitative study among traumatized Yazidi refugees in Germany. BMC Psychiatry 2021; 21:346. [PMID: 34247590 PMCID: PMC8274022 DOI: 10.1186/s12888-021-03335-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ensuring adequate utilization of healthcare services for displaced populations is critical, yet there are well-documented treatment gaps. Yazidi women captured by the Islamic State (IS) were subjected to extreme trauma and violence. This study aims to understand perceptions of healthcare providers and utilization of these services among women who experienced extreme trauma. METHODS This is a qualitative study with voluntary participation offered to approximately 400 women resettled through the Special Quota Program. An empirical approach was used to collect data and a grounded theory approach was used for content analysis. Participants ranked their interactions with providers on a Likert scale. Posttraumatic stress disorder (PTSD) symptoms were assessed using the impact of event scale-revised questionnaire. RESULTS A total of 116 Yazidi women participated in this study. The women experienced an average of 6.8 months of captivity by IS and 93% met criteria for probable PTSD. Eighty-three percent of the women interacted with a physician; 80% found this interaction helpful. Sixty-nine percent interacted with psychologists; 61% found this interaction helpful. Six themes emerged: "reminders of trauma" and "hopelessness" in relation to the traumatic experience; "immediate relief" and "healing through pharmaceutical treatment" in relation to provider interventions, and "support" and "cultural differences" in relation to interactions with providers. CONCLUSIONS There exist major barriers to care for Yazidi women who experienced extreme trauma, particularly in regards to psychiatric care. Perceptions of healthcare providers and perceived effectiveness of therapy are critical factors that must be taken into consideration to improve healthcare utilization and outcomes.
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Affiliation(s)
- Virginia M. Tran
- grid.413529.80000 0004 0430 7173Department of Emergency Medicine, Highland Hospital-Alameda Health System, 1441 E 31st St, Oakland, CA 94602 USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston MA, 25 Shattuck St, Boston, MA 02115 USA
| | - Laila Fozouni
- grid.266102.10000 0001 2297 6811School of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143 USA ,grid.38142.3c000000041936754XHarvard Humanitarian Initiative, Harvard University, 14 Story Street, Cambridge, MA 02138 USA
| | - Jana K. Denkinger
- grid.10392.390000 0001 2190 1447Medical University Hospital Tübingen, University of Tübingen, Osianderstraße 5, 72076 Tübingen, Germany
| | - Caroline Rometsch
- grid.10392.390000 0001 2190 1447Medical University Hospital Tübingen, University of Tübingen, Osianderstraße 5, 72076 Tübingen, Germany
| | - Florian Junne
- grid.10392.390000 0001 2190 1447Medical University Hospital Tübingen, University of Tübingen, Osianderstraße 5, 72076 Tübingen, Germany ,grid.5807.a0000 0001 1018 4307Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Patrick Vinck
- grid.38142.3c000000041936754XHarvard Medical School, Boston MA, 25 Shattuck St, Boston, MA 02115 USA ,grid.38142.3c000000041936754XHarvard Humanitarian Initiative, Harvard University, 14 Story Street, Cambridge, MA 02138 USA ,grid.38142.3c000000041936754XHarvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA ,grid.62560.370000 0004 0378 8294Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 USA
| | - Phuong Pham
- Harvard Medical School, Boston MA, 25 Shattuck St, Boston, MA, 02115, USA. .,Harvard Humanitarian Initiative, Harvard University, 14 Story Street, Cambridge, MA, 02138, USA. .,Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. .,Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
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Borho A, Morawa E, Schmitt GM, Erim Y. Somatic distress among Syrian refugees with residence permission in Germany: analysis of a cross-sectional register-based study. BMC Public Health 2021; 21:896. [PMID: 33975567 PMCID: PMC8114491 DOI: 10.1186/s12889-021-10731-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have already proven high rates of common mental disorders in Syrian refugees. Nevertheless, little is known about the patterns of somatic distress among this refugee population. For this reason, we aimed to examine the prevalence, co-occurrence, and risk factors of somatic distress among Syrian refugees in Germany. METHODS This study analyzes the second measurement point (N = 116) of a prospective register-based survey among 200 adult Syrian refugees with residence permission in Germany. The survey consisted of information on sociodemographic and migration-specific characteristics, health care utilization, traumatic life events, acculturative stress (Barcelona Immigration Stress Scale (BISS); subscales: perceived discrimination, intercultural contact stress, homesickness, and general psychosocial stress), and self-reported outcomes of somatic distress (Patient Health Questionnaire (PHQ-15)), depression (PHQ-9), generalized anxiety disorder (GAD-7), and post-traumatic symptoms (Essen Trauma Inventory (ETI)). RESULTS Almost half of the respondents (49.1%) were identified as being at risk of somatic distress (PHQ-15 score ≥ 6), and even 24.1% being bothered by moderate-to-severe levels of somatic distress (PHQ-15 score ≥ 10). The most robust associations with somatic distress were found for female gender, the amount of health care utilization, multiple trauma exposures, general psychosocial stress, and self-reported depression and anxiety symptoms. High comorbidities with somatic distress were shown for all of the common mental disorders studied. CONCLUSIONS The presented study reveals a significant risk of somatic distress among this displaced population and highlights implications for policy and health care providers.
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Affiliation(s)
- Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Is language disability a risk factor for complicated appendicitis? A retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.770774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Çöl M, Bilgili Aykut N, Usturalı Mut AN, Koçak C, Uzun SU, Akın A, Say L, Kobeissi L. Sexual and reproductive health of Syrian refugee women in Turkey: a scoping review within the framework of the MISP objectives. Reprod Health 2020; 17:99. [PMID: 32571350 PMCID: PMC7310196 DOI: 10.1186/s12978-020-00948-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/14/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Turkey hosts the world's largest community of Syrians displaced by the conflict. The Minimum Initial Service Package (MISP) is a coordinated set of priority reproductive health services. There is not any scoping review assessing the RH situation of Syrian refugees in Turkey within the framework of the MISP objectives. The objectives of this review is to identify the situation of sexual and reproductive health (SRH) among Syrian refugee women in Turkey, and document the health services provided for them in terms of the components of MISP. We hoped to show evidence of gaps and help guide future research to focus on priority areas to improve the range, quality, and access to SRH services and to recommend public health interventions. METHOD The literature search was conducted in Turkish and English. Multiple electronic databases (Turkish Medline, Google Scholar, PubMed, Web of Science, Medline, Cochrane Database of Systematic Reviews, EBSCOHost, CINAHL, and Embase) were searched from January 2011 to May 2018. References published in the peer-reviewed literature, the grey-literature, and on websites were eligible for inclusion if they had conducted research on one or more of the following SRH topics specifically for Syrian women in Turkey: maternal and neonatal health/antenatal care, HIV and sexually transmitted infections, use of contraceptives, sexual violence, and services delivery and accessibility. References were excluded if any of the following criteria were relevant: not specific to Syrian women refugees in Turkey. Firstly, the titles and abstracts of the articles that were found were examined to determine if they met the eligibility criteria. Secondly, if the abstracts and titles met one or more of the eligibility criteria, the full text of the articles have been examined. Finally, standard forms were prepared and used to summarize the articles narratively. The results of the screening were recorded in Excel spreadsheets for comparison, and any disagreements among the researchers were resolved by consensus. The studies were grouped according to the MISP objectives. RESULTS A total of 24 publications were eligible for inclusion in the review. Consanguineous marriage rate was 56%. The rate of marriage under age 18 were very high. Mean age at first marriage was found to be between 18 and 20. The rate of antenatal care was inadequate. The rate of using a modern contraceptive method was 24% among married and all age groups of Syrian women. The rates of unmet family planning needs were about 35%. Among patients admitted to gynecology outpatient clinics, about half of the applicants were reported to have abnormal vaginal discharge. The reported rates of sexual violence were about 8%. Only 20% of Syrian women had regular gynecological visits. CONCLUSION Overall, we conclude that early marriage, low modern contraceptive use, unmet need for contraception, sexual and gender-based violence are the major SRH issues reported. There is a need for further studies to identify the barriers limiting service uptake as well as to document successful practices. Long term strategies to improve the SRH status of Syrian refugee women should be developed with participation of all stakeholders. This review is significant in terms of that it is the first scoping review assessing the RH situation of Syrian refugees in Turkey within the framework of the MISP objectives. Based on the data of this review, relevant policy makers should consider to improve the SRH status of Syrian women refugees in Turkey.
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Affiliation(s)
- M. Çöl
- Department of Public Health, Ankara University Faculty of Medicine, Ankara, Turkey
| | - N. Bilgili Aykut
- Başkent University, Woman-Child Health and Family Planning Research and Implementation Center, Ankara, Turkey
| | - A. N. Usturalı Mut
- Department of Public Health, Ankara University Faculty of Medicine, Ankara, Turkey
| | - C. Koçak
- Department of Public Health, Ankara University Faculty of Medicine, Ankara, Turkey
| | - S. U. Uzun
- Department of Public Health, Ankara University Faculty of Medicine, Ankara, Turkey
| | - A. Akın
- Başkent University, Woman-Child Health and Family Planning Research and Implementation Center, Ankara, Turkey
| | - L. Say
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
| | - L. Kobeissi
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
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McGrath M, Acarturk C, Roberts B, Ilkkursun Z, Sondorp E, Sijbrandij M, Cuijpers P, Ventevogel P, McKee M, Fuhr DC. Somatic distress among Syrian refugees in Istanbul, Turkey: A cross-sectional study. J Psychosom Res 2020; 132:109993. [PMID: 32172038 DOI: 10.1016/j.jpsychores.2020.109993] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 12/12/2022]
Affiliation(s)
- M McGrath
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, United Kingdom.
| | - C Acarturk
- Department of Psychology, Koç University, Istanbul, Turkey.
| | - B Roberts
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, United Kingdom.
| | - Z Ilkkursun
- Department of Psychology, Koç University, Istanbul, Turkey
| | - E Sondorp
- KIT Royal Tropical Institute, Amsterdam, The Netherlands.
| | - M Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.
| | - P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.
| | - P Ventevogel
- Public Health Section, Division of Programme Management and Support, United Nations High Commissioner for Refugees, Geneva, Switzerland.
| | - M McKee
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, United Kingdom.
| | - D C Fuhr
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, United Kingdom.
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13
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Abstract
BACKGROUND Displacement after a war or an armed conflict always leads to unexpected health problems, both among migrating people and in places to which new people have migrated. This study aimed to determine the health care needs and trends of Syrian patients. METHODS This retrospective study was conducted in a secondary care hospital in the city of Nevşehir, in central Turkey, between January 2013 and December 2017. All Syrian patients who visited the outpatient clinics and emergency department (ED) were enrolled in the study. RESULTS Over a span of five years, 41 723 Syrian patients visited the hospital's outpatient clinics and ED. The patients' median age was 23 (inter-quartile range (IQR) = 7-34), and 57.7% of them were female. In 2017, one-third of the Syrian patients visited the ED, a rate that was higher than that found among local patients (30.3% vs 25.0%, P < 0.001, respectively). The rate of pediatric clinic admissions among Syrian patients was about four times greater than the rate of local patients (20.1% vs 5.2%, P < 0.001, respectively), and Syrians' rate of admission to the obstetrics and gynecology clinic was about three times greater than the rate of local patients' admissions (12.3% vs 4.3%, P < 0.001, respectively). CONCLUSIONS This study showed that Syrian patients' visits to the hospital, and especially the ED, are increasing. Further, the needs and expectations of these patients in terms of health care are different from local demands. New approaches should be applied to provide an appropriate use of health care facilities.
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Affiliation(s)
- Necmi Baykan
- Nevşehir State Hospital, Emergency Department, Nevşehir, Turkey
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14
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Treatment gap and mental health service use among Syrian refugees in Sultanbeyli, Istanbul: a cross-sectional survey. Epidemiol Psychiatr Sci 2019; 29:e70. [PMID: 31727205 PMCID: PMC8061186 DOI: 10.1017/s2045796019000660] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Syrian refugees may have increased mental health needs due to the frequent exposure to potentially traumatic events and violence experienced during the flight from their home country, breakdown of supportive social networks and daily life stressors related to refugee life. The aim of this study is to report evidence on mental health needs and access to mental health and psychosocial support (MHPSS) among Syrians refugees living in Sultanbeyli-Istanbul, Turkey. METHODS A cross-sectional survey was conducted among Syrian refugees aged 18 years or over in Sultanbeyli between February and May 2018. We used random sampling to select respondents by using the registration system of the municipality. Data among 1678 Syrian refugees were collected on mental health outcomes using the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5) and the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. We also collected data on health care utilisation, barriers to seeking and continuing care as well as knowledge and attitudes towards mental health. Descriptive analyses were used. RESULTS The estimated prevalence of symptoms of PTSD, depression and anxiety was 19.6, 34.7 and 36.1%, respectively. In total, 249 respondents (15%) screened positive for either PTSD, depression or anxiety in our survey and self-reported emotional/behavioural problems since arriving in Sultanbeyli. The treatment gap (the proportion of these 249 people who did not seek care) was 89% for PTSD, 90% for anxiety and 88% for depression. Several structural and attitudinal barriers for not seeking care were reported, including the cost of mental health care, the belief that time would improve symptoms, fear of being stigmatised and lack of knowledge on where and how to get help. Some negative attitudes towards people with mental health problems were reported by respondents. CONCLUSIONS Syrian refugees hardly access MHPSS services despite high mental health needs, and despite formally having access to the public mental health system in Turkey. To overcome the treatment gap, MHPSS programmes need to be implemented in the community and need to overcome the barriers to seeking care which were identified in this study. Mental health awareness raising activities should be provided in the community alongside the delivery of psychological interventions. This is to increase help-seeking and to tackle negative attitudes towards mental health and people with mental health problems.
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15
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Evaluating the Provision of Health Services and Barriers to Treatment for Chronic Diseases among Syrian Refugees in Turkey: A Review of Literature and Stakeholder Interviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152660. [PMID: 31349639 PMCID: PMC6696441 DOI: 10.3390/ijerph16152660] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/16/2019] [Accepted: 07/23/2019] [Indexed: 01/02/2023]
Abstract
Background: While Turkey hosts the largest number of Syrian refugees, the provision of health services for chronic disease among Syrian refugees in Turkey has been inadequate and understudied. This paper explores Turkish healthcare policies surrounding Syrian refugees’ access to health services for chronic diseases. Methods: We conducted a literature review and supplementary stakeholder interviews to evaluate the provision of chronic health services and the most common barriers to healthcare access among Syrian refugees in Turkey. Results: Though access to treatment for displaced Syrians has improved throughout the past five years, five primary barriers persist: registration procedure regulations, navigation of a new health system, language barriers, fear of adverse treatment, and cost. Conclusions: To drive improvements in healthcare for chronic diseases among Syrian refugees in Turkey, we recommend making registration procedures more accessible, developing more healthcare options in patients’ native language, increasing human resources, and advocating for more research surrounding chronic health conditions among refugees.
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16
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Ardic A, Esin MN, Koc S, Bayraktar B, Sunal N. Using the Omaha System to determine health problems of urban Syrian immigrants. Public Health Nurs 2018; 36:126-133. [DOI: 10.1111/phn.12563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/10/2018] [Accepted: 10/13/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Aysun Ardic
- Florence Nightingale Faculty of Nursing; Istanbul University˗Cerrahpasa; Istanbul Turkey
| | - Melek Nihal Esin
- Florence Nightingale Faculty of Nursing; Istanbul University˗Cerrahpasa; Istanbul Turkey
| | - Serife Koc
- Faculty of Health Science; Karaman Mehmetbey University; Karaman Turkey
| | | | - Nihal Sunal
- Faculty of Health Science; Medipol University; Istanbul Turkey
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