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Danaher FS, Obando AM, Morris JE, Biskind H, Jasrasaria R, Bosson R, Gartland MG, Mohareb AM. Responding to the Health Needs of Newly Arrived Families Within Fractured Policy Environments. Pediatr Ann 2024; 53:e161-e166. [PMID: 38700920 DOI: 10.3928/19382359-20240306-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The increase in forcibly displaced populations seeking refuge in the United States has been met with fragmented, chaotic, and highly politicized responses to the detriment of migrants and receiving communities alike. Migrants encounter compounding systemic barriers to accessing basic resettlement resources. Expanding on pandemic-era innovations can strengthen social safety net infrastructure as a whole. Pediatricians are a potential early touchpoint for newly arrived families, providing an opportunity to support their specific health needs, refer to critical safety net services, and advocate for improved systems and policies. [Pediatr Ann. 2024;53(5):e161-e166.].
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Reynolds CW, Cheung AW, Draugelis S, Bishop S, Mohareb AM, Almaguer EMM, López YB, Guerra LE, Rosenbloom R, Hua J, VanWinkle C, Vadlamudi P, Kotagal V, Schmitzberger F. Epidemiology of asylum seekers and refugees at the Mexico-US border: a cross-sectional analysis from the migrant settlement camp in Matamoros, Mexico. BMC Public Health 2024; 24:489. [PMID: 38365627 PMCID: PMC10870647 DOI: 10.1186/s12889-024-17947-7] [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: 09/27/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The number of migrants and asylum seekers at the Mexico-US border has increased to historic levels. Our objective was to determine the medical diagnoses and treatments of migrating people seeking care in humanitarian clinics in Matamoros, Mexico. METHODS We conducted a cross-sectional study of patient encounters by migrating people through a humanitarian clinic in Matamoros, Mexico, from November 22, 2019, to March 18, 2021. The clinics were operated by Global Response Medicine in concert with local non-governmental organizations. Clinical encounters were each coded to the appropriate ICD-10/CPT code and categorized according to organ system. We categorized medications using the WHO List of Essential Medicines and used multivariable logistic regression to determine associations between demographic variables and condition frequency. RESULTS We found a total of 8,156 clinical encounters, which included 9,744 diagnoses encompassing 132 conditions (median age 26.8 years, female sex 58.2%). People originated from 24 countries, with the majority from Central America (n = 5598, 68.6%). The most common conditions were respiratory (n = 1466, 15.0%), musculoskeletal (n = 1081, 11.1%), and skin diseases (n = 473, 4.8%). Children were at higher risk for respiratory disease (aOR = 1.84, 95% CI: 1.61-2.10), while older adults had greater risk for joint disorders (aOR = 3.35, 95% CI: 1.73-6.02). Women had decreased risk for injury (aOR = 0.50, 95% CI: 0.40-0.63) and higher risk for genitourinary diseases (aOR = 4.99, 95% CI: 3.72-6.85) compared with men. Among 10,405 medications administered, analgesics were the most common (n = 3190, 30.7%) followed by anti-infectives (n = 2175, 21.1%). CONCLUSIONS In this large study of a migrating population at the Mexico-US border, we found a variety of clinical conditions, with respiratory, musculoskeletal, and skin illnesses the most common in this study period which encompassed a period of restrictive immigration policy and the first year of the COVID-19 pandemic.
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Affiliation(s)
- Christopher W Reynolds
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA.
- Global Response Medicine, 7959 N Thornydale Rd, Tucson, AZ, 85741, USA.
| | - Allison W Cheung
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA
| | - Sarah Draugelis
- Team fEMR, 25615 Jefferson Ave, St. Clair Shores, MI, 48081, USA
| | - Samuel Bishop
- Global Response Medicine, 7959 N Thornydale Rd, Tucson, AZ, 85741, USA
| | - Amir M Mohareb
- Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, Suite 722, Boston, MA, 02138, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | | | | | | | - Raymond Rosenbloom
- Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, 8410501, Beer-Sheva, Israel
| | - Joanna Hua
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA
| | - Callie VanWinkle
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA
| | - Pratik Vadlamudi
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA
| | - Vikas Kotagal
- Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Ann Arbor Veterans Affairs Healthcare System (VAAAHS) and GRECC, 2215 Fuller Rd, Ann Arbor, MI, 48105, USA
| | - Florian Schmitzberger
- Department of Emergency Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
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Bozorgmehr K, McKee M, Azzopardi-Muscat N, Bartovic J, Campos-Matos I, Gerganova TI, Hannigan A, Janković J, Kállayová D, Kaplan J, Kayi I, Kondilis E, Lundberg L, Mata IDL, Medarević A, Suvada J, Wickramage K, Puthoopparambil SJ. Integration of migrant and refugee data in health information systems in Europe: advancing evidence, policy and practice. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100744. [PMID: 37927430 PMCID: PMC10625017 DOI: 10.1016/j.lanepe.2023.100744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023]
Abstract
Coverage of migrant and refugee data is incomplete and of insufficient quality in European health information systems. This is not because we lack the knowledge or technology. Rather, it is due to various political factors at local, national and European levels, which hinder the implementation of existing knowledge and guidelines. This reflects the low political priority given to the topic, and also complex governance challenges associated with migration and displacement. We review recent evidence, guidelines, and policies to propose four approaches that will advance science, policy, and practice. First, we call for strategies that ensure that data is collected, analyzed and disseminated systematically. Second, we propose methods to safeguard privacy while combining data from multiple sources. Third, we set out how to enable survey methods that take account of the groups' diversity. Fourth, we emphasize the need to engage migrants and refugees in decisions about their own health data. Based on these approaches, we propose a change management approach that narrows the gap between knowledge and action to create healthcare policies and practices that are truly inclusive of migrants and refugees. We thereby offer an agenda that will better serve public health needs, including those of migrants and refugees and advance equity in European health systems. Funding No specific funding received.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of Population Medicine & Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany
- Lancet Migration European Hub
| | - Martin McKee
- European Observatory on Health Systems and Policies, London, UK
- London School of Medicine & Tropical Hygiene, London, UK
| | | | | | - Ines Campos-Matos
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | | | - Ailish Hannigan
- WHO Collaborating Centre for Migrant’s Involvement in Health Research, School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Daniela Kállayová
- Lancet Migration European Hub
- Department of Public Health, Screening and Prevention, Ministry of Health, Slovak Republic
- Trnava University, Trnava, Slovak Republic
| | - Josiah Kaplan
- UNICEF Global Office of Research and Foresight, Florence, Italy
| | - Ilker Kayi
- Department of Public Health, School of Medicine, Koç University, Istanbul, Türkiye
| | - Elias Kondilis
- Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lene Lundberg
- Lancet Migration European Hub
- Norwegian Centre for E-health Research, Tromsø, Norway
| | | | - Aleksandar Medarević
- Institute of Public Health of Serbia 'Dr Milan Jovanovic Batut', Belgrade, Serbia
| | - Jozef Suvada
- St. Elizabeth University of Public Health and Social Work, Slovak Republic
- WHO Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, and McMaster GRADE Centre, Department of Health Research Methods, Evidence and Impact, McMaster University, Canada
| | - Kolitha Wickramage
- UN Migration Agency Global Data Institute, Migration Health Division, International Organization for Migration, Berlin, Germany
| | - Soorej Jose Puthoopparambil
- WHO Collaborating Centre on Migration and Health Data and Evidence, Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Sweden
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Murphy A, Bartovic J, Bogdanov S, Bozorgmehr K, Gheorgita S, Habicht T, Richardson E, Azzopardi-Muscat N, McKee M. Meeting the long-term health needs of Ukrainian refugees. Public Health 2023; 220:96-98. [PMID: 37290174 DOI: 10.1016/j.puhe.2023.04.015] [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: 01/27/2023] [Revised: 03/31/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Since Russia's full-scale invasion of Ukraine on 24 February 2022, millions of people have fled the country. Most people have gone to the neighbouring countries of Poland, Slovakia, Hungary, Romania, and Moldova. This vulnerable population has significant healthcare needs. Among the most challenging to address will be chronic non-communicable diseases (NCDs), including mental disorders, as these require long-term, continuous care and access to medicines. Host country health systems are faced with the challenge of ensuring accessible and affordable care for NCDs and mental disorders to this population. Our objectives were to review host country health system experiences and identify priorities for research to inform sustainable health system responses to the health care needs of refugees from Ukraine. STUDY DESIGN In-person conference workshop. METHODS A workshop on this subject was held in November 2022 at the European Public Health Conference in Berlin. RESULTS The workshop included participants from academia and non-governmental organisations, health practitioners, and World Health Organisation regional and country offices. This short communication reports the main conclusions from the workshop. CONCLUSION Addressing the challenges and research priorities identified will require international solidarity and co-operation.
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Affiliation(s)
- A Murphy
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - J Bartovic
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - S Bogdanov
- Centre for Mental Health and Psychosocial Support, The National University of Kyiv Mohyla, Kyiv, Ukraine
| | - K Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - S Gheorgita
- World Health Organization Moldova Country Office, Chișinău, Republic of Moldova
| | - T Habicht
- World Health Organization Barcelona Office for Health Systems Financing, Barcelona, Spain
| | - E Richardson
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; World Health Organization European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
| | - N Azzopardi-Muscat
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - M McKee
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Karkee R, Gurung M, Poudel L, Baral C, Adhikary P, Kc RK, Gurung S, Gajdadziev V, Duigan P, Inkochasan M, Wickramage KP, Gurung G. Management of health information of nepalese labour migrants. Global Health 2023; 19:30. [PMID: 37098590 PMCID: PMC10127173 DOI: 10.1186/s12992-023-00927-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/31/2023] [Indexed: 04/27/2023] Open
Abstract
INTRODUCTION The monitoring and improvement of the health of labour migrants (LMs) require sufficient health data to be recorded and managed. In this context, this study was conducted to explore the management of health information of Nepalese labour migrants (NLMs). METHODS This is an explorative qualitative study. Stakeholders involved directly or indirectly in maintaining the health profile of NLMs were first mapped, physically visited, and any documents or information were collected. Then, sixteen key informant interviews were conducted among these stakeholders related to labour migrants' health information management and challenges. A checklist extracted information from the interviews, and a thematic analysis was carried out to summarize the challenges. RESULTS Government agencies, non-governmental organizations, and government approved private medical centers are involved in generating and maintaining the health data of NLMs. The Foreign Employment Board (FEB) records deaths and disabilities of NLMs while at work abroad and these health records are also maintained in an online portal called Foreign Employment Information Management System (FEIMS) under the Department of Foreign Employment (DoFE). Health assessment of NLMs is a mandatory procedure before departure, which is done through the government-approved pre-departure private medical assessment centers. The health records from these assessment centers are first recorded in paper-based form and then entered into an online electronic form to be stored by the DoFE. The filled-up paper forms are sent to District Health Offices, which further report the data to the Department of Health Services (DoHS), Ministry of Health and Population (MoHP) and associated governmental infectious diseases centers. However, there is no formal health assessment of NLMs upon arrival to Nepal. Key informants raised various issues and concerns in maintaining health records of NLMs, which were grouped into three themes: lack of interest to develop a unified online system; need of competent human resources and equipment; and developing a set of health indicators for migrant health assessment. CONCLUSION The FEB and government-approved private assessment centers are the main stakeholders in keeping the health records of outgoing NLMs. The current migrant health record keeping procedure in Nepal is fragmented. The national Health Information Management Systems does not effectively capture and categorize the health record of NLMs. There is a need to effectively link national health information system with premigration health assessment centers; and potentially develop a migrant health information management system by systematically keeping health records electronically with relevant health indicators on departing and arriving NLMs.
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Affiliation(s)
- Rajendra Karkee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Minani Gurung
- Nepal Institute of Development Studies (NIDS), Kathmandu, Nepal
| | - Lisasha Poudel
- Nepal Institute of Development Studies (NIDS), Kathmandu, Nepal
| | | | - Pratik Adhikary
- Institute for Social and Environmental Research-Nepal, Chitwan, Nepal
| | | | - Sundip Gurung
- International Organization for Migration (IOM), Kathmandu, Nepal
| | - Vasil Gajdadziev
- International Organization for Migration (IOM), Kathmandu, Nepal
| | - Patrick Duigan
- IOM Regional Office for Asia and Pacific Region (ROAP), Bangkok, Thailand
| | - Montira Inkochasan
- IOM Regional Office for Asia and Pacific Region (ROAP), Bangkok, Thailand
| | | | - Ganesh Gurung
- Nepal Institute of Development Studies (NIDS), Kathmandu, Nepal
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van de Vijver S, Tensen P, Asiki G, Requena-Méndez A, Heidenrijk M, Stronks K, Cobelens F, Bont J, Agyemang C. Digital health for all: How digital health could reduce inequality and increase universal health coverage. Digit Health 2023; 9:20552076231185434. [PMID: 37434727 PMCID: PMC10331232 DOI: 10.1177/20552076231185434] [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] [Received: 10/26/2022] [Accepted: 06/14/2023] [Indexed: 07/13/2023] Open
Abstract
Digital transformation in health care has a lot of opportunities to improve access and quality of care. However, in reality not all individuals and communities are benefiting equally from these innovations. People in vulnerable conditions, already in need of more care and support, are often not participating in digital health programs. Fortunately, numerous initiatives worldwide are committed to make digital health accessible to all citizens, stimulating the long-cherished global pursuit of universal health coverage. Unfortunately initiatives are not always familiar with each other and miss connection to jointly make a significant positive impact. To reach universal health coverage via digital health it is necessary to facilitate mutual knowledge exchange, both globally and locally, to link initiatives and apply academic knowledge into practice. This will support policymakers, health care providers and other stakeholders to ensure that digital innovations can increase access to care for everyone, leading towards Digital health for all.
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Affiliation(s)
- Steven van de Vijver
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
- Family Medicine Department, OLVG Hospital, Amsterdam, The Netherlands
| | - Paulien Tensen
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Ana Requena-Méndez
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Barcelona Institute for Global Health, ISGlobal, University of Barcelona, Barcelona, Spain
| | - Michiel Heidenrijk
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
- Joep Lange Institute, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Cobelens
- Department of Global Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jettie Bont
- Department of Family Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Zenner D, Méndez AR, Schillinger S, Val E, Wickramage K. Health and illness in migrants and refugees arriving in Europe: analysis of the electronic Personal Health Record system. J Travel Med 2022; 29:6541145. [PMID: 35238944 PMCID: PMC9635060 DOI: 10.1093/jtm/taac035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/10/2022] [Accepted: 03/01/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The electronic Personal Health Record (ePHR) is a health information system that registers health data on newly arriving migrants and was implemented in eight European countries (Bulgaria, Croatia, Cyprus, Greece, Italy, Romania, Serbia and Slovenia). This is a cross-sectional study aimed to describe the health problems and health status of all migrants attended at health clinics as part of the health assessment programme established in the reception centres (2016-2019). METHODS Data were collected on demographics, clinical and laboratory findings and diagnostics performed, including medical records. We classified all diseases using pre-specified algorithms according to information on pre-specified variables from the ePHR questionnaire, ICD-10 codes, positive laboratory findings or review of medical records. Crude proportions were calculated and odds ratios (OR) estimated using logistic regression modelling. RESULTS The ePHR dataset contained a total of 19 564 clinical episodes in 14 436 individuals, recorded between January 2016 and October 2019. Most individuals (75%) were refugees or asylum seekers (22%) from 92 different nationalities. There were 2531/19 564 (12.9%) infectious diseases episodes reported during the study period, being 1283/2531 (50.7%) of them pharyngo-tonsillitis, 529 (20.9%) scabies, 158 (6.2%) viral hepatitis and 156(6.1%) lower respiratory infections. There were 2462 (17.1%) individuals with non-communicable diseases reported; including 821 (5.7%) cardiovascular diseases, 1183 (8.2%) neurological condition, 644 (4.5%) Diabetes mellitus and 212 (1.5%) kidney disease cases. Having Diabetes Mellitus (adjusted OR, aOR 3.3, [95% confidence interval, CI 2.7-4.1], P < 0.001), and neurological disorders (aOR 1.8, [95% CI 1.4-2.2], P < 0.001) were associated with cardiovascular disorders in the multivariable logistic regression model.Mental health problems were reported in 641/14 436 (4.4%) individuals and were associated with increasing age. Furthermore, 610 episodes of acute injuries were reported among 585/14 436 (4.1%) people, 517 (88.4%) of them in men (P < 0.001). CONCLUSIONS The ePHR is a valuable tool to efficiently collect health-related data to better address migrant health issues. We described a mostly healthy population with many acute infectious disease episodes particularly in children, but also with significant number of chronic conditions and less frequent injuries or mental health problems.
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Affiliation(s)
- Dominik Zenner
- Global Public Health Unit, Wolfson Institute of Population Health, 58 Turner St, London E1 2AB, UK
| | - Ana Requena Méndez
- Department of Medicine-Solna, Karolinska Institutet, 171 65 Solna, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Barcelona Institute for Global Health (ISGlobal Campus Clinic), Barcelona 08036, Spain
| | - Steffen Schillinger
- Migration Health Division, International Organization for Migration, 1226. Manila, Philippines
| | - Elena Val
- Migrant Health Division, International Organization for Migration, Regional Office for the EU/EAA and NATO B-1000 Brussels, Belgium
| | - Kolitha Wickramage
- Migration Health Division, International Organization for Migration, 1226. Manila, Philippines
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Dziedzic A, Riad A, Tanasiewicz M, Attia S. The Increasing Population Movements in the 21st Century: A Call for the E-Register of Health-Related Data Integrating Health Care Systems in Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13720. [PMID: 36360600 PMCID: PMC9657646 DOI: 10.3390/ijerph192113720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
The escalating mass influx of people to Europe in the 21st century due to geopolitical and economic reasons as well as food crises ignites significant challenges for national health care services. The lack or disruption of cross-border, e-transferred, health-related data negatively affects the health outcome and continuous care, particularly in medically compromised individuals with an unsettled status. Proposal: The urgent need of a structured database, in the form of a health-related data register funded by the European Union that allows a swift exchange of crucial medical data, was discussed to flag ever-increasing migrants' health problems, with a primary aim to support an adequate health care provision for underserved people who are at risk of deteriorating health. The data security information technology aspects, with a proposed and drafted structure of an e-health register, were succinctly highlighted. Conclusions: Focusing on long-term benefits and considering future waves of mass relocation, an investment in a health-related data register in Europe could vastly reduce health care disparities between minority groups and improve epidemiological situations with regard to major illnesses, including common, communicable diseases as well as oncological and infectious conditions. Commissioners, policymakers, and stakeholders are urged to continue a collective action to ensure vulnerable people can access health services by responding to the ongoing global migration crisis.
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Affiliation(s)
- Arkadiusz Dziedzic
- Department of Conservative Dentistry with Endodontics, Medical University of Silesia, 40-055 Katowice, Poland
| | - Abanoub Riad
- Department of Public Health, Faculty of Medicine, Masaryk University, 601 77 Brno, Czech Republic
| | - Marta Tanasiewicz
- Department of Conservative Dentistry with Endodontics, Medical University of Silesia, 40-055 Katowice, Poland
| | - Sameh Attia
- Department of Oral and Maxillofacial Surgery, Justus Liebig University, 35390 Giessen, Germany
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Buford A, Ashworth HC, Ezzeddine FL, Dada S, Nguyen E, Ebrahim S, Zhang A, Lebovic J, Hamvas L, Prokop LJ, Midani S, Chilazi M, Alahdab F. Systematic review of electronic health records to manage chronic conditions among displaced populations. BMJ Open 2022; 12:e056987. [PMID: 36285578 PMCID: PMC9453995 DOI: 10.1136/bmjopen-2021-056987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 08/15/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The objective of this study was to assess the impact of electronic health records (EHRs) on health outcomes and care of displaced people with chronic health conditions and determine barriers and facilitators to EHR implementation in displaced populations. DESIGN A systematic review protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Systematic Reviews. DATA SOURCES MEDLINE, Embase, PsycINFO, CINAHL, Health Technology Assessment, Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was searched from inception to 12 April 2021. ELIGIBILITY CRITERIA FOR SELECTED STUDIES Inclusion criteria were original research articles, case reports and descriptions of EHR implementation in populations of displaced people, refugees or asylum seekers with related chronic diseases. Grey literature, reviews and research articles unrelated to chronic diseases or the care of refugees or asylum populations were excluded. Studies were assessed for risk of bias using a modified Cochrane, Newcastle-Ottawa and Joanna Briggs Institute tools. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data from each study using Covidence. Due to heterogeneity across study design and specific outcomes, a meta-analysis was not possible. An inductive thematic analysis was conducted using NVivo V.12 (QSR International, Melbourne, Australia). An inductive analysis was used in order to uncover patterns and themes in the experiences, general outcomes and perceptions of EHR implementation. RESULTS A total of 32 studies across nine countries were included: 14 in refugee camps/settlements and 18 in asylum countries. Our analysis suggested that EHRs improve health outcomes for chronic diseases by increasing provider adherence to guidelines or treatment algorithms, monitoring of disease indicators, patient counselling and patient adherence. In asylum countries, EHRs resource allocation to direct clinical care and public health services, as well as screening efforts. EHR implementation was facilitated by their adaptability and ability to integrate into management systems. However, barriers to EHR development, deployment and data analysis were identified in refugee settings. CONCLUSION Our results suggest that well-designed and integrated EHRs can be a powerful tool to improve healthcare systems and chronic disease outcomes in refugee settings. However, attention should be paid to the common barriers and facilitating actions that we have identified such as utilising a user-centred design. By implementing adaptable EHR solutions, health systems can be strengthened, providers better supported and the health of refugees improved.
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Affiliation(s)
- Anna Buford
- Medical School, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Henry Charles Ashworth
- Emergency Medicine, Alameda Health System, Oakland, California, USA
- Hikma Health, San Jose, California, USA
| | | | - Sara Dada
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eliza Nguyen
- Obstetrics and Gynecology, Mayo Clinic, Rochester, New York State, USA
| | | | - Amy Zhang
- Hikma Health, San Jose, California, USA
| | - Jordan Lebovic
- Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York, USA
| | | | - Larry J Prokop
- Obstetrics and Gynecology, Mayo Clinic, Rochester, New York State, USA
| | - Sally Midani
- School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Michael Chilazi
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Fares Alahdab
- Houston Methodist Academic Institute, Weill Cornell Medical College, Houston, Texas, USA
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10
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Morrison M, Nobles V, Johnson-Agbakwu C, Bailey C, Liu L. Classifying Refugee Status Using Common Features in EMR. Chem Biodivers 2022; 19:e202200651. [PMID: 36050919 DOI: 10.1002/cbdv.202200651] [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: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022]
Abstract
Automated and accurate identification of refugees in healthcare databases is a critical first step to investigate healthcare needs of this vulnerable population and improve health disparities. In this study, we developed a machine-learning method, named refugee identification system (RIS) to address this need. We curated a data set consisting of 103 refugees and 930 non-refugees in Arizona. We compiled de-identified individual-level information including age, primary language, and noise-masked home address, state-level refugee resettlement statistics, and world language statistics. We then performed feature engineering to convert language and masked address into quantitative features. Finally, we built a random forest model to classify refugee and non-refugees. RIS achieved high classification accuracy (overall accuracy=0.97, specificity=0.99, sensitivity=0.85, positive predictive value=0.88, negative predictive value=0.98, and area under receiver operating characteristic curve=0.98). RIS is customizable for refugee identification outside Arizona. Its application enables large-scale investigation of refugee healthcare needs and improvement of health disparities.
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Affiliation(s)
- Malia Morrison
- Arizona State University, College of Health Solutions, 550 N 3rd Street, 85004, Phoenix, UNITED STATES
| | - Vanessa Nobles
- Arizona State University, College of Health Solutions, 550 N. 3rd St, 85004, Phoenix, UNITED STATES
| | - Christa Johnson-Agbakwu
- Arizona State University, Southwest Interdisciplinary Research Center, 411 N Central Ave, 85004, Phoenix, UNITED STATES
| | - Celeste Bailey
- Valleywise Health Medical Center, Department of Obstetrics, Gynecology and Women's Health, 2601 E Roosevelt St, 85008, Phoenix, UNITED STATES
| | - Li Liu
- Arizona State University, College of Health Solutions, 6161 E Mayo Blvd, 85054, Phoenix, UNITED STATES
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11
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Hintermeier M, Gold AW, Erdmann S, Perplies C, Bozorgmehr K, Biddle L. From Research into Practice: Converting Epidemiological Data into Relevant Information for Planning of Regional Health Services for Refugees in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8049. [PMID: 35805705 PMCID: PMC9265908 DOI: 10.3390/ijerph19138049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 12/02/2022]
Abstract
Health data of refugees and asylum seekers (ASR) is not routinely collected in Germany. Based on health data of ASR collected in 2018 in regional accommodation centres, we developed a dashboard to estimate regional burden of disease in Baden-Wuerttemberg, Germany. We aimed to find out how scientific data can support actors involved in healthcare planning for ASR in Germany and, within this scope, to explore how healthcare planning is conducted in this context. We conducted 12 qualitative semi-structured interviews including a usability test for a health data dashboard with regional decision-makers. Results showed that healthcare planning processes for ASR in Germany involve a complex set of actors in both long- and short-term decision-making. Data gained from representative surveys can support long-term decision-making and thus support the resilience of the health system, but it must balance the need for simple data presentation with transparent communication of potentially complex methods.
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Affiliation(s)
- Maren Hintermeier
- Section for Health Equity Studies & Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, 69120 Heidelberg, Germany; (A.W.G.); (C.P.); (K.B.)
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany;
| | - Andreas W. Gold
- Section for Health Equity Studies & Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, 69120 Heidelberg, Germany; (A.W.G.); (C.P.); (K.B.)
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany;
| | - Stella Erdmann
- Institute of Medical Biometry, Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Clara Perplies
- Section for Health Equity Studies & Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, 69120 Heidelberg, Germany; (A.W.G.); (C.P.); (K.B.)
| | - Kayvan Bozorgmehr
- Section for Health Equity Studies & Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, 69120 Heidelberg, Germany; (A.W.G.); (C.P.); (K.B.)
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany;
| | - Louise Biddle
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany;
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Ekezie W, Awwad S, Krauchenberg A, Karara N, Dembiński Ł, Grossman Z, del Torso S, Dornbusch HJ, Neves A, Copley S, Mazur A, Hadjipanayis A, Grechukha Y, Nohynek H, Damnjanović K, Lazić M, Papaevangelou V, Lapii F, Stein-Zamir C, Rath B. Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review. Vaccines (Basel) 2022; 10:vaccines10071038. [PMID: 35891201 PMCID: PMC9324407 DOI: 10.3390/vaccines10071038] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 01/27/2023] Open
Abstract
Vaccination has a significant impact on morbidity and mortality. High vaccination coverage rates are required to achieve herd protection against vaccine-preventable diseases. However, limited vaccine access and hesitancy among specific communities represent significant obstacles to this goal. This review provides an overview of critical factors associated with vaccination among disadvantaged groups in World Health Organisation European countries. Initial searches yielded 18,109 publications from four databases, and 104 studies from 19 out of 53 countries reporting 22 vaccine-preventable diseases were included. Nine groups representing the populations of interest were identified, and most of the studies focused on asylum seekers, refugees, migrants and deprived communities. Recall of previous vaccinations received was poor, and serology was conducted in some cases to confirm protection for those who received prior vaccinations. Vaccination coverage was lower among study populations compared to the general population or national average. Factors that influenced uptake, which presented differently at different population levels, included health service accessibility, language and vaccine literacy, including risk perception, disease severity and vaccination benefits. Strategies that could be implemented in vaccination policy and programs were also identified. Overall, interventions specific to target communities are vital to improving uptake. More innovative strategies need to be deployed to improve vaccination coverage among disadvantaged groups.
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Affiliation(s)
- Winifred Ekezie
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK
- College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
| | - Samy Awwad
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
- Stanford University, Palo Alto, CA 94305, USA
| | - Arja Krauchenberg
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
- European Parents Association, 1000 Brussels, Belgium
| | - Nora Karara
- Young European Academy of Paediatrics, 1000 Brussels, Belgium;
- Evangelical Hospital Queen Elisabeth Herzberge, 10365 Berlin, Germany
| | - Łukasz Dembiński
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Zachi Grossman
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Stefano del Torso
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Hans Juergen Dornbusch
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Ana Neves
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Sian Copley
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Artur Mazur
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Adamos Hadjipanayis
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Yevgenii Grechukha
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, FI-00271 Helsinki, Finland;
| | - Kaja Damnjanović
- Faculty of Philosophy, University of Belgrade, 11000 Beograd, Serbia;
| | - Milica Lazić
- Faculty of Philosophy, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Vana Papaevangelou
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Fedir Lapii
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | | | - Barbara Rath
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
- Correspondence:
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Brotherton T, Brotherton S, Ashworth H, Kadambi A, Ebrahim H, Ebrahim S. Development of an Offline, Open-Source, Electronic Health Record System for Refugee Care. Front Digit Health 2022; 4:847002. [PMID: 35360368 PMCID: PMC8963945 DOI: 10.3389/fdgth.2022.847002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
While electronic health records (EHRs) have been shown to be effective in improving patient care in low-resource settings, there are still barriers to implementing them, including adaptability, usability, and sustainability. Taking a user-centered design process we developed the Hikma Health EHR for low resourced clinics caring for displaced populations. This EHR was built using React Native and Typescript that sync to a Python backend repository which is deployed on Google Cloud SQL. To date the Hikma Health EHR has been deployed for 26,000 patients. The positive impacts of the system reported by clinician users are 3-fold: (1) improved continuity of care; (2) improved visualization of clinical data; and (3) improved efficiency, resulting in a higher volume of patients being treated. While further development is needed, our open-source model will allow any organization to modify this system to meet their clinical and administrative needs.
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Affiliation(s)
| | | | - Henry Ashworth
- Hikma Health, San Jose, CA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Henry Ashworth
| | - Adesh Kadambi
- Hikma Health, San Jose, CA, United States
- University of Toronto, Toronto, ON, Canada
| | - Hassaan Ebrahim
- Hikma Health, San Jose, CA, United States
- Harvard University John F. Kennedy School of Government, Cambridge, MA, United States
| | - Senan Ebrahim
- Hikma Health, San Jose, CA, United States
- Harvard Medical School, Boston, MA, United States
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Granero-Molina J, Jiménez-Lasserrotte MDM, Fernández-Medina IM, Ruiz-Fernández MD, Hernández-Padilla JM, Fernández-Sola C. Nurses' experiences of emergency care for undocumented migrants who travel by boats. Int Nurs Rev 2021; 69:69-79. [PMID: 34628657 DOI: 10.1111/inr.12723] [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: 02/25/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
AIM The aim of our study is to describe and understand the experiences of nurses providing emergency care to undocumented migrants who arrive in Spain in small boats. BACKGROUND Spain receives thousands of undocumented migrants every year who arrive by sea. Provision of appropriate emergency care to undocumented migrants is a public health problem. INTRODUCTION Nurses, along with other health care providers, such as doctors or cultural mediators, make up the Spanish Red Cross Emergency Response Team. Nurses, in particular, are associated with all phases of emergency care to undocumented migrants who arrive in small boats, offering first aid as well as clinical and humanitarian care. METHODS Qualitative descriptive study. Seventeen nurses from the Spanish Red Cross Emergency Response Team participated in face-to-face interviews. Thematic analysis was used to analyse the qualitative data. FINDINGS Three main themes emerged: (i) guaranteeing comprehensive emergency care, (ii) the nurse, the key member of the multidisciplinary care team for undocumented migrants and (iii) 'making a difference', volunteering as a nurse's role. CONCLUSIONS Nurses try to guarantee comprehensive care provision for undocumented migrants, even though they face stigma, ethical concerns or an impossibility to prescribe pharmacological treatments. Personalised care, more time and protocols, better training and the incorporation of debriefing are elements that are required to improve the emergency care given to undocumented migrants. IMPLICATIONS FOR NURSING AND HEALTH POLICY Institutions must develop policies to support provsion of emergency care to undocumented migrants. A public health issue cannot depend upon volunteer healthcare providers. Governments must guarantee funding, training and established care teams. Understanding nurses' experiences could increase awareness of the problem, reduce stigma and improve the comprehensive emergency care provided to undocumented migrants.
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Affiliation(s)
- José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Research Associate, Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | | | | | | | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, London, UK
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Research Associate, Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
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Nyanchoga MM, Lee P, Barbery G. Exploring electronic health records to estimate the extent of catch-up immunisation and factors associated with under-immunisation among refugees and asylum seekers in south east Queensland. Vaccine 2021; 39:6238-6244. [PMID: 34556368 DOI: 10.1016/j.vaccine.2021.09.026] [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: 12/15/2020] [Revised: 07/21/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Australia is one of the leading countries resettling people from refugee-like backgrounds. Catch-up immunisation is a key priority in this cohort. However, few studies have included asylum seekers and the adult age group in their study sample. In addition, Electronic Health Records (EHR) has recently been recognised as a vital tool in big data analysis with the capacity to contribute to informed strategic decision making. As such, the main aim of this study is to explore EHR routinely used in a specialised refugee clinic in South East Queensland to estimate the extent of catch-up immunisation and assess the factors associated with under-immunisation among refugees and asylum seekers. METHODS A quantitative study involving a secondary data analysis on a pre-existing dataset was undertaken. Relevant data was extracted from the EHR in the clinic. SPSS was used to perform Statistical data analysis. RESULTS The majority of clients originated from Papua New Guinea, followed by Iran and Afghanistan. When assessing the uptake of catch-up immunisations among refugees and asylum seekers, MMR (Measles-Mumps-Rubella), Polio and DTP (Diphtheria-Tetanus-Pertussis) had the highest uptake, while HPV (Human Papilloma Virus), Pneumococcal and Hib (Haemophilus influenza type b) immunisations had the lowest uptake. Binary logistic regression revealed that the younger patients, the refugees (compared to asylum seekers) and those with a longer residential duration in Australia are at a higher risk of being under-immunised. CONCLUSION This study indicates that the broader group of immigrants, and in particular refugees and asylum seekers, do not represent a homogenous group in terms of immunisation coverage, and that each cohort should be carefully considered during immunisation interventions and strategies. This will be particularly important during targeted health promotions and future immunisation programs in this cohort.
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Affiliation(s)
| | - Patricia Lee
- Senior Lecturer, School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Gaery Barbery
- Lecturer, Health Services Management, School of Medicine, Griffith University, South Bank, QLD 4101, Australia.
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Ashworth H, Ebrahim S, Ebrahim H, Bhaiwala Z, Chilazi M. A free, open-source, offline digital health system for refugee care (Preprint). JMIR Med Inform 2021; 10:e33848. [PMID: 35147509 PMCID: PMC8881778 DOI: 10.2196/33848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/27/2021] [Accepted: 01/02/2022] [Indexed: 12/30/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Henry Ashworth
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Hikma Health, San Jose, CA, United States
| | | | - Hassaan Ebrahim
- Hikma Health, San Jose, CA, United States
- Department of Public Policy, Harvard Kennedy School, Boston, MA, United States
| | | | - Michael Chilazi
- Hikma Health, San Jose, CA, United States
- Johns Hopkins Hospital, Baltimore, MD, United States
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Cratsley K, Brooks MA, Mackey TK. Refugee Mental Health, Global Health Policy, and the Syrian Crisis. Front Public Health 2021; 9:676000. [PMID: 34414156 PMCID: PMC8369241 DOI: 10.3389/fpubh.2021.676000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
The most recent global refugee figures are staggering, with over 82.4 million people forcibly displaced and 26.4 million registered refugees. The ongoing conflict in Syria is a major contributor. After a decade of violence and destabilization, over 13.4 million Syrians have been displaced, including 6.7 million internally displaced persons and 6.7 million refugees registered in other countries. Beyond the immediate political and economic challenges, an essential component of any response to this humanitarian crisis must be health-related, including policies and interventions specific to mental health. This policy and practice review addresses refugee mental health in the context of the Syrian crisis, providing an update and overview of the current situation while exploring new initiatives in mental health research and global health policy that can help strengthen and expand services. Relevant global health policy frameworks are first briefly introduced, followed by a short summary of recent research on refugee mental health. We then provide an update on the current status of research, service provision, and health policy in the leading destinations for Syrians who have been forcibly displaced. This starts within Syria and then turns to Turkey, Lebanon, Jordan, and Germany. Finally, several general recommendations are discussed, including the pressing need for more data at each phase of migration, the expansion of integrated mental health services, and the explicit inclusion and prioritization of refugee mental health in national and global health policy.
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Affiliation(s)
- Kelso Cratsley
- Department of Philosophy & Religion, American University, Washington, DC, United States
| | | | - Tim K. Mackey
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
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Granero-Molina J, Jiménez-Lasserrotte MDM, Ruiz-Fernández MD, Hernández-Padilla JM, Fernández-Medina IM, López-Rodríguez MDM, Fernández-Sola C. Physicians' experiences of providing emergency care to undocumented migrants arriving in Spain by small boats. Int Emerg Nurs 2021; 56:101006. [PMID: 33989922 DOI: 10.1016/j.ienj.2021.101006] [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: 07/07/2020] [Revised: 12/30/2020] [Accepted: 03/26/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Access to emergency care for undocumented migrants (UMs) is a public health problem. Spain receives thousands of UMs who arrive by sea. A multidisciplinary team of the Spanish Red Cross, made up of physicians, nurses, police, and cultural mediators, developed emergency care for UMs. AIM The aim of our study is to describe and understand the experiences of physicians in emergency care for UMs who arrive in Spain by small boats METHODS: Qualitative study, based on Gadamer's phenomenology. Convenience and purposive sampling was carried out and included sixteen in-depth interviews with physicians, between June 2019 and March 2020 in Spain. RESULTS Three main themes emerged: 1) Rediscovering humanistic medicine; 2) Leaving the personal and professional comfort zone; 3) Improving medical emergency care. CONCLUSIONS Triage, pharmacological prescription, and the closure of the emergency care process are the key contributions of medical care. Cultural, language and security barriers make emergency care difficult.
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Affiliation(s)
- José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Spain; Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile.
| | | | | | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Spain; Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, London, UK.
| | | | | | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Spain; Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile.
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Paccoud I, Baumann M, Le Bihan E, Pétré B, Breinbauer M, Böhme P, Chauvel L, Leist AK. Socioeconomic and behavioural factors associated with access to and use of Personal Health Records. BMC Med Inform Decis Mak 2021; 21:18. [PMID: 33435970 PMCID: PMC7805047 DOI: 10.1186/s12911-020-01383-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/25/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Access to and use of digital technology are more common among people of more advantaged socioeconomic status. These differences might be due to lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of Personal Health Records (PHR): desire, intentions and physical access to PHR. METHODS A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). Exploratory factor analysis was performed to group items derived from the UTAUT model. We applied linear and logistic regressions controlling for country-level heterogeneity, health and demographic factors. RESULTS A total of 829 individuals aged over 18 completed the questionnaire. Socioeconomic inequalities were present in the access to and use of PHR. Education and income played a significant role in individuals' desire to access their PHR. Being older than 65 years, and migrant, were negatively associated with desire to access PHR. An income gradient was found in having physical access to PHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use PHR. In fully adjusted models testing the contribution of UTAUT-derived factors, individuals who perceived PHRs to be useful and had the necessary digital skills were more inclined to use their PHR regularly. Social influence, support and lack of anxiety in using technology were strong predictors of regular PHR use. CONCLUSION The findings highlight the importance of considering all stages in PHR use: desire to access, physical access and intention to regularly use PHRs, while paying special attention to migrants and people with less advantaged socioeconomic backgrounds who may feel financial constraints and are not able to exploit the potential of PHRs. As PHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could reduce health inequalities and advance health equity.
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Affiliation(s)
- Ivana Paccoud
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality, University of Luxembourg, Belval Campus, 4366 Esch-sur-Alzette, Luxembourg
| | - Michèle Baumann
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality, University of Luxembourg, Belval Campus, 4366 Esch-sur-Alzette, Luxembourg
| | - Etienne Le Bihan
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality, University of Luxembourg, Belval Campus, 4366 Esch-sur-Alzette, Luxembourg
| | - Benoît Pétré
- Department of Public Health, University of Liège, Liège, Belgium
| | - Mareike Breinbauer
- Department of General Medicine and Geriatrics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philip Böhme
- Department of Endocrinology, Diabetology and Nutrition, Regional Network LORDIAMN, University Hospital of Nancy, Nancy, France
| | - Louis Chauvel
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality, University of Luxembourg, Belval Campus, 4366 Esch-sur-Alzette, Luxembourg
| | - Anja K. Leist
- Department of Social Sciences, Institute for Research on Socio-Economic Inequality, University of Luxembourg, Belval Campus, 4366 Esch-sur-Alzette, Luxembourg
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Saleh S, El Arnaout N, Abdouni L, Jammoul Z, Hachach N, Dasgupta A. Sijilli: A Scalable Model of Cloud-Based Electronic Health Records for Migrating Populations in Low-Resource Settings. J Med Internet Res 2020; 22:e18183. [PMID: 32788145 PMCID: PMC7453321 DOI: 10.2196/18183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/19/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022] Open
Abstract
The world is witnessing an alarming rate of displacement and migration, with more than 70.8 million forcibly displaced individuals, including 26 million refugees. These populations are known to have increased vulnerability and susceptibility to mental and physical health problems due to the migration journey. Access of these individuals to health services, whether during their trajectory of displacement or in refugee-hosting countries, remains limited and challenging due to multiple factors, including language and cultural barriers and unavailability of the refugees’ health records. Cloud-based electronic health records (EHRs) are considered among the top five health technologies integrated in humanitarian crisis preparedness and response during times of conflict. This viewpoint describes the design and implementation of a scalable and innovative cloud-based EHR named Sijilli, which targets refugees in low-resource settings. This paper discusses this solution compared with other similar practices, shedding light on its potential for scalability.
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Affiliation(s)
- Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Lina Abdouni
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Zeinab Jammoul
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Noha Hachach
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,American University of Beirut Medical Center, Beirut, Lebanon
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Gottlieb N, Bozorgmehr K, Trummer U, Rechel B. Health policies and mixed migration – Lessons learnt from the ‘Refugee Crisis’. Health Policy 2019; 123:805-808. [DOI: 10.1016/j.healthpol.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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