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Rodriguez-Morales AJ, Abbara A, Ntoumi F, Kapata N, Mwaba P, Yeboah-Manu D, Maeurer M, Dar O, Abubakar I, Zumla A. World tuberculosis day 2023 - Reflections on the spread of drug-resistant tuberculosis by travellers and reducing risk in forcibly displaced populations. Travel Med Infect Dis 2023; 53:102568. [PMID: 36963477 DOI: 10.1016/j.tmaid.2023.102568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/26/2023]
Affiliation(s)
- Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de Las Américas-Institución Universitaria Vision de Las Americas, Pereira, Risaralda, Colombia; Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, P.O. Box 36, Lebanon.
| | - Aula Abbara
- Syria Public Health Network and Imperial College, London, UK; Division of Infection and Immunity, Imperial College London, London, United Kingdom
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Brazzaville, People's Republic of Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Nathan Kapata
- National Public Health Institute, Ministry of Health, Lusaka, Zambia; UNZA-UCLMS Research and Training Program, UTH, Lusaka, Zambia
| | - Peter Mwaba
- UNZA-UCLMS Research and Training Program, UTH, Lusaka, Zambia; Lusaka Apex Medical University, Faculty of Medicine, Lusaka, Zambia
| | - Dorothy Yeboah-Manu
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana
| | - Markus Maeurer
- Champalimaud Centre for the Unknown, Lisbon, Portugal; Medizinische Klinik, Johannes Gutenberg University Mainz, Germany
| | - Osman Dar
- Global Operations, United Kingdom Health Security Agency, London, UK; Global Health Programme, Royal Institute of International Affairs, London, United Kingdom
| | - Ibrahim Abubakar
- Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom
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Khalid A, Babry JA, Vearey J, Zenner D. TURNING UP THE HEAT: A CONCEPTUAL MODEL FOR UNDERSTANDING THE MIGRATION AND HEALTH IN THE CONTEXT OF GLOBAL CLIMATE CHANGE. J Migr Health 2023; 7:100172. [PMID: 37034244 PMCID: PMC10074782 DOI: 10.1016/j.jmh.2023.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 03/22/2023] Open
Abstract
Background The triangular relationship between climate change-related events, patterns of human migration and their implications for health is an important yet understudied issue. To improve understanding of this complex relationship, a comprehensive, interdisciplinary conceptual model will be useful. This paper investigates relationships between these factors and considers their impacts for affected populations globally. Methods A desk review of key literature was undertaken. An open-ended questionnaire consisting of 11 items was designed focusing on three themes: predicting population migration by understanding key variables, health implications, and suggestions on policy and research. After using purposive sampling we selected nine experts, reflecting diverse regional and professional backgrounds directly related to our research focus area. All responses were thematically analysed and key themes from the survey were synthesised to construct the conceptual model focusing on describing the relationship between global climate change, migration and health implications and a second model focusing on actionable suggestions for organisations working in the field, academia and policymakers. Results Key themes which constitute our conceptual model included: a description of migrant populations perceived to be at risk; health characteristics associated with different migratory patterns; health implications for both migrants and host populations; the responsibilities of global and local governance actors; and social and structural determinants of health. Less prominent themes were aspects related to slow-onset migratory patterns, voluntary stay, and voluntary migration. Actionable suggestions include an interdisciplinary and innovative approach to study the phenomenon for academicians, preparedness and globalized training and awareness for field organisations and migrant inclusive and climate sensitive approach for policymakers. Conclusion Contrary to common narratives, participants framed the impacts of climate change-related events on migration patterns and their health implications as non-linear and indirect, comprising many interrelated individual, social, cultural, demographic, geographical, structural, and political determinants. An understanding of these interactions in various contexts is essential for risk reduction and preventative measures. The way forward broadly includes inclusive and equity-based health services, improved and faster administrative systems, less restrictive (im)migration policies, globally trained staff, efficient and accessible research, and improved emergency response capabilities. The focus should be to increase preventative and adaptation measures in the face of any environmental changes and respond efficiently to different phases of migration to aim for better "health for all and promote universal well-being" (WHO) (World Health Organization 1999).
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Sherif B, Awaisu A, Kheir N. Refugee healthcare needs and barriers to accessing healthcare services in New Zealand: a qualitative phenomenological approach. BMC Health Serv Res 2022; 22:1310. [PMID: 36329410 PMCID: PMC9632582 DOI: 10.1186/s12913-022-08560-8] [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: 09/05/2021] [Accepted: 07/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Refuges and asylum seekers have specific healthcare needs; however there has been insufficient attention and effort to address these needs globally. Furthermore, effective communication between healthcare providers and refugees remains poor, further widening the imbalanced power dynamics. The aim of this research project was to examine refugee healthcare needs and current barriers to accessing healthcare services in New Zealand, and to propose solutions by exploring the perceptions, attitudes, beliefs, and opinions of key stakeholders regarding refugee healthcare needs within the scaffold of health and social care systems. Methods We conducted semi-structured interviews between September and December 2018 with 18 purposively selected refugee service provider stakeholders in New Zealand using an interview guide that addressed healthcare needs, existing barriers to access healthcare services, and perceived future healthcare delivery solutions. Results Thematic analysis of emergent themes of this study indicated the need for a national framework of inclusion, mandating cultural safety training of frontline personnel, improving access to interpreters and cultural mediators, and establishing the role of patient navigators. Barriers to accessing health services included entrenched social health determinants such as housing scarcity and disenfranchised community environments; refugee health-seeking behaviour and poor health literacy; along with existing social support networks. We propose that healthcare delivery should focus on capacity building of existing services, including co-design processes with refugees and asylum seekers and increasing funding for refugee-specific health service via the implementation of an overarching national strategy. Conclusion Based on the findings of this study, refugee organisations and their frontline personnel should seek to address the deficiencies identified in order to provide equitable, timely and culturally-accessible healthcare services for refugees in New Zealand and in comparable countries.
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Affiliation(s)
- Bafreen Sherif
- Inpatient Pharmacy, Waitemata District Health Board, Auckland, New Zealand.,School of Pharmacy, Faculty of Medical and Health Sciences, Auckland University, Auckland, New Zealand
| | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Nadir Kheir
- School of Pharmacy, Faculty of Medical and Health Sciences, Auckland University, Auckland, New Zealand. .,College of Pharmacy, Ajman University, Al Jerf 2, P.O.Box 346, Ajman, United Arab Emirates.
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Nomura S, Sakamoto H, Ishizuka A, Shimizu K, Shibuya K. Tracking sectoral allocation of official development assistance: a comparative study of the 29 Development Assistance Committee countries, 2011-2018. Glob Health Action 2021; 14:1903222. [PMID: 33820500 PMCID: PMC8032342 DOI: 10.1080/16549716.2021.1903222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Official development assistance (ODA) is one of the most important means for donor countries to foster diplomatic relations with low- and middle-income countries and contribute to the welfare of the international community. Objective: This study estimated the sectoral allocation of gross disbursements of ODA of the 29 Development Assistance Committee (DAC) member countries of the Organisation for Economic Co-operation and Development (OECD) for the duration of 2011 to 2018, by aid type (bilateral, multilateral, and both aids). Methods: Data from the OECD iLibrary were used. The sector definition was based on the OECD sector classification. For core funding to multilateral agencies that do not specialize in each aid sector, we estimated ODA and its flows based on the OECD methodology for calculating imputed multilateral ODA. Results: For all 29 countries, during the period of 2014–2018 where data were available for all the countries, the sector with the highest average annual ODA contribution was health at 20.34 billion USD (13.21%), followed by humanitarian aid at 18.04 billion (11.72%). Humanitarian aid has increased in the sectoral share rankings in both bilateral and multilateral aid, and the sectoral share for refugees in donor countries has increased in bilateral aid. While the 29 countries show relatively similar trends for sectoral shares, some countries and sectors display unique trends. For instance, infrastructure and energy sectors in bilateral aid of Japan are particularly high accounts for 48.48% of the total bilateral ODA of the country in 2018. Conclusions: This paper evaluated ODA trends by major donors of DAC countries in the pre-COVID-19 pandemic periods. We hope that our estimates will contribute to the review of the strategic decision-making and the effective implementation of future ODA policy discussions in the DAC countries while ensuring transparency.
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Affiliation(s)
- Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.,Department of Global Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Haruka Sakamoto
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.,Department of Global Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Aya Ishizuka
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.,Department of Global Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kazuki Shimizu
- Department of Health Policy, London School of Economics and Political Science, London, UK.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.,Institute for Population Health, King's College London, London, UK
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Manauis CM, Loh M, Lim AHJ, Kwan J, Teo HJ, Teng DKP, Vasoo SS, Leo YS, Ang H. The next wave: key adaptations to operational workflows of National Screening Centre (Singapore) and the emergency department during the COVID-19 pandemic. Int J Emerg Med 2021; 14:14. [PMID: 33627063 PMCID: PMC7903370 DOI: 10.1186/s12245-021-00337-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/02/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Charmaine Malenab Manauis
- Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Marvin Loh
- Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Singapore, Singapore.
| | | | - James Kwan
- Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Han Jie Teo
- Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - David Kuan Peng Teng
- Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Shawn Sushilan Vasoo
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Hou Ang
- Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
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Müller F, Kleinert E, Hillermann N, Simmenroth A, Hummers E, Scharff AZ, Dopfer C, Happle C, Jablonka A. Disease burden in a large cohort of asylum seekers and refugees in Germany. J Glob Health 2021; 11:04002. [PMID: 33643633 PMCID: PMC7897448 DOI: 10.7189/jogh.11.04002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Currently, health care systems worldwide are challenged with providing care to an increasing number of migrants, refugees, and displaced persons. In this article, we report on disease burden and drug prescription patterns in a large refugee cohort in Germany. Methods We conducted a cross-sectional study of anonymized medical records including demographic data, diagnoses, and drug prescriptions in two refugee reception centres between 2015 and 2019. Refugees and migrants received medical assistance exclusively through the on-site clinics. Thus, this study represents all medical visits of the housed residents. Results In total, n = 15531 diagnoses from n = 4858 patients in a cohort of n = 10431 accommodated refugees were recorded. N = 11898 medications were prescribed. Overall, 29.8% of all refugees sought medical attention. Half of the patients were female (49.6%), the average age was 23.8 years (SD [standard deviation] 17.0, min 0, max 81), and 41.5% were minors (<18 years). Most patients had Middle Eastern or Northern African origin (63.9%). The largest proportion of diagnoses belonged to the ICD (International Statistical Classification of Diseases and Related Health Problems) category “R” (miscellaneous, 33.5%), followed by diseases of the respiratory system (category “J”, 16.5%), or the musculoskeletal system (category “M”, 7.1%). Non-steroidal anti-inflammatory drugs were most frequently prescribed. Conclusions This analysis in two large refugee centres in Germany shows that about one third of refugees seek medical attention upon initial arrival. Complaints are manifold, with a high prevalence of respiratory infections.
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Affiliation(s)
- Frank Müller
- Department of General Practice, University Medical Centre Goettingen, Goettingen, Germany
| | - Evelyn Kleinert
- Department of General Practice, University Medical Centre Goettingen, Goettingen, Germany
| | - Nele Hillermann
- Department of General Practice, University Medical Centre Goettingen, Goettingen, Germany
| | - Anne Simmenroth
- Department of General Practice, University Medical Centre Goettingen, Goettingen, Germany.,Department of General Practice, University Medical Centre Wuerzburg, Wuerzburg, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Centre Goettingen, Goettingen, Germany
| | | | - Christian Dopfer
- Department of Paediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Christine Happle
- Department of Paediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany.,German Centre for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/ BREATH, Hannover, Germany
| | - Alexandra Jablonka
- German Centre for Infection Research (DZIF), Partner Site Hannover-Brunswick, Braunschweig, Germany.,Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
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Hertting O, Luthander J, Giske CG, Bennet R, Eriksson M. Acute infection as cause of hospitalization of asylum-seeking children and adolescents in Stockholm, Sweden 2015-2016. Eur J Pediatr 2021; 180:893-898. [PMID: 32974759 PMCID: PMC7886722 DOI: 10.1007/s00431-020-03795-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/04/2020] [Accepted: 08/26/2020] [Indexed: 11/27/2022]
Abstract
We aimed to identify hospitalizations due to infectious diseases among asylum seekers and compare them to those of the resident population 1.6.2015-31.10.2016. Administrative numbers assigned to hospitalized non-resident children made them identifiable in the discharge register. The examined populations, expressed as person-years, were 334,573 residents and 7565 asylum seekers. There were 2500 episodes of infectious disease in 2240 resident children and 139 episodes in 121 asylum seekers. Among prevalent infections contracted before or during migration, there were 33 cases of tuberculosis, four of malaria, and one of louse-borne relapsing fever, all of which occurred in 13-17-year-old unaccompanied minors. Among younger asylum seekers, there were no significant differences in the spectrum of infectious discharge diagnoses compared to residents, but across all incident infections, 0-6-year-old asylum seekers had 3.2-fold and 7-12-year-old a 4.7-fold greater risk of being admitted. Screening for multidrug-resistant bacteria showed that 45/160 (28%) of the asylum seekers were colonized, but clinical infections caused by these species were rare.Conclusion: There was a high rate of hospitalizations for acute infectious diseases in asylum-seeking children, but the spectrum and severity of infections were similar to that in resident children. What is known: • Mental and physical health problems are common in immigrant children and adolescents. What is new: • Hospitalizations due to acute infections in asylum-seeking children and adolescents are common. In the context of this study, the severity and spectrum of infectious diseases seemed to be the same in the two groups; the increased hospitalization rate in asylum seekers may be due to social factors and perceived need for more support.
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Affiliation(s)
- Olof Hertting
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. .,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Joachim Luthander
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden ,Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Christian G. Giske
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden ,Division of Clinical microbiology, Department of Laboratory medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rutger Bennet
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Eriksson
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
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Loganathan T, Rui D, Pocock NS. Healthcare for migrant workers in destination countries: a comparative qualitative study of China and Malaysia. BMJ Open 2020; 10:e039800. [PMID: 33268413 PMCID: PMC7713184 DOI: 10.1136/bmjopen-2020-039800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This paper explores policies addressing migrant worker's health and barriers to healthcare access in two middle-income, destination countries in Asia with cross-border migration to Yunnan province, China and international migration to Malaysia. DESIGN Qualitative interviews were conducted in Rui Li City and Tenchong County in Yunnan Province, China (n=23) and Kuala Lumpur, Malaysia (n=44), along with review of policy documents. Data were thematically analysed. PARTICIPANTS Participants were migrant workers and key stakeholders with expertise in migrant issues including representatives from international organisations, local civil society organisations, government agencies, medical professionals, academia and trade unions. RESULTS Migrant health policies at destination countries were predominantly protectionist, concerned with preventing transmission of communicable disease and the excessive burden on health systems. In China, foreign wives were entitled to state-provided maternal health services while female migrant workers had to pay out-of-pocket and often returned to Myanmar for deliveries. In Malaysia, immigration policies prohibit migrant workers from pregnancy, however, women do deliver at healthcare facilities. Mandatory HIV testing was imposed on migrants in both countries, where it was unclear whether and how informed consent was obtained from migrants. Migrants who did not pass mandatory health screenings in Malaysia would runaway rather than be deported and become undocumented in the process. Excessive attention on migrant workers with communicable disease control campaigns in China resulted in inadvertent stigmatisation. Language and financial barriers frustrated access to care in both countries. Reported conditions of overcrowding and inadequate healthcare access at immigration detention centres raise public health concern. CONCLUSIONS This study's findings inform suggestions to mainstream the protection of migrant workers' health within national health policies in two middle-income destination countries, to ensure that health systems are responsive to migrants' needs as well as to strengthen bilateral and regional cooperation towards ensuring better migration management.
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Affiliation(s)
- Tharani Loganathan
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Deng Rui
- School of Public Health, Kunming Medical University, Kunming, China
| | - Nicola Suyin Pocock
- Gender Violence & Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- United Nations University - International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
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Controlled copper in situ growth-amplified lateral flow sensors for sensitive, reliable, and field-deployable infectious disease diagnostics. Biosens Bioelectron 2020; 171:112753. [PMID: 33120235 PMCID: PMC7575433 DOI: 10.1016/j.bios.2020.112753] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 01/10/2023]
Abstract
A polyethyleneimine (PEI)-assisted copper in-situ growth (CISG) strategy was proposed as a controlled signal amplification strategy to enhance the sensitivity of gold nanoparticle-based lateral flow sensors (AuNP-LFS). The controlled signal amplification is achieved by introducing PEI as a structure-directing agent to regulate the thermodynamics of anisotropic Cu nanoshell growth on the AuNP surface, thus controlling shape and size of the resultant AuNP@Cu core-shell nanostructures and confining free reduction and self-nucleation of Cu2+ for improved reproducibility and decreased false positives. The PEI-CISG-enhanced AuNP-LFS showed ultrahigh sensitivities with the detection limits of 50 fg mL-1 for HIV-1 capsid p24 antigen and 6 CFU mL-1 for Escherichia coli O157:H7. We further demonstrated its clinical diagnostic efficacy by configuring PEI-CISG into a commercial AuNP-LFS detection kit for SARS-CoV-2 antibody detection. Altogether, this work provides a reliable signal amplification platform to dramatically enhance the sensitivity of AuNP-LFS for rapid and accurate diagnostics of various infectious diseases.
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Unexpected public health consequences of the COVID-19 pandemic: a national survey examining anti-Asian attitudes in the USA. Int J Public Health 2020; 65:747-754. [PMID: 32728852 PMCID: PMC7388430 DOI: 10.1007/s00038-020-01440-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 10/30/2022] Open
Abstract
OBJECTIVES This paper empirically examines whether and how COVID-19 may be activating bias and discrimination toward individuals of Asian descent. METHODS In March 2020, we used a national online survey to collect data from 1141 US residents. Using descriptive statistics and multivariate regression, we estimated the prevalence and COVID-19-related predictors of bias toward people of Asian descent. RESULTS We found over 40% of our sample reported they would engage in at least one discriminatory behavior toward people of Asian descent. Respondents who were fearful of COVID-19 (b = .09, p < 0.001) and had less accurate knowledge about the virus (b = - .07, p < 0.001) reported more negative attitudes toward Asians as did respondents with less trust in science (b = - .06, p < 0.001) and more trust in President Trump (b = .04, p < 0.001). CONCLUSIONS Public health leaders must confront fear of the virus, improve knowledge, and bolster trust in science as these factors may evoke negative attitudes toward Asians and increase prejudice and discrimination. Specifically, our findings warrant the adoption of public health campaigns that provide health information and build trust in scientific knowledge.
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Abstract
The years 2014 and 2015 saw a dramatic rise in the number of migrants entering Europe via the Mediterranean. This rise was mostly accounted for by refugees fleeing the civil war in the Syrian Arab Republic. Since that time Europe has been gripped in a political and humanitarian crisis as the incoming numbers overwhelmed individual state and collective European Union ability to respond effectively. In this article, I explore the European Migrant Crisis in geographical, political and humanitarian perspectives, describing and explaining the key events of the crisis. I then go on to a study of the major health issues arising from the crisis in terms of communicable and non-communicable disease, mental health, gender-related health and access to healthcare. Finally, I discuss the global dimensions of the refugee crisis and enter into a discussion of the roles and effectiveness of the UNHCR and the European Union's response as a whole.
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Schmutzhard E, Pfausler B. [Imported infections of the central nervous system : Migration and travel neurology]. DER NERVENARZT 2020; 91:161-169. [PMID: 32016511 DOI: 10.1007/s00115-019-00865-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The numbers of migrants, refugees and asylum seekers reached an unprecedented high in Europe in 2015 and 2016 but in 2019 they are back to the average numbers of the last 30 years. In contrast, frequencies of international and intercontinental travelers have continuously increased over the past decades and will continue to do so in the coming years. In 2018 more than 1.35 billion incoming travelers were reported worldwide by international organizations. Detailed knowledge of the epidemiology, transmission types, risk behavior and clinical presentation of acute and chronic central nervous system (CNS) infections enables timely diagnosis and initiation of potentially life-saving emergency treatment. Acute infections of the CNS, e.g. cerebral Plasmodium falciparum malaria or arboviral encephalitis, are seen most frequently and almost exclusively in travelers returning from tropical countries, whereas chronic CNS infections, e.g. tuberculous meningitis or neurocysticercosis, are typically seen in migrants and refugees. Beside CNS infections genetic diseases, environment-associated, nutrition-related, metabolic or cerebrovascular diseases also need to be considered when discussing differential diagnostic possibilities.
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Affiliation(s)
- Erich Schmutzhard
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Bettina Pfausler
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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de Gruchy T. Responding to the health needs of migrant farm workers in South Africa: Opportunities and challenges for sustainable community-based responses. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:60-68. [PMID: 31476093 PMCID: PMC6916584 DOI: 10.1111/hsc.12840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/24/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
Reflecting global trends, migrant farm workers in South Africa experience challenges in accessing healthcare. On the commercial farms in Musina, a sub-district bordering Zimbabwe, Medécins sans Frontières and the International Organization for Migration both implemented migration-aware community-based programmes that included the training of community-based healthcare workers, to address these challenges. Using qualitative data, this paper explores the experiences that migrant farm workers, specifically those involved in the programmes, had of these interventions. A total of 79 semi-structured interviews were completed with migrant farm workers, farm managers, NGO employees and civil servants between January 2017 and July 2018. These data were supplemented by a review of grey and published literature, as well as observation and field notes. Findings indicate that participants were primarily positive about the interventions. However, since the departure of both Medécins sans Frontières and the International Organization for Migration, community members have struggled to sustain the projects and the structural differences between the two programmes have created tensions. This paper highlights the ways in which local interventions that mobilise community members can improve the access that rural, migrant farming communities have to healthcare. However, it simultaneously points to the ways in which these interventions are unsustainable given the realities of non-state interventions and the fragmented state approach to community-based healthcare workers. The findings presented in this paper support global calls for the inclusion of migration and health in government policy making at all levels. However, findings also capture the limitations of community-based interventions that do not recognise community-based healthcare workers as social actors and fail to take into account their motivations, desires and need for continued supervision. As such, ensuring that the ways in which migration and health are included in policy making are sustainable emerges as a necessary element to be included in global calls.
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Affiliation(s)
- Thea de Gruchy
- The African Centre for Migration & SocietyUniversity of the WitwatersrandJohannesburgSouth Africa
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14
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Paran Y, Ben-Ami R, Orlev B, Halutz O, Elalouf O, Wasserman A, Zimmerman O, Nahmani I, Rabinowich L, Finn T. Chronic schistosomiasis in African immigrants in Israel: Lessons for the non-endemic setting. Medicine (Baltimore) 2019; 98:e18481. [PMID: 31876734 PMCID: PMC6946286 DOI: 10.1097/md.0000000000018481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
To study the clinical presentation of Chronic Schistosomiasis (CS) in immigrants from East Africa to Israel and the tests that were useful in confirming the diagnosis.A retrospective study of all medical notes pertaining to hospitalized patients who were immigrants from East Africa with a pathological or microscopic confirmation of CS. Literature review was also conducted focusing on diagnosis of schistosomiasis among immigrants from endemic countries.We identified 32 suspected and 11 confirmed cases of CS. Most of the patients (82%) presented with gastrointestinal symptoms. Sensitivity of stool smear, serology and tissue diagnosis (by histopathology or microscopy) were 14%, 100%, 89%, respectively. Patients have undergone extensive diagnostic evaluation with long hospitalization stays (median 10 days, range 4 to 33 days).CS has multiple presentations and is seen in Israel among refugees from Eritrea and Sudan. Most of the manifestations are gastrointestinal, suggestive of infection with Schistosoma mansoni (S. mansoni). Standard diagnostic techniques used in endemic countries, such as microscopy for ova and parasites were unhelpful, necessitating more advanced procedures like colonoscopic or liver biopsy. We propose a diagnostic algorithm for CS in this patient population in order to make an accurate diagnosis and avoid unnecessary invasive procedures.
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Affiliation(s)
- Yael Paran
- Infectious Diseases Unit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ronen Ben-Ami
- Infectious Diseases Unit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | | | | | | | - Asaf Wasserman
- Infectious Diseases Unit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ofer Zimmerman
- Infectious Diseases Unit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ido Nahmani
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | | | - Talya Finn
- Sanz Medical Centre, Laniado Hospital, Netanya
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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15
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Happle C, Dopfer C, Ernst D, Kleinert E, Vakilzadeh A, Hellms S, Evlampidou I, Hillermann N, Schmidt RE, Behrens GMN, Müller F, Wetzke M, Jablonka A. Pediatric Healthcare Utilization in a Large Cohort of Refugee Children Entering Western Europe During the Migrant Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224415. [PMID: 31718046 PMCID: PMC6888204 DOI: 10.3390/ijerph16224415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Abstract
: Background: Currently, half of the population displaced worldwide is children and adolescents. Little is known on healthcare demand in underage migrants. MATERIALS AND METHODS We analyzed healthcare utilization in n = 1.411 children and adolescents living in a large German refugee reception in 2015-2016. RESULTS The mean age of all included refugees was 9 years (60.8% male). The majority came from the eastern Mediterranean region. During a mean camp inhabitance of 34 days, 57.6% needed primary healthcare, with a significant inverse correlation of healthcare seeking frequency with age and duration of camp inhabitance. Infants and unaccompanied minors displayed particular high demands for medical help. DISCUSSION Our analysis showed that pediatric primary healthcare in pediatric and adolescent refugees are most sought during the first period upon arrival with particular demand in infants, toddlers, and unaccompanied minors. Based on this data, future care taking strategies should be adapted accordingly.
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Affiliation(s)
- Christine Happle
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany; (C.H.); (C.D.); (M.W.)
- German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, 30625 Hannover, Germany
| | - Christian Dopfer
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany; (C.H.); (C.D.); (M.W.)
- German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, 30625 Hannover, Germany
| | - Diana Ernst
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
| | - Evelyn Kleinert
- Department of General Practice, University Medical Center Göttingen, 37073 Göttingen, Germany; (E.K.); (N.H.); (F.M.)
| | | | - Susanne Hellms
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, 30625 Hannover, Germany;
| | | | - Nele Hillermann
- Department of General Practice, University Medical Center Göttingen, 37073 Göttingen, Germany; (E.K.); (N.H.); (F.M.)
| | - Reinhold E. Schmidt
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
| | - Georg M. N. Behrens
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, 37073 Göttingen, Germany; (E.K.); (N.H.); (F.M.)
| | - Martin Wetzke
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany; (C.H.); (C.D.); (M.W.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
| | - Alexandra Jablonka
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-511-532-5337; Fax: +49-511-532-5324
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Vearey J, Orcutt M, Gostin L, Braham CA, Duigan P. Building alliances for the global governance of migration and health. BMJ 2019; 366:l4143. [PMID: 31527042 PMCID: PMC6741739 DOI: 10.1136/bmj.l4143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Health governance has an important role in dealing with global migration, argue Jo Vearey and colleagues
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Affiliation(s)
- Jo Vearey
- African Centre for Migration and Society, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Centre of African Studies, University of Edinburgh, Edinburgh, UK
| | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | - Larry Gostin
- Georgetown University Center for Aphasia Research and Rehabilitation, Washington, DC, USA
- World Health Organization Collaborating Center on National and Global Health Law, Washington, USA
| | - Christy Adeola Braham
- African Platform for Migration and Inclusion in Health, London, UK
- University of Sheffield, Sheffield, UK
| | - Patrick Duigan
- International Organization for Migration, Regional Office for Asia and the Pacific, Bangkok, Thailand
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Pottie K, Agic B, Archibald D, Ratnayake A, Tapia M, Thanos J. HEIA tools: inclusion of migrants in health policy in Canada. Health Promot Int 2019; 34:697-705. [PMID: 29672682 DOI: 10.1093/heapro/day016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This paper introduces the Migrant Populations Equity Extension for Ontario's Health Equity Impact Assessment (HEIA) initiatives. It provides a mechanism to address the needs of migrant populations, within a program and policy framework. Validation of an equity extension framework using community leaders and health practitioners engaged in HEIA workshops across Ontario. Participants assessed migrants' health needs and discussed how to integrate these needs into health policy. The Migrant Populations Equity Extension's framework assists decision makers assess relevant populations, collaborate with immigrant communities, improve policy development and mitigate unintended negative impacts of policy initiatives. The tool framework aims to build stakeholder capacity and improve their ability to conduct HEIAs while including migrant populations. The workshops engaged participants in equity discussions, enhanced their knowledge of migrant policy development and promoted HEIA tools in health decision-making. Prior to these workshops, many participants were unaware of the HEIA tool. The workshops informed the validation of the equity extension and support materials for training staff in government and public health. Ongoing research on policy implementation would be valuable. Public health practitioners and migrant communities can use the equity extension's framework to support decision-making processes and address health inequities. This framework may improve policy development and reduce health inequities for Ontario's diverse migrant populations. Many countries are now using health impact assessment and health equity frameworks. This migration population equity extension is an internationally unique framework that engages migrant communities.
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Affiliation(s)
- Kevin Pottie
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Cresc. Suite 201, Ottawa, ON, Canada.,Department of Epidemiology and Community Medicine, Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Branka Agic
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Cresc. Suite 201, Ottawa, ON, Canada
| | - Ayesha Ratnayake
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
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Kindermann D, Schmid C, Schell T, Junne F, Thalheimer M, Daniels JK, Herzog W, Nikendei C. Experiences and psychological strain in volunteer medical doctors providing medical visual examination for asylum seekers in a reception center in Germany – a qualitative interview study. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2019. [DOI: 10.1080/15555240.2019.1586550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- David Kindermann
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Carolin Schmid
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Schell
- Public Health Authority, Rhine-Neckar-County and City of Heidelberg, Heidelberg, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Markus Thalheimer
- Department of Quality Management and Medical Controlling of the University Hospital Heidelberg, Heidelberg, Germany
| | - Judith K. Daniels
- Department of Psychology, Division of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Cinaroglu S. EU-28 Country Clusters and Patterns of Disease During the European Refugee Crisis. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2019. [DOI: 10.1007/s12134-019-00686-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Medical Clerkship in a State Registration and Reception Center for Forced Migrants in Germany: Students' Experiences, Teachable Moments, and Psychological Burden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101704. [PMID: 31096613 PMCID: PMC6572228 DOI: 10.3390/ijerph16101704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/03/2019] [Accepted: 05/10/2019] [Indexed: 11/17/2022]
Abstract
Aspects of global health are becoming increasingly relevant for doctors of future generations. However, medical curricula rarely include courses which focus on global health or forced migration. Furthermore, it remains unclear whether students are at risk to develop psychological strain, after being confronted with highly burdened or even traumatized asylum seekers. This is a prospective study using a mixed-methods approach. We included n = 22 medical students performing a medical clerkship in a state registration and reception center for refugees. By applying (1) qualitative interviews, (2) reflective diaries, and (3) psychometric questionnaires, we examined the students’ experiences, teachable moments, and potential psychological burdens. In the interviews, the students emphasized the importance of cultural sensitivity during their clerkship. However, they also reported cognitive changes concerning their views of themselves and the world in general; this could indicate vicarious traumatization. The reflective diaries displayed high learning achievements. According to the psychometric questionnaires, the assignment in the reception center had not caused any significant psychological strain for the students. By completing their medical clerkship in a reception center, students were able to improve their medical, organizational, and interactional knowledge and skills. Furthermore, they reported that they had broadened their personal and cultural horizons.
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21
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Jirovsky E, Hoffmann K, Mayrhuber EAS, Mechili EA, Angelaki A, Sifaki-Pistolla D, Petelos E, van den Muijsenbergh M, van Loenen T, Dückers M, Kolozsvári LR, Rurik I, Rotar Pavlič D, Sandoval DC, Borgioli G, Pinilla MJC, Ajduković D, De Graaf P, van Ginneken N, Dowrick C, Lionis C. Development and evaluation of a web-based capacity building course in the EUR-HUMAN project to support primary health care professionals in the provision of high-quality care for refugees and migrants. Glob Health Action 2019; 11:1547080. [PMID: 30499386 PMCID: PMC6282415 DOI: 10.1080/16549716.2018.1547080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The ongoing refugee crisis has revealed the need for enhancing primary health care (PHC) professionals' skills and training. OBJECTIVES The aim was to strengthen PHC professionals in European countries in the provision of high-quality care for refugees and migrants by offering a concise modular training that was based on the needs of the refugees and PHC professionals as shown by prior research in the EUR-HUMAN project. METHODS We developed, piloted, and evaluated an online capacity building course of 8 stand-alone modules containing information about acute health issues of refugees, legal issues, provider-patient communication and cultural aspects of health and illness, mental health, sexual and reproductive health, child health, chronic diseases, health promotion, and prevention. The English course template was translated into seven languages and adapted to the local contexts of six countries. Pre- and post-completion knowledge tests were administered to effectively assess the progress and knowledge increase of participants so as to issue CME certificates. An online evaluation survey post completion was used to assess the acceptability and practicability of the course from the participant perspective. These data were analyzed descriptively. RESULTS A total of 390 participants registered for the online course in 6 countries with 175 completing all modules of the course, 47.7 % of them medical doctors. The mean time for completion was 10.77 hours. In total, 123 participants completed the online evaluation survey; the modules on acute health needs, legal issues (both 44.1%), and provider-patient communication/cultural issues (52.9%) were found particularly important for the daily practice. A majority expressed a will to promote the online course among their peers. CONCLUSION This course is a promising learning tool for PHC professionals and when relevant supportive conditions are met. The course has the potential to empower PHC professionals in their work with refugees and other migrants.
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Affiliation(s)
- Elena Jirovsky
- a Department of General Practice and Family Medicine , Medical University of Vienna , Vienna , Austria
| | - Kathryn Hoffmann
- a Department of General Practice and Family Medicine , Medical University of Vienna , Vienna , Austria
| | | | - Enkeleint Aggelos Mechili
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Agapi Angelaki
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Dimitra Sifaki-Pistolla
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Elena Petelos
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Maria van den Muijsenbergh
- c Department of Primary and Community Care , Radboud University Medical Centre , Nijemegen , The Netherlands
| | - Tessa van Loenen
- c Department of Primary and Community Care , Radboud University Medical Centre , Nijemegen , The Netherlands
| | | | - László Róbert Kolozsvári
- e Department of Family and Occupational Medicine, Faculty of Public Health , University of Debrecen , Debrecen , Hungary
| | - Imre Rurik
- e Department of Family and Occupational Medicine, Faculty of Public Health , University of Debrecen , Debrecen , Hungary
| | - Danica Rotar Pavlič
- f Department of Family Medicine , University of Ljubljana , Lubljana , Slovenia
| | | | - Giulia Borgioli
- h Azienda USL Toscana Centro - Global Health Center , Region of Tuscany , Florence , Italy
| | | | - Dean Ajduković
- j Department of Psychology, Faculty of Humanities and Social Sciences , University of Zagreb , Zagreb , Croatia
| | - Pim De Graaf
- g European Forum for Primary Care , Utrecht , The Netherlands
| | - Nadja van Ginneken
- k Primary Medical Care , University of Liverpool , Liverpool , United Kingdom
| | - Christopher Dowrick
- k Primary Medical Care , University of Liverpool , Liverpool , United Kingdom
| | - Christos Lionis
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
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Kakalou E, Riza E, Chalikias M, Voudouri N, Vetsika A, Tsiamis C, Choursoglou S, Terzidis A, Karamagioli E, Antypas T, Pikoulis E. Demographic and clinical characteristics of refugees seeking primary healthcare services in Greece in the period 2015-2016: a descriptive study. Int Health 2019; 10:421-429. [PMID: 29992276 DOI: 10.1093/inthealth/ihy042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 05/17/2018] [Indexed: 11/14/2022] Open
Abstract
Background In 2015-2016, more than a million refugees entered Greece. Along with other organizations, PRAKSIS, a local non-governmental organization, deployed mobile medical units on three islands and in temporary settlements in Athens. Methods This is a descriptive cross-sectional study aimed at analysing the demographic and clinical characteristics of the population (n=6688) that received services from PRAKSIS between October 2015 and June 2016 in different locations (islands of Samos, Kos and Leros in the southeastern Aegean Sea and on the mainland at Athens-Piraeus Port Gate E) before and after the closure of European borders in March 2016. Results The majority (88%) of the population came from Syria, Afghanistan and Iraq. Among them, 53% were women and children. Infectious diseases decreased as the population moved from the islands to the Athens-Piraeus Port, while all other disease categories increased in relative frequency, the difference being statistically significant (p<0.05). Among all consultations, dental and oral cavity health complaints also increased in the Athens-Piraeus Port, but failed to reach statistical significance (p=0.11). Referrals from the mobile health units to specialist care rose from 4.2% of all patients clinically examined on the islands to 9.9% in the Athens-Piraeus Port, and the difference was statistically significant (p<0.05). Conclusions More research and systematic data collection are needed to inform appropriate policies for the humanitarian challenges posed by the recent refugee and migrant waves in Europe.
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Affiliation(s)
- E Kakalou
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | - E Riza
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece.,Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | - M Chalikias
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece.,Piraeus University of Applied Science, Thebon & Petrou Ralli 250, Aigaleo, Greece
| | | | - A Vetsika
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | - C Tsiamis
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece.,Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | | | - A Terzidis
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | - E Karamagioli
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
| | - T Antypas
- PRAKSIS, Stournari 57, Athens, Greece
| | - E Pikoulis
- Programme of Postgraduate Education, International Medicine-Health Crisis Management, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece
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Bempong NE, Sheath D, Seybold J, Flahault A, Depoux A, Saso L. Critical reflections, challenges and solutions for migrant and refugee health: 2nd M8 Alliance Expert Meeting. Public Health Rev 2019; 40:3. [PMID: 30923641 PMCID: PMC6423837 DOI: 10.1186/s40985-019-0113-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/15/2019] [Indexed: 11/24/2022] Open
Abstract
Throughout recent years, we have witnessed an increase in human migration as a result of conflict, political instability and changes in the climate. Despite the growing number of migrants and refugees, provisions to address their health needs remain inadequate and often unmet. Whilst a variety of instruments exist to assert and emphasise the importance for migrant and refugee health, the lack of shared priorities between partners and stakeholders results in poor access to healthcare and essential medicines. In response to the growing health challenges faced by migrants and refugees, members of the M8 Alliance launched an annual Expert Meeting on Migrants’ and Refugees’ Health. This report is shaped by discussions from the second M8 Alliance Expert Meeting (Sapienza University of Rome, Italy, 15–16 June 2018) and is supported by supplementing literature to develop a framework addressing critical reflections, challenges and solutions of and for migrant and refugee health. This report aims to inform decision-making fostering a humanitarian, ethics and rights-based approach. Through a series of country-specific case studies and discussions, this report captures the most prominent themes and recommendations such as mental health, tuberculosis (TB) and best practices for increased access.
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Affiliation(s)
- Nefti-Eboni Bempong
- 1Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Danny Sheath
- 1Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Antoine Flahault
- 1Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anneliese Depoux
- Centre Virchow-Villermé for Public Health Paris-Berlin-Paris Office, Paris, France
| | - Luciano Saso
- 4Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
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Child Morbidity and Disease Burden in Refugee Camps in Mainland Greece. CHILDREN-BASEL 2019; 6:children6030046. [PMID: 30884873 PMCID: PMC6463168 DOI: 10.3390/children6030046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 12/01/2022]
Abstract
The crisis conflicts in Syria have forced a lot of people to relocate and live in mainland Greece, where they are hosted in refugee camps. In the present study, our aim was to assess child morbidity and overall disease burden in two camps in northern Greece during a six-month winter period. A primary health care office was founded in each camp. Refugees of all ages with health problems were examined daily by specialty doctors. Cases were classified into two categories: Infectious or non-infectious. In total, 2631 patients were examined during this period (out of the 3760 refugees hosted). Of these patients, 9.8% were infants, 12.7% were toddlers, and 13.4% were children. Most of the visits for children aged less than 12 years old were due to infectious diseases (80.8%). The most common sites of communicable diseases among children were the respiratory tract (66.8%), the skin (23.2%), and the urinary (3.2%) and gastrointestinal tracts (6.2%). Non-communicable diseases were mostly due to gastrointestinal (20.2%), respiratory (18.2%), surgical (13.1%), and allergic (10.3%) disorders. Infants, toddlers, and children suffered more frequently from respiratory infections, while in adolescents and adults, non-infectious diseases were more common. Toddlers and children were more likely to fall ill in comparison to infants. Conclusions: During the winter period, infectious diseases, especially of the respiratory tract, are the main reason for care seeking among refugees in Greek camps, with toddlers suffering more than other age groups. The overall mortality and referral percentage were low, indicating that adequate primary care is provided in this newly established refugee hosting model.
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Population-based assessment of health, healthcare utilisation, and specific needs of Syrian migrants in Germany: what is the best sampling method? BMC Med Res Methodol 2019; 19:5. [PMID: 30616507 PMCID: PMC6323854 DOI: 10.1186/s12874-018-0652-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 12/26/2018] [Indexed: 02/06/2023] Open
Abstract
Background Studies elucidating health-related information and special needs of Syrian migrants living in Germany are urgently required. However, data is scarce and finding appropriate sampling strategies to obtain representative results is challenging. In order to increase survey response in hard-to-reach populations, new methods were developed. One of them is respondent-driven sampling (RDS), a network sampling technique. We aimed to assess if respondent-driven sampling is a better approach to recruit Syrian migrants for health research than classical random sampling via the population registry. Methods A cross-sectional study was conducted in Munich between April and June 2017 inviting adults (18+ years) born in Syria to answer an online questionnaire asking for sociodemographic and health-related information. Recruitment of participants was done using a) random sampling via the population registry (PR) and b) RDS. The two study populations recruited via respondent-driven sampling and the population registry were compared to a sample drawn from the population registry with respect to gender and citizenship. In addition, the two study populations were compared to each other regarding self-reported health status, healthcare utilisation, lifestyle factors, social network size, and acculturation. Results Of 374 persons randomly drawn from the population registry, 49 individuals answered the questionnaire completely (response: 13.1%) while via RDS 195 participants were recruited by 16 seeds. More persons possessed German citizenship in the total sample (20.5, 95% CI: 16.6 to 24.8%) and in the PR study population (28.6, 95% CI: 16.6 to 43.3%) than in the study population (0.5, 95% CI: 0.1 to 1.5%). Participants recruited via the population registry were older, smoked less, reported more often to hold a university degree, and indicated a higher prevalence of chronic diseases, more frequent healthcare utilisation, higher scores of acculturation as well as a larger social network compared to the study population obtained via RDS. Conclusions Response was very low in the PR sample. The number of participants recruited via RDS was larger and led to a study population with substantially different characteristics. Our study thus indicates that RDS is a useful way to gain access to specific subgroups that are hard to reach via traditional random sampling. Electronic supplementary material The online version of this article (10.1186/s12874-018-0652-1) contains supplementary material, which is available to authorized users.
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Hjern A, Stubbe Østergaard L, Nörredam ML. Health examinations of child migrants in Europe: screening or assessment of healthcare needs? BMJ Paediatr Open 2019; 3:e000411. [PMID: 30957030 PMCID: PMC6422244 DOI: 10.1136/bmjpo-2018-000411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND More than 800 000 asylum-seeking children were registered in Europe during 2015-2017. Many of them arrived with accumulated needs of healthcare. In this study, we examined the legislation for health examinations on arrival for migrant children in the EU/EAA area. METHODS We did a survey to child health professionals within the EU-funded MOCHA project, supplemented by desktop research of official documents. RESULTS In all but three surveyed countries in the EU/EEA, there were systematic health examinations of newly settled migrant children. In most eastern European countries and Germany, this health examination was mandatory; while in the rest of western and northern Europe it was mostly voluntary. All countries that had a mandatory policy of health examinations screened for communicable diseases to protect the host population. Almost all countries with a voluntary policy also aimed to assess a child's individual healthcare needs, but this was rarely the case in countries with a mandatory policy. CONCLUSION Systematic health examinations of migrant children are routinely performed in most countries in the EU/EEA; but in many countries, it could be improved considerably by extending the focus from screening for communicable diseases to assessing and addressing individual needs of healthcare.
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Affiliation(s)
- Anders Hjern
- Centre for Health Equity Studies (CHESS), Karolinska Institutet/Stockholm University, Stockholm, Sweden.,Clinical Epidemiology, Department of Medicine, Karolinska Institutet/Stockholm University, Clinical Epidemiology, Stockholm, Sweden
| | - Liv Stubbe Østergaard
- Section for Health Services Research, Danish Research Centre for Migration, Ethnicity and Health (MESU), Copenhagen, Denmark
| | - Marie-Louise Nörredam
- Section for Health Services Research, Danish Research Centre for Migration, Ethnicity and Health (MESU), Copenhagen, Denmark
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Affiliation(s)
- Walid Ammar
- Lebanese Ministry of Public Health, Beirut, Lebanon; Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.
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Abubakar I, Aldridge RW, Devakumar D, Orcutt M, Burns R, Barreto ML, Dhavan P, Fouad FM, Groce N, Guo Y, Hargreaves S, Knipper M, Miranda JJ, Madise N, Kumar B, Mosca D, McGovern T, Rubenstein L, Sammonds P, Sawyer SM, Sheikh K, Tollman S, Spiegel P, Zimmerman C. The UCL-Lancet Commission on Migration and Health: the health of a world on the move. Lancet 2018; 392:2606-2654. [PMID: 30528486 PMCID: PMC7612863 DOI: 10.1016/s0140-6736(18)32114-7] [Citation(s) in RCA: 400] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 12/22/2022]
Abstract
With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations. Those in positions of political and economic power continue to restrict or publicly condemn migration to promote their own interests. Meanwhile nationalist movements assert so-called cultural sovereignty by delineating an us versus them rhetoric, creating a moral emergency. In response to these issues, the UCL-Lancet Commission on Migration and Health was convened to articulate evidence-based approaches to inform public discourse and policy. The Commission undertook analyses and consulted widely, with diverse international evidence and expertise spanning sociology, politics, public health science, law, humanitarianism, and anthropology. The result of this work is a report that aims to be a call to action for civil society, health leaders, academics, and policy makers to maximise the benefits and reduce the costs of migration on health locally and globally. The outputs of our work relate to five overarching goals that we thread throughout the report. First, we provide the latest evidence on migration and health outcomes. This evidence challenges common myths and highlights the diversity, dynamics, and benefits of modern migration and how it relates to population and individual health. Migrants generally contribute more to the wealth of host societies than they cost. Our Article shows that international migrants in HICs have, on average, lower mortality than the host country population. However, increased morbidity was found for some conditions and among certain subgroups of migrants, (eg, increased rates of mental illness in victims of trafficking and people fleeing conflict) and in populations left behind in the location of origin. Currently, in 2018, the full range of migrants’ health needs are difficult to assess because of poor quality data. We know very little, for example, about the health of undocumented migrants, people with disabilities, or lesbian, gay, bisexual, transsexual, or intersex (LGBTI) individuals who migrate or who are unable to move. Second, we examine multisector determinants of health and consider the implication of the current sector-siloed approaches. The health of people who migrate depends greatly on structural and political factors that determine the impetus for migration, the conditions of their journey, and their destination. Discrimination, gender inequalities, and exclusion from health and social services repeatedly emerge as negative health influences for migrants that require cross-sector responses. Third, we critically review key challenges to healthy migration. Population mobility provides economic, social, and cultural dividends for those who migrate and their host communities. Furthermore, the right to the highest attainable standard of health, regardless of location or migration status, is enshrined in numerous human rights instruments. However, national sovereignty concerns overshadow these benefits and legal norms. Attention to migration focuses largely on security concerns. When there is conjoining of the words health and migration, it is either focused on small subsets of society and policy, or negatively construed. International agreements, such as the UN Global Compact for Migration and the UN Global Compact on Refugees, represent an opportunity to ensure that international solidarity, unity of intent, and our shared humanity triumphs over nationalist and exclusionary policies, leading to concrete actions to protect the health of migrants. Fourth, we examine equity in access to health and health services and offer evidence-based solutions to improve the health of migrants. Migrants should be explicitly included in universal health coverage commitments. Ultimately, the cost of failing to be health-inclusive could be more expensive to national economies, health security, and global health than the modest investments required. Finally, we look ahead to outline how our evidence can contribute to synergistic and equitable health, social, and economic policies, and feasible strategies to inform and inspire action by migrants, policy makers, and civil society. We conclude that migration should be treated as a central feature of 21st century health and development. Commitments to the health of migrating populations should be considered across all Sustainable Development Goals (SDGs) and in the implementation of the Global Compact for Migration and Global Compact on Refugees. This Commission offers recommendations that view population mobility as an asset to global health by showing the meaning and reality of good health for all. We present four key messages that provide a focus for future action.
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Affiliation(s)
- Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK.
| | - Robert W Aldridge
- Institute for Health Informatics, University College London, London, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | - Rachel Burns
- Institute for Global Health, University College London, London, UK
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health, Fundação Oswaldo Cruz, Salvador-Bahia, Brazil
| | - Poonam Dhavan
- International Organization for Migration, Geneva, Switzerland
| | - Fouad M Fouad
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nora Groce
- Leonard Cheshire Centre, Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Yan Guo
- School of Public Health, Peking University, Beijing, China
| | - Sally Hargreaves
- Institute of Infection and Immunity, St George's, University of London, London, UK; International Health Unit, Section of Infectious Diseases and Immunity, Imperial College London, London, UK
| | - Michael Knipper
- Institute for the History of Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nyovani Madise
- African Institute for Development Policy, Lilongwe, Malawi; Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
| | - Bernadette Kumar
- Norwegian Centre for Minority Health Research, Oslo, Norway; Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Davide Mosca
- International Organization for Migration, Geneva, Switzerland
| | - Terry McGovern
- Program on Global Health Justice and Governance, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Leonard Rubenstein
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, and Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Sammonds
- Institute for Risk and Disaster Reduction, University College London, London, UK
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Kabir Sheikh
- Public Health Foundation of India, Institutional Area Gurgaon, India; Nossal Institute of Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul Spiegel
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cathy Zimmerman
- Gender, Violence and Health Centre, London School of Hygiene and Tropical Medicine, London, UK
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Zumla A, Abubakar I. Improving access to multi-drug resistant tuberculosis diagnostic and health services for refugees and migrants. BMC Med 2018; 16:221. [PMID: 30497477 PMCID: PMC6267830 DOI: 10.1186/s12916-018-1218-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 12/12/2022] Open
Abstract
By the end of 2017, an estimated 68.5 million people were displaced from their homes worldwide, of whom 25.4 million were refugees. The transmission and globalization of multi-drug resistant tuberculosis during refugee migration is a now priority issue in the public health agenda. Political and scientific commitment at the highest national and international levels will be critical to intensifying action in promoting improved health services for migrants and refugees.
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Affiliation(s)
- Alimuddin Zumla
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK.,NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ibrahim Abubakar
- UCL Institute for Global Health, University College London, London, UK.
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Tiittala P, Tuomisto K, Puumalainen T, Lyytikäinen O, Ollgren J, Snellman O, Helve O. Public health response to large influx of asylum seekers: implementation and timing of infectious disease screening. BMC Public Health 2018; 18:1139. [PMID: 30249224 PMCID: PMC6154941 DOI: 10.1186/s12889-018-6038-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/13/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Infectious disease screening of migrants at increased risk is a feature of national infection prevention and control measures. Asylum seekers in Finland are offered screening of tuberculosis (TB), hepatitis B, human immunodeficiency virus infection (HIV) and syphilis based on individual risk assessment. We aimed to evaluate the public health response to a large influx of asylum seekers to Finland in 2015-2016 with respect to national guidelines on initial health services and infectious disease screening. METHODS We used immigration and healthcare procurement data for all 38,134 asylum seekers to Finland during 2015-2016 to assess the implementation, timing and yields of infectious disease screening. RESULTS The coverage of pulmonary TB screening was 71.6% [95% CI 71.1-72.0%] and that of hepatitis B, HIV or syphilis 60.6% [60.1-61.1%] among those eligible for screening. The estimated average delay from arrival to pulmonary TB screening was 74 days for adults and 43 days for children. Delay to hepatitis B, HIV and syphilis screening was 91 days for adults and 47 days for children. The seroprevalence of hepatitis B surface antigen positivity was 1.4% [95% CI 1.3-1.6%], HIV 0.3% [95% CI 0.1-0.4%] and Treponema pallidum specific antibodies 1.0% [95% CI 0.8-1.1%]. Data did not allow assessment of yields of pulmonary TB screening. CONCLUSIONS Up to one third of asylum seekers were not reached by screening and screenings were delayed from target timeframes. Children, as a vulnerable population, were screened earlier than adults. To ensure higher screening coverage, infectious disease risks should be reassessed and screening completed at contacts to healthcare during the post-asylum phase of integration. The large influx of asylum seekers to Finland in 2015-2016 tested the country's public health preparedness. After action reviews of the public health response to the large migrant influx such as screening implementation can be used for evidence-based improvement of public health preparedness and guidelines for initial health services and infectious disease screening.
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Affiliation(s)
- Paula Tiittala
- Doctoral Programme for Population Health, University of Helsinki, Helsinki, Finland. .,Department of Health Security, Infectious Disease Control and Vaccinations Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
| | - Karolina Tuomisto
- Department of Health Security, Infectious Disease Control and Vaccinations Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Taneli Puumalainen
- Department of Health Security, Infectious Disease Control and Vaccinations Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Outi Lyytikäinen
- Department of Health Security, Infectious Disease Control and Vaccinations Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, Infectious Disease Control and Vaccinations Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | | | - Otto Helve
- Department of Health Security, Infectious Disease Control and Vaccinations Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
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Matlin SA, Depoux A, Schütte S, Flahault A, Saso L. Migrants’ and refugees’ health: towards an agenda of solutions. Public Health Rev 2018. [PMCID: PMC6182765 DOI: 10.1186/s40985-018-0104-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Despite the greatly increased numbers of migrants and refugees worldwide in recent years, insufficient attention has been paid to addressing their health needs. While a variety of international instruments assert the right to health, in practice, migrants and refugees—especially those awaiting clarification of their status, such as asylum seekers and those without documentation—often fall in cracks between service providers and humanitarian relief programmes at national and regional levels. This report provides a summary of the current state of knowledge regarding the health issues of migrants and refugees and of the extent to which they are being met. It highlights, through a series of case studies, the diverse approaches to policies, entitlements and services provided in different jurisdictions, ranging from regional (Europe) and country (Germany, Iran, Italy, Turkey, South Africa) levels to provinces and cities (Quebec/Montreal, Berlin). These provide evidence of successes and challenges and highlight areas requiring further effort, including in the domains of policy, service design and delivery, education and training, research and communication. They also underscore the challenges of highly neglected aspects such as mental health and the critical importance of developing cultural/transnational competence in the health professional individuals and institutions working with migrants and refugees. Results from discussions taking place in an M8 Alliance Expert Group Meeting (Rome, 23–24 June 2017) and from the literature are synthesised to develop an ‘agenda of solutions’. This agenda aims to provide a comprehensive framework, which bridges humanitarian, ethical and rights-based imperatives to provide a framework for action to tackle this crucial area.
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Goodman LF, Jensen GW, Galante JM, Farmer DL, Taché S. A cross-sectional investigation of the health needs of asylum seekers in a refugee clinic in Germany. BMC FAMILY PRACTICE 2018; 19:64. [PMID: 29769017 PMCID: PMC5956552 DOI: 10.1186/s12875-018-0758-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/02/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Over one million asylum seekers were registered in Germany in 2016, most from Syria and Afghanistan. The Refugee Convention guarantees access to healthcare, however delivery mechanisms remain heterogeneous. There is an urgent need for more data describing the health conditions of asylum seekers to guide best practices for healthcare delivery. In this study, we describe the state of health of asylum seekers presenting to a multi-specialty primary care refugee clinic. METHODS Demographic and medical diagnosis data were extracted from the electronic medical records of patients seen at the ambulatory refugee clinic in Dresden, Germany between 15 September 2015 and 31 December 2016. Data were de-identified and analyzed using Stata version 14.0. RESULTS Two-thousand-seven-hundred and fifty-three individual patients were seen in the clinic. Of these, 2232 (81.1%) were insured by the state indicating arrival within the last 3 months. The median age was 25, interquartile range 16-34. Only 786 (28.6%) were female, while 1967 (71.5%) were male. The most frequent diagnoses were respiratory (17.4%), followed by miscellaneous symptoms and otherwise not classified ailments (R series, 14.1%), infection (10.8%), musculoskeletal or connective tissue (9.3%), gastrointestinal (6.8%), injury (5.9%), and mental or behavioral (5.1%) categories. CONCLUSIONS This study illustrates the diverse medical conditions that affect the asylum seeker population. Asylum seekers in our study group did not have a high burden of communicable diseases, however several warranted additional screening and treatment, including for tuberculosis and scabies. Respiratory illnesses were more common amongst newly arrived refugees. Trauma-related mental health disorders comprised half of mental health diagnoses.
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Affiliation(s)
- Laura F. Goodman
- Department of Surgery, University of California Davis Health, 2315 Stockton Blvd, OP 512, Sacramento, CA 95817 USA
| | - Guy W. Jensen
- Department of Surgery, University of California Davis Health, 2315 Stockton Blvd, OP 512, Sacramento, CA 95817 USA
| | - Joseph M. Galante
- Department of Surgery, University of California Davis Health, 2315 Stockton Blvd, OP 512, Sacramento, CA 95817 USA
| | - Diana L. Farmer
- Department of Surgery, University of California Davis Health, 2315 Stockton Blvd, OP 512, Sacramento, CA 95817 USA
| | - Stephanie Taché
- General Medicine Division, MK3, Technical University Dresden, Carus School of Medicine, Fetscherstrasse 74, 01307 Dresden, Germany
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Alberer M, Malinowski S, Sanftenberg L, Schelling J. Notifiable infectious diseases in refugees and asylum seekers: experience from a major reception center in Munich, Germany. Infection 2018; 46:375-383. [PMID: 29616458 DOI: 10.1007/s15010-018-1134-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/16/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE In 2016, the number of refugees worldwide reached 65.6 million. So far, only limited data are available on the health status of refugees and asylum seekers (RAs). Especially, notifiable infectious diseases (NIDs) carry the risk of outbreaks in communal accommodations hosting RAs. METHODS We conducted a monocentric retrolective cross-sectional study including 15,137 RAs treated in a special health care unit for RAs located in the major reception center in Munich from November 2014 to October 2016. Altogether 811 RAs with NIDs according to sections 6 and 7 of the German Infection Protection Act or with other infections relevant in the setting of a communal accommodation (RIDs) could be identified. RESULTS The gender and age distribution was generally comparable to that of refugees in Germany. However, patients from East Africa and Nigeria were significantly overrepresented. NIDs/RIDs were dominated by cases of tuberculosis, hepatitis B, and vaccine-preventable and parasitic diseases. Significant risk factors included country of origin (COI) and age for hepatitis B, age for hepatitis C, gender and age for HIV, and COI, gender and age for tuberculosis and ectoparasitosis. Calculated prevalences of hepatitis B, hepatitis C, and HIV were mostly below those of the COI. Incidences of tuberculosis were mostly strongly elevated. CONCLUSIONS COI, gender, and age have an impact on the occurrence of NIDs/RIDs. Early vaccinations and improved hygiene could be effective in preventing NIDs/RIDs in communal accommodations. Screening, prompt therapy, and infection protection measures are necessary to prevent the transmission of diseases.
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Affiliation(s)
- Martin Alberer
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the Ludwig-Maximilians-University (LMU), Munich, Germany.
| | - Svea Malinowski
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jörg Schelling
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
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Beeres DT, Cornish D, Vonk M, Ravensbergen SJ, Maeckelberghe ELM, Boele Van Hensbroek P, Stienstra Y. Screening for infectious diseases of asylum seekers upon arrival: the necessity of the moral principle of reciprocity. BMC Med Ethics 2018; 19:16. [PMID: 29499693 PMCID: PMC5834863 DOI: 10.1186/s12910-018-0256-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 02/21/2018] [Indexed: 11/26/2022] Open
Abstract
Background With a large number of forcibly displaced people seeking safety, the EU is facing a challenge in maintaining solidarity. Europe has seen millions of asylum seekers crossing European borders, the largest number of asylum seekers since the second world war. Endemic diseases and often failing health systems in their countries of origin, and arduous conditions during transit, raise questions around how to meet the health needs of this vulnerable population on arrival in terms of screening, vaccination, and access to timely and appropriate statutory health services. This paper explores the potential role of the principle of reciprocity, defined as the disposition ‘to return good in proportion to the good we receive, and to make reparations for the harm we have done’, as a mid-level principle in infectious disease screening policies. Main text More than half of the European countries implemented screening programmes for newly arrived asylum seekers. Screening may serve to avoid potential infectious disease risks in the receiving countries as well as help identify health needs of asylum seekers. But screening may infringe upon basic rights of those screened, thus creating an ethical dilemma. The use of the principle of reciprocity can contribute to the identification of potential improvements for current screening programmes and emphasizes the importance of certain rights into guidelines for screening. It may create a two way moral obligation, upon asylum seekers to actively participate in the programme, and upon authorities to reciprocate the asylum seekers’ participation and the benefits for the control of public health. Conclusion The authors argue that the reciprocity principle leads to a stronger ethical justification of screening programmes and help achieve a balance between justifiable rights claims of the host population and the asylum seekers. The principle deserves a further and more thorough exploration of its potential use in the field of screening, migration and infectious diseases.
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Affiliation(s)
- Dorien T Beeres
- Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Darren Cornish
- Babylon Primary Health Care Services, Elst, Groningen, The Netherlands
| | - Machiel Vonk
- Department of Infectious Diseases, Regional Public Health Service Groningen, Groningen, The Netherlands
| | - Sofanne J Ravensbergen
- Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Els L M Maeckelberghe
- Institute for Medical Education, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter Boele Van Hensbroek
- Faculty of Philosophy, Department of Ethics, Social and Political Philosophy, University of Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- Infectious Disease Unit, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Slavik T, Lauwers GY. Navigating the jungles of tropical infectious gastrointestinal pathology: a pattern-based approach to the endoscopic biopsy. Virchows Arch 2018; 472:135-147. [PMID: 28589386 PMCID: PMC7087759 DOI: 10.1007/s00428-017-2166-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/17/2017] [Accepted: 05/30/2017] [Indexed: 12/22/2022]
Abstract
International travels and global human migration have had the unforeseen consequence of increasing the exposure of histopathologists in developed countries to the pathology of tropical infectious disease. The gastrointestinal tract (GIT) is often the primary site of infection due to the faecal-oral route of transmission and the high risk of exposure to contaminated water, food or soil when travelling to these regions. Whilst current microbiologic techniques are far more sensitive than histology in detecting infectious pathogens, the histopathologist nonetheless retains a pivotal role in diagnosing tropical GIT disease. This role entails evaluating endoscopic biopsies for any characteristic inflammatory pattern, identifying pathogens which may be present and excluding other look-alike pathologies. Recent advances in commercially available diagnostic modalities, including molecular techniques, have further broadened the scope of the histopathologist's armamentarium. This review outlines a practical pattern-based approach to diagnosing tropical GIT infections in endoscopic material, so as to assist pathologists less familiar with this spectrum of pathology.
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Affiliation(s)
- Tomas Slavik
- Ampath Pathology Laboratories, Pretoria, South Africa.
- Department of Anatomical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
- , Private Bag X9, Highveld Park, Centurion, Pretoria, 0067, South Africa.
| | - Gregory Y Lauwers
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Hong MK, Varghese RE, Jindal C, Efird JT. Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1107. [PMID: 28946650 PMCID: PMC5664608 DOI: 10.3390/ijerph14101107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
Abstract
Refugees frequently face extended delays in their efforts to enter the United States (U.S.) and those who are successful, in many cases, encounter overwhelming obstacles, inadequate resources, and a complex system of legal barriers. Travel restrictions based on equivocal health concerns and a drop in refugee admittance ceilings have complicated the situation. The authors retrieved and analyzed peer-reviewed journal articles, government agency press releases, media postings, epidemiologic factsheets, and relevant lay publications to critically assess U.S. policy regarding refugee resettlement based on health-related grounds. While refugees arguably exhibit an increased incidence of measles and tuberculosis compared with the U.S. population, the legitimacy of the medical examination will be undermined if other diseases that are endemic to refugee populations, yet currently deemed admissible, are used to restrict refugees from entering the U.S. This paper addressees the historic refugee policy of the U.S. and its consequent effect on the health of this vulnerable population. The needs of refugees should be carefully considered in the context of increased disease burden and the associated health care challenges of the country as a whole.
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Affiliation(s)
- Mi-Kyung Hong
- Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, The University of Newcastle (UoN), Callaghan, NSW 2308, Australia.
| | - Reshma E Varghese
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA.
| | - Charulata Jindal
- Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, The University of Newcastle (UoN), Callaghan, NSW 2308, Australia.
| | - Jimmy T Efird
- Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, The University of Newcastle (UoN), Callaghan, NSW 2308, Australia.
- Center for Health Disparities (CHD), Brody School of Medicine, East Carolina University (ECU), Greenville, NC 27834, USA.
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Hermans MPJ, Kooistra J, Cannegieter SC, Rosendaal FR, Mook-Kanamori DO, Nemeth B. Healthcare and disease burden among refugees in long-stay refugee camps at Lesbos, Greece. Eur J Epidemiol 2017; 32:851-854. [PMID: 28597126 DOI: 10.1007/s10654-017-0269-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess current medical problems at two Greek refugee sites at Lesbos island (Camp Moria and Caritas hotel), to explore which care is needed and to assess how the provided healthcare can be improved. DESIGN In this dynamic cohort study all consecutive patients who visited doctors from the Boat Refugee Foundation were included. OUTCOME Treatment Rates (TR) with 95% Confidence Intervals (95% CI) were calculated for all major health issues. Additionally, the provided health care was evaluated using the SPHERE project standards. RESULTS During the observation period of 30 March 2016 to 15 May 2016, 2291 persons were followed for a total of 289 person years (py). The median age of patients was 23.0 (IQR 8-38) years, 30.0% was aged <18. The healthcare demand was high with 3.6 patient visits per py. Upper respiratory tract infections were most commonly diagnosed with a TR of 89.6/100py (95% CI 78.7-10.1) followed by dental problems (TR 18.0/100py, 95% CI 13.1-22.9). The rate of suicide attempts was high at TR 1.4/100py (95% CI 0.03-2.8), and many psychological problems were diagnosed, TR 19.4/100py (95% CI 14.3-24.4). Major health care threats are the lack of a vaccination program, inadequate sanitation and hygiene, and severe overcrowding. CONCLUSIONS This study can help policy makers and Non-Governmental Organizations decide which health care is needed most in the current European refugee crisis. There is an urgent need for mental and dental healthcare. Furthermore, it is crucial that vaccination programs are initiated and "hotspot" camps should transform in camps designed for long-stay situations.
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Affiliation(s)
- Maaike P J Hermans
- Department of Cardiology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | | | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands.,Department of Thrombosis and Haemostasis, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands.,Department of Primary Care/Public Health, Leiden University Medical Center, 2300RC, Leiden, The Netherlands
| | - Banne Nemeth
- Department of Clinical Epidemiology, Leiden University Medical Center, 2300RC, Leiden, The Netherlands. .,Department of Orthopaedic Surgery, Leiden University Medical Center, 2300RC, Leiden, The Netherlands.
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Korn L, Betsch C, Böhm R, Meier NW. Drawbacks of communicating refugee vaccination rates. THE LANCET. INFECTIOUS DISEASES 2017; 17:364-365. [PMID: 28346173 DOI: 10.1016/s1473-3099(17)30141-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Lars Korn
- Center for Empirical Research in Economics and Behavioral Sciences, and Media and Communication Science, University of Erfurt, 99089 Erfurt, Germany.
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences, and Media and Communication Science, University of Erfurt, 99089 Erfurt, Germany
| | - Robert Böhm
- School of Business and Economics, RWTH Aachen University, Aachen, Germany
| | - Nicolas W Meier
- School of Business and Economics, RWTH Aachen University, Aachen, Germany
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Ozaras R, Balkan II, Yemisen M. Prejudice and reality about infection risk among Syrian refugees. THE LANCET INFECTIOUS DISEASES 2016; 16:1222-1223. [DOI: 10.1016/s1473-3099(16)30400-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
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40
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Maskery B, Coleman MS, Weinberg M, Zhou W, Rotz L, Klosovsky A, Cantey PT, Fox LM, Cetron MS, Stauffer WM. Economic Analysis of the Impact of Overseas and Domestic Treatment and Screening Options for Intestinal Helminth Infection among US-Bound Refugees from Asia. PLoS Negl Trop Dis 2016; 10:e0004910. [PMID: 27509077 PMCID: PMC4980012 DOI: 10.1371/journal.pntd.0004910] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/18/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many U.S.-bound refugees travel from countries where intestinal parasites (hookworm, Trichuris trichuria, Ascaris lumbricoides, and Strongyloides stercoralis) are endemic. These infections are rare in the United States and may be underdiagnosed or misdiagnosed, leading to potentially serious consequences. This evaluation examined the costs and benefits of combinations of overseas presumptive treatment of parasitic diseases vs. domestic screening/treating vs. no program. METHODS An economic decision tree model terminating in Markov processes was developed to estimate the cost and health impacts of four interventions on an annual cohort of 27,700 U.S.-bound Asian refugees: 1) "No Program," 2) U.S. "Domestic Screening and Treatment," 3) "Overseas Albendazole and Ivermectin" presumptive treatment, and 4) "Overseas Albendazole and Domestic Screening for Strongyloides". Markov transition state models were used to estimate long-term effects of parasitic infections. Health outcome measures (four parasites) included outpatient cases, hospitalizations, deaths, life years, and quality-adjusted life years (QALYs). RESULTS The "No Program" option is the least expensive ($165,923 per cohort) and least effective option (145 outpatient cases, 4.0 hospitalizations, and 0.67 deaths discounted over a 60-year period for a one-year cohort). The "Overseas Albendazole and Ivermectin" option ($418,824) is less expensive than "Domestic Screening and Treatment" ($3,832,572) or "Overseas Albendazole and Domestic Screening for Strongyloides" ($2,182,483). According to the model outcomes, the most effective treatment option is "Overseas Albendazole and Ivermectin," which reduces outpatient cases, deaths and hospitalization by around 80% at an estimated net cost of $458,718 per death averted, or $2,219/$24,036 per QALY/life year gained relative to "No Program". DISCUSSION Overseas presumptive treatment for U.S.-bound refugees is a cost-effective intervention that is less expensive and at least as effective as domestic screening and treatment programs. The addition of ivermectin to albendazole reduces the prevalence of chronic strongyloidiasis and the probability of rare, but potentially fatal, disseminated strongyloidiasis.
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Affiliation(s)
- Brian Maskery
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Margaret S. Coleman
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Michelle Weinberg
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Weigong Zhou
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lisa Rotz
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alexander Klosovsky
- International Organization for Migration, Washington, D.C., United States of America
| | - Paul T. Cantey
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - LeAnne M. Fox
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Martin S. Cetron
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William M. Stauffer
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
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Mentis AFA. Child migration: from social determinants of health to the development agenda and beyond. Med Confl Surviv 2016; 32:221-227. [PMID: 27866409 DOI: 10.1080/13623699.2016.1258806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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