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Mirza M, Trimboli C, Hartman J, Gamble A, Rfat M, Bentley J, Gross M, Alheresh R, Hussein Q, Markos T. Examining Barriers to Rehabilitation and Addressing Rehabilitation Needs Among Persons With Forced Migration Experiences: Interdisciplinary Perspectives. Arch Phys Med Rehabil 2024; 105:1793-1806. [PMID: 38763346 DOI: 10.1016/j.apmr.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 04/01/2024] [Accepted: 05/02/2024] [Indexed: 05/21/2024]
Abstract
Globally, human displacement is at a record high. According to the United Nations High Commissioner for Refugees, 110 million people have been forcibly displaced worldwide owing to persecution, mass conflict, or human rights violations. Conflicts continue to rage in different parts of the world such as Ukraine, Palestine, Sudan, and Tigray. Large-scale political upheaval is also on the rise in many countries such as Haiti, Venezuela, and Iran. Natural disasters fueled by climate change will further contribute to large-scale forced migration. Persons with forced migration experiences (PFMEs) tend to have significant rehabilitation needs because of high risk of physical injuries, mental trauma, and exacerbation of pre-existing health problems during displacement. Rehabilitation practitioners in host countries must be well equipped to address the complex needs of this population. However, there is currently limited literature to guide best practice. In this article, a group of interdisciplinary professionals examine rehabilitation needs among PFMEs, provide examples of established and emerging rehabilitation interventions with PFMEs in the context of asylum and resettlement, identify barriers to accessing rehabilitation services in host countries, and propose avenues for professional advocacy in this area.
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Affiliation(s)
- Mansha Mirza
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, United States.
| | - Concettina Trimboli
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Jeff Hartman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - April Gamble
- Wchan Organization for Victims of Human Rights Violations, Kurdistan, Iraq
| | - Mustafa Rfat
- Brown School of Social Work, Washington University in St. Louis, MO, United States
| | - Jacob Bentley
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | | | - Rawan Alheresh
- Department of Occupational Therapy, University of Jordan, Amman, Jordan
| | - Qusay Hussein
- Steve Hicks School of Social Work, The University of Texas at Austin, TX, United States
| | - Tedros Markos
- Northeastern Illinois University, Chicago, IL, United States
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Nordin L, Bothe SK, Perrin S, Rorsman I. Severe Cognitive Impairment in Trauma-Affected Refugees-Exploring the Impact of Traumatic Brain Injury. J Clin Med 2024; 13:5096. [PMID: 39274309 PMCID: PMC11396430 DOI: 10.3390/jcm13175096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: This study explores the relationship between cognitive performance measured by the Symbol Digit Modality Test (SDMT) and the severity of self-reported head injury, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), depression, pain, and psychosocial dysfunction in a population of trauma-affected refugees. Refugees, especially those who have been subjected to torture, often face various difficulties, such as PTSD, depression and somatic disturbances (e.g., pain), which can significantly impact their day-to-day functioning. Methods: Participants included 141 adult refugees (38% women) with a mean age of 45.4 years (SD = 9.4) and 9.7 years (SD = 4.9) of education who were referred for treatment of post-traumatic distress to DIGNITY, Danish Institute Against Torture. Participants completed standardized self-report measures of PTSD, anxiety, depression, pain, and health-related disability and measures of trauma history, physical injuries including head injury and loss of consciousness, and the SDMT, a quick standardized performance-based measure of cognitive impairment. Results: Eighty-eight percent of participants evidenced signs of substantial cognitive impairment as indexed by lower SDMT scores. Those with a self-reported history of TBI, marked by loss of consciousness, exhibited lower SDMT scores and higher health-related disabilities. Severity of PTSD, depression, anxiety, and pain were highly correlated with lower SDMT scores. TBI history was not significantly associated with the severity of PTSD, depression, anxiety, or pain, suggesting a complex interplay among these factors. Conclusions: Cognitive impairments are prevalent in trauma-affected refugees, interacting with symptoms of post-traumatic stress and pain, likely explaining the high disability levels in this population. Further research should employ a broader range of cognitive measures and detailed investigations of head injury/TBI experiences to investigate their impact on overall functioning, treatment response, and longer-term outcomes. This study adds to a small but growing body of studies documenting cognitive impairments in trauma-affected refugees, highlighting the importance of addressing cognitive impairments in treatment for trauma-affected refugees, particularly those with histories of torture and TBI. Clinicians working with trauma-affected refugees should consider the assessment of cognitive difficulties as part of comprehensive care planning.
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Affiliation(s)
- Linda Nordin
- DIGNITY-Danish Institute Against Torture, 2100 Copenhagen, Denmark
- Department of Psychology, Lund University, 221-00 Lund, Sweden
| | - Søren Kit Bothe
- DIGNITY-Danish Institute Against Torture, 2100 Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Sean Perrin
- Department of Psychology, Lund University, 221-00 Lund, Sweden
| | - Ia Rorsman
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, 221-85 Lund, Sweden
- Department of Clinical Sciences Neurology, Lund University, 221-85 Lund, Sweden
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Jahan N, Velasco M, Vranceanu AM, Alegría M, Saadi A. Clinician perspectives on characteristics and care of traumatic brain injury among asylum seekers and refugees. Disabil Rehabil 2024:1-10. [PMID: 38831593 DOI: 10.1080/09638288.2024.2356014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/10/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Traumatic brain injury (TBI) disproportionately affects asylum-seekers and refugees (ASR), although underdiagnosed and undertreated. Our study assesses clinicians' perspectives on characteristics and management of TBI among ASR, with the hope of improving TBI management in this population. MATERIALS AND METHODS We conducted six focus groups of 16 clinicians across two academic medical centers in Boston, Massachusetts, United States. Clinicians in our sample included primary care clinicians, nurse practitioners, social workers, psychologists, neurologists, psychiatrists, and neuropsychologists. We analyzed the qualitative data following a hybrid inductive-deductive thematic analytic approach. RESULTS Clinicians characterized TBI among ASR as mostly mild and remote, involving head strikes, perpetrated predominantly by interpersonal violence and strangulation-related brain injury, and involving symptom overlap with mental health diagnoses, challenging diagnosis. Clinicians also described inadequate screening, the importance of connecting the physical and psychological symptoms of the brain injury rather than viewing them as distinct, and addressing diagnosis-related stigma and shame. Finally, they discussed lack of TBI-specific knowledge among providers and patients alike, and resource limitations affecting the continuum of care for this population. CONCLUSION Integrating clinicians' perspectives in caring for this population allows us to best meet their needs, including in TBI recovery.
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Affiliation(s)
- Nusrath Jahan
- Tufts University School of Medicine, Boston, MA, USA
| | - Margarita Velasco
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Margarita Alegría
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Al-Hajj S, Moustafa M, El Hechi M, Chahrour MA, Nasrallah AA, Kaafarani H. Physical injuries and burns among refugees in Lebanon: implications for programs and policies. Confl Health 2023; 17:42. [PMID: 37749592 PMCID: PMC10518957 DOI: 10.1186/s13031-023-00539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 08/29/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Refugees are prone to higher risks of injury due to often austere living conditions, social and economic disadvantages, and limited access to health care services in host countries. This study aims to systematically quantify the prevalence of physical injuries and burns among the refugee community in Western Lebanon and to examine injury characteristics, risk factors, and outcomes. METHODS We conducted a cluster-based population survey across 21 camps in the Beqaa region of Lebanon from February to April 2019. A modified version of the 'Surgeons Overseas Assessment of Surgical Need (SOSAS)' tool (Version 3.0) was administered to the head of the refugee households and documented all injuries sustained by family members over the last 12 months. Descriptive and univariate regression analyses were performed to understand the association between variables. RESULTS 750 heads of households were surveyed. 112 (14.9%) households sustained injuries in the past 12 months, 39 of which (34.9%) reported disabling injuries that affected their work and daily living. Injuries primarily occurred inside the tent (29.9%). Burns were sustained by at least one household member in 136 (18.1%) households in total. The majority (63.7%) of burns affected children under 5 years and were mainly due to boiling liquid (50%). Significantly more burns were reported in households where caregivers cannot lock children outside the kitchen while cooking (25.6% vs 14.9%, p-value = 0.001). Similarly, households with unemployed heads had significantly more reported burns (19.7% vs. 13.3%, p value = 0.05). Nearly 16.1% of the injured refugees were unable to seek health care due to the lack of health insurance coverage and financial liability. CONCLUSIONS Refugees severely suffer from injuries and burns, causing substantial human and economic repercussions on the affected individuals, their families, and the host healthcare system. Resources should be allocated toward designing safe camps as well as implementing educational awareness campaigns specifically focusing on teaching about heating and cooking safety practices.
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Affiliation(s)
- Samar Al-Hajj
- Faculty of Health Sciences, American University of Beirut, Van Dyck Hall, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
| | | | - Majed El Hechi
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohamad A Chahrour
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali A Nasrallah
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Haytham Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Saadi A, Williams J, Parvez A, Alegría M, Vranceanu AMM. Head Trauma in Refugees and Asylum Seekers: A Systematic Review. Neurology 2023; 100:e2155-e2169. [PMID: 37019660 PMCID: PMC10238158 DOI: 10.1212/wnl.0000000000207261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/21/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Refugees and asylum seekers are at risk of head trauma. They endure blows to the head due to exigent circumstances necessitating resettlement (e.g., torture, war, interpersonal violence) and during their dangerous journeys to refuge. Our objective was to assess the global prevalence of head trauma in refugees and asylum seekers and describe its clinical characteristics in this population. METHODS The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42020173534). PubMed/MEDLINE, PsycInfo, Web of Science, Embase, and Google Scholar databases were searched for relevant studies. We included all studies in English that comprised refugees or asylum seekers of any age and examined the prevalence or characteristics of head trauma. We excluded studies that were not peer-reviewed original research. Information was recorded on the prevalence of head trauma, method of ascertaining head trauma, severity, mechanism of injury, other trauma exposures, and comorbidities. Descriptive analyses and narrative syntheses were performed. RESULTS A total of 22 studies were included, of which 13 with 6,038 refugees and asylum seekers reported head trauma prevalence. Prevalence estimates ranged from 9% to 78%. Heterogeneity among studies precluded meta-analysis. Most studies were US based (n = 9, 41%), followed by the Middle East (n = 5, 23%). Most refugees or asylum seekers were from the Middle East (n = 9, 41%), with those from Latin America least represented (n = 3, 14%). Studies disproportionately involved younger (pooled mean age = 29 years) adult samples composed of men. Recruitment settings were predominantly hospitals/clinics (n = 14, 64%), followed by refugee camps (n = 3, 14%). The most common mechanism of injury was direct impact through a beating or blow to the head. Studies varied greatly in how head trauma was defined and ascertained; no study used a validated traumatic brain injury (TBI)-specific screening tool. Similarly, TBI severity was not uniformly assessed, although hospital-based samples captured more moderate-to-severe head injuries. Mental health comorbidities were more frequently documented rather than physical health ones. Only 2 studies included a comparison with local populations. DISCUSSION Refugees and asylum seekers are vulnerable to head trauma, but studies using systematic approaches to screening are lacking. Increased attention to head trauma in displaced populations will allow for optimizing equitable care for this growing vulnerable population.
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Affiliation(s)
- Altaf Saadi
- From the Department of Neurology (A.S.), Massachusetts General Hospital; Harvard Medical School (A.S., M.A., A.-M.M.V.), Boston, MA; University of Connecticut School of Medicine (J.W.), Farmington; University College London Medical School (A.P.), United Kingdom; and Disparities Research Unit (M.A.), Department of Medicine, and Center for Health Outcomes and Interdisciplinary Research (A.-M.M.V.), Massachusetts General Hospital, Boston.
| | - Jasmin Williams
- From the Department of Neurology (A.S.), Massachusetts General Hospital; Harvard Medical School (A.S., M.A., A.-M.M.V.), Boston, MA; University of Connecticut School of Medicine (J.W.), Farmington; University College London Medical School (A.P.), United Kingdom; and Disparities Research Unit (M.A.), Department of Medicine, and Center for Health Outcomes and Interdisciplinary Research (A.-M.M.V.), Massachusetts General Hospital, Boston
| | - Ameerah Parvez
- From the Department of Neurology (A.S.), Massachusetts General Hospital; Harvard Medical School (A.S., M.A., A.-M.M.V.), Boston, MA; University of Connecticut School of Medicine (J.W.), Farmington; University College London Medical School (A.P.), United Kingdom; and Disparities Research Unit (M.A.), Department of Medicine, and Center for Health Outcomes and Interdisciplinary Research (A.-M.M.V.), Massachusetts General Hospital, Boston
| | - Margarita Alegría
- From the Department of Neurology (A.S.), Massachusetts General Hospital; Harvard Medical School (A.S., M.A., A.-M.M.V.), Boston, MA; University of Connecticut School of Medicine (J.W.), Farmington; University College London Medical School (A.P.), United Kingdom; and Disparities Research Unit (M.A.), Department of Medicine, and Center for Health Outcomes and Interdisciplinary Research (A.-M.M.V.), Massachusetts General Hospital, Boston
| | - Ana-Maria M Vranceanu
- From the Department of Neurology (A.S.), Massachusetts General Hospital; Harvard Medical School (A.S., M.A., A.-M.M.V.), Boston, MA; University of Connecticut School of Medicine (J.W.), Farmington; University College London Medical School (A.P.), United Kingdom; and Disparities Research Unit (M.A.), Department of Medicine, and Center for Health Outcomes and Interdisciplinary Research (A.-M.M.V.), Massachusetts General Hospital, Boston
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Davies J, Dinyarian C, Wheeler AL, Dale CM, Cleverley K. Traumatic Brain Injury History Among Individuals Using Mental Health and Addictions Services: A Scoping Review. J Head Trauma Rehabil 2023; 38:E18-E32. [PMID: 35452016 DOI: 10.1097/htr.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Traumatic brain injury (TBI) has been increasingly linked in population research to psychiatric problems as well as substance use and related harms, suggesting that individuals with TBI may also present more frequently to mental health and addictions (MHA) services. Little is known, however, about TBI history among MHA service users. The objectives of this review were to understand (i) the prevalence of TBI history among MHA service users; (ii) how TBI history is identified in MHA service settings; and (iii) predictors or outcomes of TBI that have been reported in MHA service users. METHODS A scoping review was conducted in accordance with PRISMA Scoping Review Extension guidelines. A search for relevant literature was conducted in MEDLINE, PsycINFO, SPORTDiscus, CINAHL, and Embase as well as various gray literature sources. RESULTS Twenty-eight relevant studies were identified. TBI was defined and operationalized heterogeneously between studies, and TBI history prevalence rates ranged considerably among the study samples. The included studies used varied methods to identify TBI history in MHA settings, such as clinical chart audits, single-item questions, or structured questionnaires (eg, Brain Injury Screening Questionnaire or Ohio State University TBI Identification Method). TBI history was most consistently associated with indicators of more severe substance use problems and mental health symptoms as well as increased aggression or risk to others. Studies reported less consistent findings regarding the relationship of TBI to physical health, cognitive impairment, functioning, risk to self, and type of psychiatric diagnosis. CONCLUSION Screening for TBI history in MHA settings may contribute important information for risk assessment and care planning. However, to be clinically useful, assessment of TBI history will require consistent operationalization of TBI as well as use of validated screening methods.
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Affiliation(s)
- Julia Davies
- Lawrence S. Bloomberg Faculty of Nursing (Mss Davies and Dinyarian and Drs Dale and Cleverley) and Faculty of Medicine (Drs Dale and Cleverley), University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada (Ms Davies and Dr Cleverley); Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, and Department of Physiology, University of Toronto, Toronto, Canada (Dr Wheeler); and Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, and University of Toronto Centre for the Study of Pain, Toronto, Canada (Dr Dale)
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Mukhtarzada MG, Monteith TS. Equity and Disparities in Diagnosis, Management, and Research of Post-Traumatic Headache. Curr Pain Headache Rep 2022; 26:555-566. [PMID: 35567660 DOI: 10.1007/s11916-022-01058-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW There are notable health disparities and inequities in individuals with traumatic brain injury (TBI) and concussion by race, ethnicity, gender, socioeconomic status, and geography. This review will evaluate these disparities and inequities and assess the social determinants of health that drive outcomes for post-traumatic headache. Interventions for achieving this are also discussed. RECENT FINDINGS Significant disparities and inequities exist in TBI and concussion among people of different races, socioeconomic status, and geographic locations. Migraine is a common symptom post-concussion, for which disparities and social determinants of health are also discussed. Overall, multi-level interventions to reduce these disparities and inequities are reviewed for post-traumatic headache but require further investigation. Interventions are needed to reduce disparities and inequities including public health initiatives, improvements in clinical care, diversity/inclusion training, and research efforts. As literature expands, we can form guidance to identify solutions for eliminating disparities in care of diverse populations.
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Affiliation(s)
- Mejgan G Mukhtarzada
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, 1120 NW 14 Street #13th floor, Miami, FL, 33136, USA
| | - Teshamae S Monteith
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, 1120 NW 14 Street #13th floor, Miami, FL, 33136, USA.
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Saleem GT, Champagne M, Haider MN, Leddy JJ, Willer B, Asante I, Kent A, Joseph T, Fitzpatrick JM. Prevalence and Risk Factors for Intimate Partner Physical Violence-Related Acquired Brain Injury Among Visitors to Justice Center in New York. J Head Trauma Rehabil 2022; 37:E10-E19. [PMID: 34985036 DOI: 10.1097/htr.0000000000000750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The recent United States Government Accountability Office report highlights the need for improved data on the prevalence of intimate partner violence (IPV)-related acquired brain injury (ABI) to help direct Health & Human Services public efforts. This article identifies the prevalence and risk factors for IPV-related ABI among survivors of IPV at a Justice Center in New York. SETTING Community Justice Center. PARTICIPANTS Forty survivors of IPV, aged 17 to 73 years (median 32, interquartile range: 25.25, 42) were assessed within 60 days of sustaining physical violence. DESIGN Retrospective chart review. MAIN MEASURES The HELPS and the Danger Assessment-Revised were used at the initial Center visit. RESULTS Of the 40 physical IPV survivors screened, all (100%) reported a prior history of partner-induced ABI within the past 60 days. Thirty-seven (92.5%) survivors also reported sustaining at least 1 potential hypoxic brain injury from strangulation. However, only 16 (40%) survivors screened positive on the HELPS for a history of IPV-related mild traumatic brain injury. Females (95%) and individuals with low income (67.5%) largely comprised our sample. Compared with the County's average, the proportion of African Americans/Blacks and refugees was 227% higher (42.5% vs 13%) and 650% higher (7.5% vs 1.09%), respectively. Refugee status (P = .017) also correlated with number of previous ABIs. On an exploratory binary logistic regression with stepwise selection, only balance difficulties (P = .023) and difficulty concentrating/remembering (P = .009) predicted a positive screen for mild traumatic brain injury. CONCLUSIONS Consistent with previous findings, our data indicate a high prevalence of IPV-related ABI among visitors to a New York Justice Center. An overrepresentation of African Americans/Blacks and refugees in our sample relative to the region signified a higher prevalence of IPV in these populations and warrants a provision of more trauma-informed ABI resources to these groups/communities. Intimate partner violence survivors visiting Justice Centers should be screened for motor/neurocognitive symptoms suggestive of mild traumatic brain injury. Further research to identify the prevalence and risk factors of IPV-related ABI statewide and nationwide is urgently needed to improve resource allocation and clinical management.
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Affiliation(s)
- Ghazala T Saleem
- Department of Rehabilitation Sciences, University at Buffalo, The State University of New York (Dr Saleem); Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo (Mss Champagne, Kent, and Joseph); UBMD Department of Orthopaedics and Sports Medicine (Drs Haider and Leddy) and Department of Psychiatry (Willer), Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo; Department of Public Health, School of Public Health and Health Professions, The State University of New York, Buffalo (Mr Asante); and Department of Social Work, The State University of New York, Buffalo State College (Dr Fitzpatrick)
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Al-Hajj S, Chahrour MA, Nasrallah AA, Hamed L, Pike I. Physical trauma and injury: A multi-center study comparing local residents and refugees in Lebanon. J Glob Health 2021; 11:17001. [PMID: 34737871 PMCID: PMC8542374 DOI: 10.7189/jogh.11.17001] [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: 11/16/2022] Open
Abstract
Background Refugees are susceptible to various types of injury mechanisms associated with their dire living conditions and settlements. This study aims to compare and characterize the emergency department admissions due to physical trauma and injuries among local residents and refugees in greater Beirut. Methods This epidemiological study analyzes injury incidence and characteristics of patients presenting to Emergency Departments of 5 sentinel hospitals between 2017 and 2019. Using the WHO Injury Surveillance Guidelines and Pan-Asia Trauma Outcomes Study form, an injury data surveillance form was designed and used in hospital settings to collect data on injuries. Chi-square test analysis was performed to compare differences in injury characteristics between local residents and refugees. Regression models were constructed to assess the effect of being a refugee on the characteristics of injuries and outcomes of interest. Results A total of 4847 injuries (3933 local residents and 914 refugees) were reported. 87.4% of the total injuries among refugees were sustained by the younger age groups 0-45 years compared to 68.8% among local residents. The most prevalent injury mechanism was fall (39.4%) for locals and road traffic injury (31.5%) for refugees. The most injured body part was extremities for both populations (78.2% and 80.1%). Injuries mostly occurred at home or its vicinity (garden or inside the camp) for both populations (29.3% and 23.1%). Refugees sustained a higher proportion of injuries at work (6%) compared to locals (1.3%). On multivariate analysis, refugee status was associated with higher odds of having an injury due to a stab/gunshot (odds ratio (OR) = 3.392, 95% confidence interval (CI) = 2.605-4.416), having a concussion injury (OR = 1.718, 95% CI = 1.151-2.565), and being injured at work (OR = 4.147, 95% CI = 2.74-6.278). Refugee status was associated with increased odds of leaving the hospital with injury-related disability (OR = 2.271, 95% CI = 1.891-2.728)] Conclusions Injury remains a major public health problem among resident and refugee communities in Beirut, Lebanon. Refugees face several injury-related vulnerabilities, which adversely affect their treatment outcomes and long-term disabilities. The high prevalence of occupational and violence-related injuries among refugees necessitates the introduction of targeted occupational safety and financial security interventions, aiming at reducing injuries while enhancing social justice among residents.
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Affiliation(s)
- Samar Al-Hajj
- Health Management and Policy Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohamad A Chahrour
- Health Management and Policy Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ali A Nasrallah
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lara Hamed
- Health Management and Policy Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ian Pike
- Department of Pediatrics, Faculty of Medicine, University of British Columbia. BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Vancouver, BC, Canada
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McMurry HS, Tsang DC, Lin N, Symes SN, Dong C, Monteith TS. Head injury and neuropsychiatric sequelae in asylum seekers. Neurology 2020; 95:e2605-e2609. [PMID: 33004606 DOI: 10.1212/wnl.0000000000010929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/14/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Asylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers. We examined HI prevalence and association with neuropsychiatric comorbidities in asylum seekers. METHODS A retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, posttraumatic stress disorder, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics. RESULTS A total of 139 medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1 years, 56.8% were female, and 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.7) and depression (OR 2.5, 95% CI 1.1-5.7). CONCLUSIONS We observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.
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Affiliation(s)
- Hannah S McMurry
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Darren C Tsang
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Nicole Lin
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Stephen N Symes
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Chuanhui Dong
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Teshamae S Monteith
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL.
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Im H, Swan LET, Heaton L. Polyvictimization and mental health consequences of female genital mutilation/circumcision (FGM/C) among Somali refugees in Kenya. Women Health 2020; 60:636-651. [DOI: https:/www.tandfonline.com/doi/abs/10.1080/03630242.2019.1689543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 06/22/2023]
Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Laura E. T. Swan
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lindsay Heaton
- School of Social Work, Catholic University of America, Washington, DC, USA
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Im H, Swan LET, Heaton L. Polyvictimization and mental health consequences of female genital mutilation/circumcision (FGM/C) among Somali refugees in Kenya. Women Health 2019; 60:636-651. [PMID: 31711407 DOI: 10.1080/03630242.2019.1689543] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Female genital mutilation or circumcision (FGM/C) is a perilous social and cultural practice that affects the physical, mental, and psychological health of affected women. It is widespread around the world, affecting 200 million women and girls. This study aimed to explore the relation of FGM/C to mental and physical conditions in Somali refugees displaced in a low-resource setting, applying the concept of poly-victimization to reveal multifaceted trauma sequelae. Data for this cross-sectional study with 143 female Somali youth living in Eastleigh, Kenya were collected between April and May in 2013. FGM/C was strongly associated with negative physical and mental health outcomes, including post-traumatic stress disorder and depressive, anxiety, and somatic symptoms. Logistic regression analysis revealed that separation from a parent and poly-victimization experiences were significantly associated with FGM/C experience. The results also showed that FGM/C and other traumas did not occur singly but were indicative of cumulative adversities, especially for women who were socially vulnerable and marginalized. The results of this study highlight the practice of FGM/C in the context of other adverse living conditions of refugees and the importance of attending to other co-occurring risk factors that prevail with FGM/C practice in the ecological system of refugee forced migration.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University , Richmond, Virginia, USA
| | - Laura E T Swan
- School of Social Work, Virginia Commonwealth University , Richmond, Virginia, USA
| | - Lindsay Heaton
- School of Social Work, Catholic University of America , Washington, DC, USA
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Traumatic brain injury: an underappreciated public health issue. THE LANCET PUBLIC HEALTH 2016; 1:e44. [DOI: 10.1016/s2468-2667(16)30022-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/04/2016] [Indexed: 11/21/2022] Open
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