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Cherri Z, Lau K, Nellums LB, Himmels J, Deal A, McGuire E, Mounier-Jack S, Norredam M, Crawshaw A, Carter J, Seedat F, Clemente NS, Bouaddi O, Friedland JS, Edelstein M, Hargreaves S. The immune status of migrant populations in Europe and implications for vaccine-preventable disease control: a systematic review and meta-analysis. J Travel Med 2024; 31:taae033. [PMID: 38423523 DOI: 10.1093/jtm/taae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Ensuring vaccination coverage reaches established herd immunity thresholds (HITs) is the cornerstone of any vaccination programme. Diverse migrant populations in European countries have been associated with cases of vaccine-preventable diseases (VPDs) and outbreaks, yet it is not clear to what extent they are an under-immunized group. METHODS We did a systematic review and meta-analysis to synthesize peer-reviewed published primary research reporting data on the immune status of migrants in EU/EEA countries, the UK and Switzerland, calculating their pooled immunity coverage for measles, mumps, rubella and diphtheria using random-effects models. We searched on Web of Science, Embase, Global Health and MEDLINE (1 January 2000 to 10 June 2022), with no language restrictions. The protocol is registered with PROSPERO (CRD42018103666). FINDINGS Of 1103 abstracts screened, 62 met eligibility criteria, of which 39 were included in the meta-analysis. The meta-analysis included 75 089 migrants, predominantly from outside Europe. Pooled immunity coverage among migrant populations was well below the recommended HIT for diphtheria (n = 7, 57.4% [95% confidence interval (CI): 43.1-71.7%] I2 = 99% vs HIT 83-86%), measles (n = 21, 83.7% [95% CI: 79.2-88.2] I2 = 99% vs HIT 93-95%) and mumps (n = 8, 67.1% [95% CI: 50.6-83.6] I2 = 99% vs HIT 88-93%) and midway for rubella (n = 29, 85.6% [95% CI: 83.1-88.1%] I2 = 99% vs HIT 83-94%), with high heterogeneity across studies. INTERPRETATION Migrants in Europe are an under-immunized group for a range of important VPDs, with this study reinforcing the importance of engaging children, adolescents and adults in 'catch-up' vaccination initiatives on arrival for vaccines, doses and boosters they may have missed in their home countries. Co-designing strategies to strengthen catch-up vaccination across the life course in under-immunized groups is an important next step if we are to meet European and global targets for VPD elimination and control and ensure vaccine equity.
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Affiliation(s)
- Zeinab Cherri
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Karen Lau
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Lancet Migration European Regional Hub
| | - Laura B Nellums
- Faculty of Medicine and Heath Sciences, University of Nottingham, Nottingham, UK
| | - Jan Himmels
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma McGuire
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Alison Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Farah Seedat
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Nuria Sanchez Clemente
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
| | - Oumnia Bouaddi
- Lancet Migration European Regional Hub
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
- Mohammed VI Center for Research and Innovation, Rabat, Morocco
| | - Jon S Friedland
- Institute for Infection and Immunity, St Georges, University of London, London, UK
| | | | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St Georges, University of London, London, UK
- Lancet Migration European Regional Hub
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Lerskullawat A, Puttitanun T. Impact of migrants on communicable diseases in Thailand. BMC Public Health 2024; 24:2016. [PMID: 39075400 PMCID: PMC11285427 DOI: 10.1186/s12889-024-19503-9] [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: 10/22/2023] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND While foreign migrants contribute to economic development, they may impact public health by transmitting communicable diseases to the local population. With its geopolitical position, Thailand has been a primary destination for migrants from neighbouring countries in Southeast Asia and beyond. This positioning makes it a focal point for examining the complexities of migration dynamics and its implications for public health. Through a quantitative analysis, this paper investigates the influence of foreign migrants on physical health issues in Thailand, exploring their impact on various types of communicable diseases. The utilization of provincial-level data from Thailand offers insights into the localized effects of migrant populations on public health within the country. These insights can serve as a valuable resource for researchers and policymakers who conduct comparative analyses, facilitating a deeper understanding of the complex relationship between international migration and public health worldwide. METHODS A spatial panel autoregressive model (SAR) is applied on the provincial level communicable diseases and socio-economic data in Thailand from the period 2016 to 2021. RESULTS The results indicate that the influence of foreign migrants on communicable diseases in Thailand varies depending on the type of disease. While an increase in migrants correlates with a higher prevalence of respiratory and other communicable diseases, it conversely reduces the prevalence of vaccine-preventable diseases. Additionally, we found that migrants do not significantly impact the prevalence of food- and water-borne diseases, insect-borne diseases, animal-borne diseases, or sexually transmitted diseases in Thailand. Additionally, other factors, such as GPP per capita, unemployment, poverty, and technology access, strongly correlate with most types of communicable diseases. CONCLUSION As revealed by this study, the increase in migrants leads to a rise in respiratory and other communicable diseases, as well as a decrease in vaccine-preventable diseases, which carries significant policy implications. These results urge policymakers, the Ministry of Labour, and the Ministry of Public Health to implement tailored policies and measures to enhance public health and effectively mitigate the risk of communicable diseases transmitted by migrants in the future.
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Affiliation(s)
- Attasuda Lerskullawat
- Department of Economics, Faculty of Economics, Kasetsart University, 50 Ngam Wong Wan Rd., Lat Yao, Chatuchak, Bangkok, 10900, Thailand
| | - Thitima Puttitanun
- Department of Economics, Faculty of Economics, Kasetsart University, 50 Ngam Wong Wan Rd., Lat Yao, Chatuchak, Bangkok, 10900, Thailand.
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Acar D, Tekin FC. The problem of unconscious and unidentified patients in emergency department admissions; a 3-year retrospective study. PLoS One 2024; 19:e0307540. [PMID: 39046967 PMCID: PMC11268634 DOI: 10.1371/journal.pone.0307540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
Unidentified patients present a medical information dilemma for all medical departments but can be a major problem in Emergency Departments (EDs). This study aimed to determine the clinical and socio-demographic profile of 'unidentified' patients admitted to the ED with altered consciousness and to define the outcomes of these patients. All ED presentations were analyzed retrospectively for the unidentified patients brought to the hospital by ambulance with altered consciousness. We assessed demographic data, clinical presentation, discharge information, and major clinical outcomes. In this study, 1324 unidentified patients were admitted with altered consciousness to the ED. Of these, 1048 (80.1%) were foreign nationals. In this patient group, the most common diagnoses were; traffic accidents, assault or sharp object injuries, drug addicts, or syncope-epilepsy. In addition, the number of patients who left the hospital without permission or escaped and therefore could not be diagnosed was higher in the foreign nationalities group and constituted approximately one-fifth of the patients (18.9% vs. 5.4%, p:0.001). Of the unidentified patients, 903 (68.2%) were discharged after treatment. 351 (26.5%) patients left the ED unattended. 32 (2.4%) patients were hospitalized. 38 (2.9%) patients died in ED. The majority of the unidentified patients admitted to the ED with altered consciousness were immigrant males. Unidentified patients are a high-need population, most commonly presenting with substance misuse or trauma. Although most of the patients were seeking urgent treatment, more than one-fourth of the patients left the hospital without appropriate treatment and most of these patients were also immigrants. We believe that economic, linguistic, and social disadvantages played an important role in this outcome.
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Affiliation(s)
- Demet Acar
- Department of Emergency Medicine, Konya City Hospital, Karatay, Konya, Türkiye
| | - Fatih Cemal Tekin
- Department of Emergency Medicine, Konya City Hospital, Karatay, Konya, Türkiye
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Kean ER, Sammon M, Bettigole C, Myers S, Mohammadie S, Rosenberg N, Henwood P. Operation Allies Welcome Medical Response Unit at Philadelphia International Airport: A Framework for Medical Triage of High Volume of Displaced Persons Arriving by Air. Popul Health Manag 2024. [PMID: 38994631 DOI: 10.1089/pop.2024.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
In the aftermath of the US withdrawal from Afghanistan, over 100,000 individuals were evacuated to the United States, primarily arriving through Philadelphia International Airport and Dulles International Airport under Operation Allies Welcome. In Philadelphia, evacuees were greeted at the airport by a medical triage unit (MTU) that was rapidly assembled to provide on-site medical care. The MTU triaged emergent medical complaints, handled minor complaints on-site to reduce impact on local health care systems, distributed patients who did require a higher level of care among area hospitals, and ensured appropriate follow-up care for individuals with ongoing needs. Although there are regional and federal entities whose purview is the establishment and coordination of such responses, these entities were not mobilized to respond immediately when planes began to arrive carrying the first wave of evacuees as this event was not a designated disaster. The MTU was a grassroots effort initiated by local health care providers in coordination with the local Medical Reserve Corps and Department of Public Health. This article presents a framework for similar operations, anticipating an ongoing need for planning for sudden arrivals of large numbers of displaced persons, particularly via air travel, in a time of increasing mass displacement events, as well as a rationale for establishing more robust networks of local medical professionals willing to respond in the case of an emergency and involving them in the emergency planning processes to ensure preexisting protocols are practical.
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Affiliation(s)
- Efrat R Kean
- Department of Emergency Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Maura Sammon
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Cheryl Bettigole
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Sage Myers
- Children's Hospital of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Setareh Mohammadie
- Department of Emergency Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Naomi Rosenberg
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Patricia Henwood
- Department of Emergency Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Forray AI, Oltean O, Hanft-Robert S, Madzamba R, Liem A, Schouten B, Anthonissen C, Swartz L, Cherecheș RM, Higgen S, Hall BJ, Mösko M. Uncovering multi-level mental healthcare barriers for migrants: a qualitative analysis across China, Germany, Netherlands, Romania, and South Africa. BMC Public Health 2024; 24:1593. [PMID: 38877460 PMCID: PMC11177472 DOI: 10.1186/s12889-024-19046-z] [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: 11/06/2023] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Forced displacement is a significant issue globally, and it affected 112 million people in 2022. Many of these people have found refuge in low- and middle-income countries. Migrants and refugees face complex and specialized health challenges, particularly in the area of mental health. This study aims to provide an in-depth qualitative assessment of the multi-level barriers that migrants face in accessing mental health services in Germany, Macao (Special Administrative Region of China), the Netherlands, Romania, and South Africa. The ultimate objective is to inform tailored health policy and management practices for this vulnerable population. METHODS Adhering to a qualitative research paradigm, the study centers on stakeholders' perspectives spanning microsystems, mesosystems, and macrosystems of healthcare. Utilizing a purposive sampling methodology, key informants from the aforementioned geographical locations were engaged in semi-structured interviews. Data underwent thematic content analysis guided by a deductive-inductive approach. RESULTS The study unveiled three pivotal thematic barriers: language and communication obstacles, cultural impediments, and systemic constraints. The unavailability of professional interpreters universally exacerbated language barriers across all countries. Cultural barriers, stigmatization, and discrimination, specifically within the mental health sector, were found to limit access to healthcare further. Systemic barriers encompassed bureaucratic intricacies and a conspicuous lack of resources, including a failure to recognize the urgency of mental healthcare needs for migrants. CONCLUSIONS This research elucidates the multifaceted, systemic challenges hindering equitable mental healthcare provision for migrants. It posits that sweeping policy reforms are imperative, advocating for the implementation of strategies, such as increasing the availability of language services, enhancing healthcare providers' capacity, and legal framework and policy change to be more inclusive. The findings substantially contribute to scholarly discourse by providing an interdisciplinary and international lens on the barriers to mental healthcare access for displaced populations.
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Affiliation(s)
- Alina Ioana Forray
- Faculty of Political, Administrative and Communication Sciences, Center for Health Innovation, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Community Medicine, Discipline of Public Health and Management, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ovidiu Oltean
- Faculty of Political, Administrative and Communication Sciences, Center for Health Innovation, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Saskia Hanft-Robert
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Rowan Madzamba
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Andrian Liem
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Selangor, Malaysia
| | - Barbara Schouten
- Department of Communication Science, Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Center for Urban Mental Health, Amsterdam, The Netherlands
| | - Christine Anthonissen
- Department of General Linguistics, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Răzvan Mircea Cherecheș
- Faculty of Political, Administrative and Communication Sciences, Center for Health Innovation, Babeș-Bolyai University, Cluj-Napoca, Romania
- Postgraduate Program for Bio-Behavioral Integrative Medicine (UBBMed), Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Sanna Higgen
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Brian J Hall
- Center for Global Health Equity, NYU Shanghai, Shanghai, China
| | - Mike Mösko
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
- Department of Applied Human Sciences, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany.
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Khanom A, Evans BA, Alanazy W, Couzens L, Fagan L, Fogarty R, John A, Khan T, Kingston MR, Moyo S, Porter A, Richardson G, Rungua G, Williams V, Snooks H. Navigating challenges and workarounds: A qualitative study of healthcare and support workers' perceptions on providing care to people seeking sanctuary. Health Expect 2024; 27:e14061. [PMID: 38678592 PMCID: PMC11056205 DOI: 10.1111/hex.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 03/12/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barriers to resource constraints. This qualitative study seeks to delve into the perspectives of healthcare and support workers' experience of workarounds, employed to overcome barriers to providing care. AIM This study aims to describe healthcare providers', practitioners' and health and third sector support workers' views on barriers and workarounds to providing care for people seeking sanctuary, to inform policy and practice. DESIGN A qualitative study was carried out using semi-structured telephone interviews. SETTING This study focused on primary, secondary, community and specialist National Health Service (NHS) support services for people seeking sanctuary in Wales, United Kingdom (2018). METHOD We interviewed 32 healthcare providers, practitioners and support workers employed by primary care and third sector organisations. Our approach involved obtaining verbal informed consent before digitally recording and transcribing all interviews. To analyse the data, we used the Four Levels of Change for Improving Quality model as a guiding framework for interpretation. RESULTS Our study findings reveal that certain respondents expressed challenges in meeting the needs of people seeking sanctuary; notably, their experience of delivering care differed by care settings. Specifically, those involved in providing specialist NHS care believed that there was room for improvement. Mainstream primary, secondary and community health practitioners faced limitations due to resource constraints and lacked tailored information to address the unique circumstances and needs of sanctuary seekers. To address these gaps, workarounds emerged at both individual and local levels (team/departmental and organisational level). These included establishing informal communication channels between providers, fostering cross service collaboration to fill gaps and adapting existing services to enhance accessibility. CONCLUSION Understanding healthcare providers', practitioners' and support workers' perspectives offers invaluable insights into ways to enhance healthcare delivery to sanctuary seekers. Acknowledging challenges and harnessing innovative workarounds can foster a more effective and compassionate service for this vulnerable population. PATIENT OR PUBLIC CONTRIBUTION The HEAR study actively involved public contributors in the design, delivery and dissemination of the research. Two public contributors (S. M. and G. R.) who had personal experience of seeking asylum served as study co-applicants. They played pivotal roles in shaping the research by participating in its development and securing funding. Alongside other co-applicants, S. M. and G. R. formed the Research Management Group, overseeing study delivery. Their contributions extended to strategic decision-making and specific feedback at critical junctures, including participant recruitment, data collection, analysis and reporting. Additionally, S. M. and G. R. were instrumental in recruiting and supporting a team of peer researchers, enhancing respondent participation among people seeking sanctuary. To facilitate effective public involvement, we provided named contacts for support (A. K. and R. F.), research training, honoraria, reimbursement of expenses and accessible information in line with best practice.
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Affiliation(s)
| | - Bridie A. Evans
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | | | | | | | - Ann John
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | - Mark R. Kingston
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | - Alison Porter
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | | | | | - Helen Snooks
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
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Okuyan CB, Bilgili N. Assessment of health perceptions, use of health services and traditional health practices of Afghan immigrants in Türkiye. Glob Health Promot 2024:17579759241243365. [PMID: 38822634 DOI: 10.1177/17579759241243365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
Immigration, as a social determinant of health, encompasses several social and economic transformations. Neglecting to adequately address this issue could potentially worsen pre-existing challenges within health systems and in the management of migration. In the present study, we aim to evaluate the health perceptions, traditional health practices and use of health services of Afghan immigrants. We enrolled 1597 Afghan immigrants over 18 years old in the descriptive cross-sectional research. The mean age of the immigrants was 49.19 ± 1.6 years. The smallest number of points that can be achieved on the health perception scale is 15, while the greatest number is 75. We found that the health perception scale average score is 37.61 ± 7.32. Some factors, such as age 65 and over, female gender, postgraduate education level, good social insurance and economic status, being a public officer, not having any infectious diseases, and having a good Turkish level, have positively affected the health perception levels (p < 0.05). Moreover, we observed that cultural differences, expensive health care, a lack of social insurance, fear and anxiety, lack of language skills, waiting times and traditional health practices were the most common barriers to accessing healthcare services. Considering these issues in the health system, identifying the factors that negatively affect the perception of health and related to the use of health services can help immigrants increase their use of health services and improve their health.
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Affiliation(s)
- Canan Birimoglu Okuyan
- Department of Public Health Nursing, Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Türkiye
| | - Naile Bilgili
- 2Department of Public Health Nursing, Faculty of Nursing, Gazi University, Ankara, Türkiye
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Haque S, Mengersen K, Barr I, Wang L, Yang W, Vardoulakis S, Bambrick H, Hu W. Towards development of functional climate-driven early warning systems for climate-sensitive infectious diseases: Statistical models and recommendations. ENVIRONMENTAL RESEARCH 2024; 249:118568. [PMID: 38417659 DOI: 10.1016/j.envres.2024.118568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/01/2024]
Abstract
Climate, weather and environmental change have significantly influenced patterns of infectious disease transmission, necessitating the development of early warning systems to anticipate potential impacts and respond in a timely and effective way. Statistical modelling plays a pivotal role in understanding the intricate relationships between climatic factors and infectious disease transmission. For example, time series regression modelling and spatial cluster analysis have been employed to identify risk factors and predict spatial and temporal patterns of infectious diseases. Recently advanced spatio-temporal models and machine learning offer an increasingly robust framework for modelling uncertainty, which is essential in climate-driven disease surveillance due to the dynamic and multifaceted nature of the data. Moreover, Artificial Intelligence (AI) techniques, including deep learning and neural networks, excel in capturing intricate patterns and hidden relationships within climate and environmental data sets. Web-based data has emerged as a powerful complement to other datasets encompassing climate variables and disease occurrences. However, given the complexity and non-linearity of climate-disease interactions, advanced techniques are required to integrate and analyse these diverse data to obtain more accurate predictions of impending outbreaks, epidemics or pandemics. This article presents an overview of an approach to creating climate-driven early warning systems with a focus on statistical model suitability and selection, along with recommendations for utilizing spatio-temporal and machine learning techniques. By addressing the limitations and embracing the recommendations for future research, we could enhance preparedness and response strategies, ultimately contributing to the safeguarding of public health in the face of evolving climate challenges.
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Affiliation(s)
- Shovanur Haque
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Kerrie Mengersen
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia; Centre for Data Science (CDS), Queensland University of Technology (QUT), Brisbane, Australia
| | - Ian Barr
- World Health Organization Collaborating Centre for Reference and Research on Influenza, VIDRL, Doherty Institute, Melbourne, Australia; Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia
| | - Liping Wang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Division of Infectious disease, Chinese Centre for Disease Control and Prevention, China
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Sotiris Vardoulakis
- HEAL Global Research Centre, Health Research Institute, University of Canberra, ACT Canberra, 2601, Australia
| | - Hilary Bambrick
- National Centre for Epidemiology and Population Health, The Australian National University, ACT 2601 Canberra, Australia
| | - Wenbiao Hu
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
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Nybru Gleditsch R, Skogset Ofitserova T, Aubrey White R, Karoline Råberg Kjøllesdal M, Dvergsdal E, Hansen BT, Askeland Winje B. Vaccine coverage among children born to immigrant parents in Norway, 2000-2020. Vaccine 2024; 42:3049-3056. [PMID: 38582692 DOI: 10.1016/j.vaccine.2024.03.073] [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: 12/16/2022] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The Norwegian Childhood Immunization Program maintains a high national coverage of 95-97% in the most recent years. Whether there are subgroups with lower uptake is less studied. This study examines pertussis and measles vaccination coverage among six immigrant groups in Norway. These vaccines are normally administered as part of different combination vaccines and their coverage rate indicate the national vaccination coverage against a range of additional infections. METHODS Data from the Norwegian National Population Register were linked at individual level with vaccination data from the Norwegian Immunisation Registry. The final sample consisted of 53,052 children born during 2000-2018 in Norway to parents who were born in Iraq, Lithuania, Pakistan, Poland, Somalia, or Vietnam. Vaccination coverage was measured at 2-years of age. Multivariate linear regression was utilized to estimate the relationship between vaccinations status, year of birth, gender, mother's length of residency in Norway, and area of residence. RESULTS At two years of age, the majority of the children were vaccinated. Coverage among the groups varied at, above, and below the national average for the two vaccines. For most of the years examined, children born by parents from Lithuania, Poland, and Somalia had lower coverage for the measles vaccine (range 81-84% in 2020) than the national level (97% in 2020). Children born by parents from the Eastern-European countries also had lower coverage than the national level for the pertussis vaccine (range 87-89% in 2020). DISCUSSION This study illustrates how subgroups with lower vaccination coverage may exists within a well-established vaccination program with high national coverages. Differences in coverage were found for both vaccines, but the differences were more pronounced for the measles vaccine. The high vaccination coverage in Norway provides indirect protection through herd immunity for unvaccinated individuals, however, the lower vaccination coverage in some immigrant groups is a concern.
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Affiliation(s)
- Rebecca Nybru Gleditsch
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway; The Fafo Institute for Labour and Social Research, PO Box 2947 Tøyen, N-0608 Oslo, Norway.
| | | | | | | | - Evy Dvergsdal
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway.
| | - Bo T Hansen
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway.
| | - Brita Askeland Winje
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway; Oslo Metropolitan University, PO Box 4, St. Olavs plass, N-0130 Oslo, Norway.
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Petrie G, Angus K, O'Donnell R. A scoping review of academic and grey literature on migrant health research conducted in Scotland. BMC Public Health 2024; 24:1156. [PMID: 38658855 PMCID: PMC11044410 DOI: 10.1186/s12889-024-18628-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Migration to Scotland has increased since 2002 with an increase in European residents and participation in the Asylum dispersal scheme. Scotland has become more ethnically diverse, and 10% of the current population were born abroad. Migration and ethnicity are determinants of health, and information on the health status of migrants to Scotland and their access to and barriers to care facilitates the planning and delivery of equitable health services. This study aimed to scope existing peer-reviewed research and grey literature to identify gaps in evidence regarding the health of migrants in Scotland. METHODS A scoping review on the health of migrants in Scotland was carried out for dates January 2002 to March 2023, inclusive of peer-reviewed journals and grey literature. CINAHL/ Web of Science/SocIndex and Medline databases were systematically searched along with government and third-sector websites. The searches identified 2166 journal articles and 170 grey literature documents for screening. Included articles were categorised according to the World Health Organisation's 2016 Strategy and Action Plan for Refugee and Migrant Health in the European region. This approach builds on a previously published literature review on Migrant Health in the Republic of Ireland. RESULTS Seventy-one peer reviewed journal articles and 29 grey literature documents were included in the review. 66% were carried out from 2013 onwards and the majority focused on asylum seekers or unspecified migrant groups. Most research identified was on the World Health Organisation's strategic areas of right to health of refugees, social determinants of health and public health planning and strengthening health systems. There were fewer studies on the strategic areas of frameworks for collaborative action, preventing communicable disease, preventing non-communicable disease, health screening and assessment and improving health information and communication. CONCLUSION While research on migrant health in Scotland has increased in recent years significant gaps remain. Future priorities should include studies of undocumented migrants, migrant workers, and additional research is required on the issue of improving health information and communication.
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Affiliation(s)
- G Petrie
- Caledonia House, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - K Angus
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - R O'Donnell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
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Jolof L, Rocca P, Carlsson T. Women's experiences of trauma-informed care for forced migrants: A qualitative interview study. Heliyon 2024; 10:e28866. [PMID: 38596047 PMCID: PMC11002685 DOI: 10.1016/j.heliyon.2024.e28866] [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: 08/11/2023] [Revised: 03/11/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Forced migration affect the health and wellbeing of millions of women. The aim was to explore experiences of trauma-informed care among women who are forced migrants. Methods This was an exploratory qualitative study. Eleven women who had concluded treatment at multidisciplinary trauma centers in Sweden were interviewed, recruited through consecutive sampling. Audio-recorded interviews were transcribed and analyzed with systematic text condensation. Results Women dealt with mental and physical manifestations in a challenging psychosocial situation. Various structural and individual barriers were addressed that hindered access to adequate health services. Women appreciated various benefits of the treatment and recalled the care as supportive and compassionate. However, undergoing treatment was considered demanding, requiring significant determination and energy. Participants suggested that peer support could enhance the support. Conclusions Migrant women experience a range of health-related burdens and encounter barriers to trauma-informed care. While demanding, treatment has the potential to alleviate symptoms. Health professionals and stakeholders providing trauma-informed care need to ensure that their services are accessible and culturally sensitive towards the unique needs of women. Peer support has the potential to enhance support further, which need further evaluation.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Alves YM, Berra TZ, Tavares RBV, Popolin MAP, da Costa FBP, de Jezus SV, Ferezin LP, Tártaro AF, Serrano-Gallardo MDP, Pinto IC, Maciel ELN, Arcêncio RA. International Migration, Refugees, and Spread of Tuberculosis in Brazil: Analysis of Clusters, Trends, and Associated Factors (2010-2021). Trop Med Infect Dis 2024; 9:82. [PMID: 38668543 PMCID: PMC11053982 DOI: 10.3390/tropicalmed9040082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND International migration is a global phenomenon with significant implications on the health-disease process due to exposures along transit routes and local/destination epidemiological indicators. We aimed to analyze the transmission and spread of tuberculosis among international migrants and refugees from a spatiotemporal perspective and the associated factors. METHOD This was an ecological study of cases of tuberculosis in international migrants in Brazil, between 2010 and 2021. Annual incidence rates were calculated and spatiotemporal scan techniques were used to identify municipalities at risk. Multiple logistic regression was used to identify factors associated with tuberculosis in international migrants. RESULTS A total of 4037 cases of tuberculosis were reported in Brazil in international migrants. Municipalities at risk for this event were identified using the spatiotemporal scan technique, and a cluster was identified with ITT: +52.01% and ETT: +25.60%. A higher probability of TB infection was identified in municipalities with a TB incidence rate >14.40 cases/100 inhabitants, population >11,042 inhabitants, Gini index >0.49, and illiteracy rate >13.12%. A lower probability was found in municipalities with average per capita household income >BRL 456.43. CONCLUSIONS It is recommended that health authorities implement monitoring and rigorous follow-up in affected areas to ensure proper diagnosis and treatment completion for international migrants, preventing disease spread to other communities.
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Affiliation(s)
- Yan Mathias Alves
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Thaís Zamboni Berra
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Reginaldo Bazon Vaz Tavares
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Marcela Antunes Paschoal Popolin
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
- Nursing Department, Federal University of Tocantins, Palmas 77001-090, Brazil
| | - Fernanda Bruzadelli Paulino da Costa
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Sonia Vivian de Jezus
- Instituto de Ciências da Saúde, Federal University of Mato Grosso, Sinop 78550-728, Brazil
| | - Letícia Perticarrara Ferezin
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Ariela Fehr Tártaro
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | | | - Ione Carvalho Pinto
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
| | - Ethel Leonor Noia Maciel
- Ministry of Health, Secretary of Health Surveillance and Environment, Brasília 70058-900, Brazil;
| | - Ricardo Alexandre Arcêncio
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo 14040-902, Brazil; (T.Z.B.); (R.B.V.T.); (M.A.P.P.); (F.B.P.d.C.); (L.P.F.); (A.F.T.); (R.A.A.)
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Krzyż EZ, Lin HR. Meta-synthesis of mental healthcare-seeking behavior - Perspectives of refugees and asylum seekers. Arch Psychiatr Nurs 2024; 49:10-22. [PMID: 38734444 DOI: 10.1016/j.apnu.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 10/31/2023] [Accepted: 01/13/2024] [Indexed: 05/13/2024]
Abstract
The number of refugees and asylum seekers worldwide is increasing, and these populations often experience significant mental health challenges due to their difficult life experiences. This study aims to explore the perspectives of refugees and asylum seekers regarding their behavior when seeking mental healthcare. We conducted a meta-synthesis of thirteen articles published between January 2000 and January 2023. The study identified four main themes: understanding of mental health, utilization of health services, the role of society, and necessary interventions. Based on our findings, we provided recommendations for healthcare providers, governments, and researchers to improve the mental healthcare-seeking behavior of these populations in the future.
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Affiliation(s)
- Ewa Zuzanna Krzyż
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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14
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Surkan PJ, Rayes D, Bertuzzi L, Figueiredo N, Melchior M, Tortelli A. A qualitative evaluation of the use of Problem Management Plus (PM+) among Arabic-speaking migrants with psychological distress in France - The APEX study. Eur J Psychotraumatol 2024; 15:2325243. [PMID: 38501438 PMCID: PMC10953778 DOI: 10.1080/20008066.2024.2325243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 12/21/2023] [Indexed: 03/20/2024] Open
Abstract
ABSTRACTBackground: Feasibility studies with non-French speaking migrants in France are needed to inform appropriate adaptation of psychosocial intervention procedures.Objective: To test the WHO Problem Management Plus (PM+) intervention protocol for Arabic-speaking migrants in the Paris metropolitan region.Methods: Between 2019 and 2021 we recruited participants from three accommodation centres receiving asylum seekers or migrants experiencing social and economic difficulties. Participants experiencing psychological distress underwent five PM + sessions with trained helpers. Feasibility was evaluated through 15 interviews with 8 participants, 4 helpers, and 3 study supervisors. Interview topics covered PM + implementation in general and for each component. We also sought to understand problems with delivery and gathered suggestions for improvement. Data were analysed thematically using a deductive approach.Results: We found implementation of PM + to be feasible, with predominantly positive reactions from participants, helpers and study staff. All intervention components were considered beneficial, with breathing exercises considered easy to implement and often sustained. Selection of problems and strategies to address them were described as challenging to execute. Psychosocial support from and rapport with helpers and the use of the native language were considered key strengths of the programme. However, we observed the need for complementary or higher intensity psychological support in some cases. Findings also highlighted the importance of addressing distress among non-specialist helpers delivering PM + . Finally, local guidance to social resources were suggested to be added in the protocol.Conclusion: PM + was well-liked and feasible, with cultural adjustments and increased access to community resources for migrants needed.
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Affiliation(s)
- P. J. Surkan
- Social and Behavioral Interventions Program, Department of International Health Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institut d’Etudes Avancées de Paris, Paris, France
| | - D. Rayes
- Social and Behavioral Interventions Program, Department of International Health Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L. Bertuzzi
- INSERM, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique: IPLESP, Paris, France
| | - N. Figueiredo
- INSERM, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique: IPLESP, Paris, France
| | - M. Melchior
- INSERM, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique: IPLESP, Paris, France
| | - A. Tortelli
- INSERM, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique: IPLESP, Paris, France
- GHU Paris, Psychiatrie & Neurosciences – Pôle Psychiatrie Précarité, Paris, France
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15
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Simonek T, Zahos H, Mahroof-Shaffi S, Harkensee C. Seasonal patterns of communicable disease incidence and antibiotic prescribing in Moria refugee camp, Greece. J Public Health (Oxf) 2024; 46:41-50. [PMID: 37968097 DOI: 10.1093/pubmed/fdad212] [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: 06/02/2023] [Revised: 09/27/2023] [Accepted: 10/19/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Infectious diseases remain a major risk for refugees living in camps. Limited research has been undertaken into the burden and impact of infections in the current refugee crisis around the Mediterranean.This analysis examines the frequency and incidence rates of common infections, and use of antibiotics at a healthcare facility inside Moria refugee camp on the island of Lesvos, Greece, during the winter and summer seasons of 2019. METHODS This is a retrospective analysis of routinely, prospectively collected service data from the main acute healthcare facility inside Moria camp. RESULTS Of a total of 9601 consultations, 25.16% were for infections (winter: 31.53%, summer: 19.45%). Respiratory, skin and gastrointestinal infections were the most frequent, with incidence rates up to 3.5 times, 50 times and twice as high as those in Western Europe, respectively. Antibiotic prescribing was high (27.7% of all respiratory infections) with high use of broad-spectrum antibiotics (40.2%), raising concerns about induction of antimicrobial resistance. CONCLUSIONS The burden of infectious diseases in refugee camps remains high throughout all seasons. Antimicrobial stewardship programmes should be adapted to refugee camp settings to prevent the development of unnecessary antimicrobial resistance. Improving living conditions and access to healthcare in refugee camps is likely to reduce infection rates and antimicrobial resistance among refugees.
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Affiliation(s)
- Tomas Simonek
- UNHCR Camp Lesbos Greece, St. Elizabeth University, Namestie, 1 Maja 1, 81000 Bratislava, Slovakia
| | - Helen Zahos
- School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, QLD 4222, Gold Coast, Australia
| | | | - Christian Harkensee
- Queen Elizabeth Hospital Gateshead, Queen Elizabeth Avenue, Gateshead, NE9 6SX, UK
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16
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Gulyani P, Rawat P, Elmi Y, Gupta S, Wan CS. Barriers and facilitators of lifestyle management among adult South Asian migrants living with chronic diseases: A mixed-methods systematic review. Diabetes Metab Syndr 2024; 18:102944. [PMID: 38281447 DOI: 10.1016/j.dsx.2024.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND AND AIM South Asian migrants have a higher prevalence of chronic diseases than Caucasians. Despite much literature that has explored challenges in chronic disease management amongst the South Asian population in the past decades, their chronic disease management is still suboptimal. Understanding their determinants of disease management behaviour using the Theoretical Domains Framework will inform the development of a culturally sensitive intervention relevant to consumer-end-users. This study aimed to synthesise qualitative and quantitative studies on chronic disease management among adult South Asian immigrants. METHODS A mixed-methods systematic review was conducted using electronic databases. The Mixed Methods Appraisal Tool assessed the quality of the included studies. Quantitative data were transformed into qualitative data and analysed thematically. Subthemes were mapped in the Theoretical Domains Framework presenting barriers and facilitators under each theme. RESULTS 18293 studies were identified, of which 37 studies were included. The barriers and facilitators identified were categorised into four overarching themes: patient-provider interaction and relationship (e.g., complex language use by health professionals), the impact of migration (e.g., weather conditions had an impact on engagement with physical activity), heritage-based practices (e.g., an obligation to consume energy-dense food in social gatherings), and chronic disease management strategies (e.g., lack understanding of appropriate disease management strategies). CONCLUSION This review provides a comprehensive understanding of the complexity of chronic disease management among South Asian migrants and insights into developing multifaceted interventions to address barriers to chronic disease management, guiding the healthcare professionals in helping overcome South Asians perceived barriers to managing chronic disease in the host countries.
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Affiliation(s)
- Purva Gulyani
- Department of Sport, Exercise and Nutrition Sciences, La Trobe University, Bundoora, Australia; Diet Yumm, Craigieburn, Victoria, Australia.
| | | | - Yusra Elmi
- Diet Yumm, Craigieburn, Victoria, Australia
| | - Sabrina Gupta
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
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17
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Jolof L, Rocca P, Carlsson T. Support interventions to promote health and wellbeing among women with health-related consequences following traumatic experiences linked to armed conflicts and forced migration: a scoping review. Arch Public Health 2024; 82:8. [PMID: 38225672 PMCID: PMC10790529 DOI: 10.1186/s13690-023-01235-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Women exposed to armed conflicts and forced migration face significant health-related risks and consequences. Consequently, there is a need to identify and develop effective interventions that provide tailored support for them. The aim of this scoping review was to examine research evaluating support interventions promoting the health and well-being among women with traumatic experiences linked to armed conflict and/or forced migration. METHODS A scoping review of empirical studies evaluating non-pharmacologic/non-surgical interventions promoting health and well-being among adult women with traumatic experiences linked to armed, torture, and/or forced migration, identified through systematic searches in February 2022 within five databases (AMED, CINAHL, Cochrane Library, PsycINFO, and PubMed). Methodological characteristics and results were extracted and analyzed with narrative analysis using tabulations, descriptive statistics, text-based summaries, and thematization. RESULTS Assessment of 16 748 records resulted in 13 included reports. The methodological approaches were quantitative (n = 9), qualitative (n = 2), and mixed methods (n = 2), with most reports being feasibility/pilot studies (n = 5) and/or randomized controlled trials (n = 4). The most common recruitment strategy was non-probability sampling (n = 8). Most interventions were conducted in North America (n = 4), Asia (n = 3) or Middle East (n = 3). Thirteen intra-intervention techniques and five categories of components utilized within the interventions were identified, the most common being skill building (n = 12). Ten developed the interventions through theoretical frameworks or manuals/therapy, while five developed interventions through public or stakeholder involvement. Eleven studies evaluated outcomes related to psychological health, disorders, or distress. A large proportion of the investigated outcomes showed post-exposure improvements and improvements when compared with controls. Qualitative findings highlighted improved mental and physical health, empowerment and stigma reduction, and enhanced knowledge. CONCLUSION Few studies have developed and evaluated tailored support interventions for this population, containing a range of components and intra-intervention techniques. No clear focus was identified regarding outcome measures, and most studies used non-probability sampling. Few developed interventions through public contribution in collaboration with women. While limited studies show promising effects on women's mental health, more empirical intervention research that closely corresponds to women's needs are needed.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden.
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Gabarrell-Pascuet A, Lloret-Pineda A, Franch-Roca M, Mellor-Marsa B, Alos-Belenguer MDC, He Y, Hafi-Elmokhtari RE, Villalobos F, Bayes-Marin I, Aparicio Pareja L, Álvarez Bobo O, Espinal Cabezas M, Osorio Y, Haro JM, Cristóbal-Narvaez P. Impact of perceived discrimination and coping strategies on well-being and mental health in newly-arrived migrants in Spain. PLoS One 2023; 18:e0294295. [PMID: 38134016 PMCID: PMC10745147 DOI: 10.1371/journal.pone.0294295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/29/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES To explore how perceived discrimination impacts the emotional well-being and mental health of newly-arrived migrants in Spain; and to identify the coping strategies and behavioral changes used to deal with perceived discrimination. DESIGN 102 individual audio-recorded in-depth qualitative interviews were conducted. The interviews were transcribed and analyzed through content analysis. RESULTS Negative emotions related to perceived discrimination included disgust, sadness, fear, loneliness, humiliation, sense of injustice, rage, feeling undervalued or vulnerable, and mixed emotions. Change in behaviors due to perceived discrimination comprised westernization or cultural assimilation, creating a good image, avoiding going out or leaving alone, hypervigilance, stop participating in politics, self-sufficiency, a positive adaptation, and paradoxically, becoming an oppressor. The identified coping strategies to deal with perceived discrimination were ignoring or not responding, isolation, self-medication, engagement in intellectual activities, leisure and sport, talking or insulting the oppressor, denouncement, physical fight or revenge, seeking comfort, increasing solidarity with others, crying, or using humor. Discrimination-related stress and related mental health problems were conveyed, as challenges related to substance abuse and addictive behaviors, mood, and anxiety. CONCLUSIONS Findings establish initial evidence of the great impact of perceived discrimination on the health, emotional well-being, and behavior of newly-arrived migrants in Spain, alerting to the need for targeted policies and services to address the effects of discrimination in this population. Further research is needed to explore more closely the causes and effects of perceived discrimination on mental health, to develop more targeted and effective interventions.
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Affiliation(s)
- Aina Gabarrell-Pascuet
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
| | - Amanda Lloret-Pineda
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Marta Franch-Roca
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Blanca Mellor-Marsa
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Yuelu He
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Rachid El Hafi-Elmokhtari
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Felipe Villalobos
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ivet Bayes-Marin
- Center for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - Lola Aparicio Pareja
- Servicio de Atención a la Migración en Salud Mental (SATMI), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Oscar Álvarez Bobo
- Servicio de Atención a la Migración en Salud Mental (SATMI), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Mercedes Espinal Cabezas
- Servicio de Atención a la Migración en Salud Mental (SATMI), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Yolanda Osorio
- Servicio de Atención a la Migración en Salud Mental (SATMI), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Equip Salut Mental Sense Sostre (ESMES), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Josep Maria Haro
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
| | - Paula Cristóbal-Narvaez
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Center for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
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Solfrank M, Nikendei C, Zehetmair C, Friederich HC, Nagy E. The burden of substance use and (mental) distress among asylum seekers: a cross sectional study. Front Psychiatry 2023; 14:1258140. [PMID: 38173702 PMCID: PMC10761509 DOI: 10.3389/fpsyt.2023.1258140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Background Asylum seekers are a particularly vulnerable population due to a wide range of external stressors. Traumatic events and difficult social/economic prospects can lead to an elevated susceptibility for substance use disorders. The aim of the present study was to determine whether asylum seekers suffering from mental or physical distress present higher levels of substance use disorder (SUD) in a state reception center in Germany and whether there are identifiable risk or protective factors. Methods We performed a hierarchical logistic regression on data of N = 238 people who had applied for asylum in Germany to analyze the SUD variance explanation by (1) sociodemographic, (2) flight-specific, and (3) psychometric (ERQ, SOC-9 L, SCL-K9) variables. On level (4), we included the location of data collection (walk-in clinic or accommodation,) as an indicator of individual's need for a psychologist's or General practitioner's help in order to assess for the participant's (mental) distress. Results Low educational level, lower sense of coherence, and mental distress (location of data collection in the psychosocial or general medical outpatient clinic) were associated with SUD. Those suffering from SUD seemed to be less aware of external stressors as SUD was also associated with low levels of reported post-migratory stress. Discussion The association of SUD with psychological distress and lower education reaffirms the concept that some vulnerable groups are at a higher risk for substance-related difficulties. Strengthening the sense of coherence with targeted interventions might enable at-risk groups to cope better with forthcoming burdens and help with abstaining from current or future consumption.
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Affiliation(s)
- Maximilian Solfrank
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | - Ede Nagy
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Rossoni I, Chollier M, Dudushi R, Ghigo J, Padovese V. A scoping review of sexual and reproductive health recommendations in the context of migration to Europe. J Eur Acad Dermatol Venereol 2023; 37:2450-2461. [PMID: 37591613 DOI: 10.1111/jdv.19428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 07/21/2023] [Indexed: 08/19/2023]
Abstract
In recent years, growing instability and conflict around the world have continued to fuel outward migration, including migration to the EU/EEA. Many migrants hail from countries and regions with a higher burden of STIs-including HIV-and are exposed to enhanced risks of sexual and gender-based violence leading to sexual health issues during their journeys. This scoping review aims to identify existing sexual health recommendations for non-European migrants in the EU/EEA and identify gaps in their implementation. Sexual health recommendations formulated in relation to the migrant population in peer- reviewed journals or by expert consensus, between 2010 and 2021, were included. A keyword search was used to retrieve relevant publications on PubMed, ScienceDirect, the Cochrane Library databases, WHO and ECDC websites. The search strategy employed was charted in a dedicated Prisma Chart. Overall, 180 publications were retrieved. Based on the abstract and after eliminating duplicates, 33 publications were included for full-text reading. The references of these publications were screened. In total, 19 publications met the inclusion criteria. Evidence-based sexual health recommendations target only newly arrived migrants and migrant children (at arrival and during stay in the country). Screening practices are mostly informed by the country of origin and related prevalence, which remains a limitation; challenges faced during migration should also be considered. Implementation and compliance with these recommendations remain uncertain, as sexual health is not funded and addressed in a uniform manner across Europe.
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Affiliation(s)
- I Rossoni
- Van Vollenhoven Institute for Law, Governance and Society, Leiden University, Leiden, The Netherlands
| | - M Chollier
- CRIR-AVS PACA, APHM, Marseille, France
- UNESCO Chair for Sexual Health and Human Rights, Paris, France
| | - R Dudushi
- Faculty of Social Sciences, University of Tirana, Tirana, Albania
| | - J Ghigo
- Department of Obstetrics and Gynecology, Mater Dei Hospital, Msida, Malta
| | - V Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta
- International Foundation for Dermatology, Migrant Health Dermatology Working Group, London, UK
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O'Sullivan A. Undocumented migrants' access to healthcare in Sweden, and the impact of Act 2013:407. Nurs Ethics 2023:9697330231215947. [PMID: 37999980 DOI: 10.1177/09697330231215947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
BACKGROUND Research shows that undocumented migrants have difficulties in accessing healthcare. Act 2013:407 came into force in 2013 and entitled undocumented migrants to healthcare that cannot be deferred. To date, studies about undocumented migrants' access to care in Sweden and the impact of Act 2013:407 are sparse. Hence, the aim of this study was to describe professionals' experiences of access to healthcare for undocumented migrants in Sweden and the impact of Act 2013:407. METHODS A qualitative design with semi-structured interviews was employed. Nine interviews were carried out in 2015 with nurses at two NGO healthcare centres for undocumented migrants - and an additional seven interviews in 2022 with staff at an NGO healthcare centre for undocumented migrants and personnel at a regional health and medical care administration. Interpretive description was used for the analyses. ETHICAL CONSIDERATIONS Permission to carry out the study was obtained from managers at the participating NGOs and the regional health and medical care administration. Participants received verbal and written information about the study, and informed consent was obtained from all participants. FINDINGS Six categories emerged from the analysis: Changes since the Act was introduced, General problems with healthcare access, Care for undocumented migrants - politics and social economy, Lack of knowledge, 'Healthcare that cannot be deferred' and Being an undocumented migrant. CONCLUSION Undocumented migrants' social needs are as great as their needs for healthcare. Healthcare staff are burdened with healthcare cost considerations which affect their judgement of care provision and prioritization. Healthcare staff attitudes towards undocumented migrants affect their access to healthcare. Undocumented migrants in need of healthcare are especially vulnerable due to their legal status, being ill and the fear of being reported and deported. To assure undocumented migrants' access to healthcare and maintain healthcare ethics, the only possible solution is to provide healthcare based on needs.
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Barnett ED, Wheelock AB, MacLeod WB, McCarthy AE, Walker PF, Coyle CM, Greenaway CA, Castelli F, López-Vélez R, Gobbi FG, Trigo E, Grobusch MP, Gautret P, Hamer DH, Kuhn S, Stauffer WM. Infections with long latency in international refugees, immigrants, and migrants seen at GeoSentinel sites, 2016-2018. Travel Med Infect Dis 2023; 56:102653. [PMID: 37852594 PMCID: PMC10760402 DOI: 10.1016/j.tmaid.2023.102653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The continued increase in global migration compels clinicians to be aware of specific health problems faced by refugees, immigrants, and migrants (RIM). This analysis aimed to characterize RIM evaluated at GeoSentinel sites, their migration history, and infectious diseases detected through screening and diagnostic workups. METHODS A case report form was used to collect data on demographics, migration route, infectious diseases screened, test results, and primary infectious disease diagnosis for RIM patients seen at GeoSentinel sites. Descriptive statistics were performed. RESULTS Between October 2016 and November 2018, 5,319 RIM patients were evaluated at GeoSentinel sites in 19 countries. Africa was the region of birth for 2,436 patients (46 %), followed by the Americas (1,644, 31 %), and Asia (1,098, 21 %). Tuberculosis (TB) was the most common infection screened and reported as positive (853/2,273, 38 % positive by any method). TB, strongyloidiasis, and hepatitis B surface antigen positivity were observed across all migration administrative categories and regions of birth. Chagas disease was reported only among RIM patients from the Americas (393/394, 100 %) and schistosomiasis predominantly in those from Africa (480/510, 94 %). TB infection (694/5,319, 13 %) and Chagas disease (524/5,319, 10 %) were the leading primary infectious disease diagnoses. CONCLUSIONS Several infections of long latency (e.g. TB, hepatitis B, and strongyloidiasis) with potential for long-term sequelae were seen among RIM patients across all migration administrative categories and regions of origin. Obtaining detailed epidemiologic information from RIM patients is critical to optimize detection of diseases of individual and public health importance, particularly those with long latency periods.
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Affiliation(s)
- Elizabeth D Barnett
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alyse B Wheelock
- Section of Preventive Medicine and Epidemiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Anne E McCarthy
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Patricia F Walker
- Department of Medicine, University of Minnesota, HealthPartners Institute, Minnesota, USA
| | - Christina M Coyle
- Department of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christina A Greenaway
- SMBD Jewish General Hospital, Division of Infectious Diseases, McGill University, Montreal, Quebec, Canada
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Lombardy, Italy
| | - Rogelio López-Vélez
- Ramón y Cajal Institute for Health Research, Ramón y Cajal University Hospital, Madrid, Spain
| | - Federico G Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elena Trigo
- Department of Internal Medicine, National Referral Unit for Imported Tropical Diseases, High Level Isolation Unit, Hospital Universitario La Paz-Carlos III, IdiPAZ, Madrid, Spain
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Philippe Gautret
- VITROME, Aix Marseille University, IRD, AP-HM, SSA, Marseille, France; Institut Méditerranée Infection, Marseille, France
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Susan Kuhn
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Fassin D, Defossez AC. Displaced people's perilous journeys: border violence as a public health issue. Lancet 2023; 402:1209-1211. [PMID: 37805197 DOI: 10.1016/s0140-6736(23)02030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Didier Fassin
- Collège de France, 75005 Paris, France; Institute for Advanced Study, Princeton, NJ, USA; École des Hautes Études en Sciences Sociales, Paris, France.
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Biesiada A, Mastalerz-Migas A, Babicki M. Response to provide key health services to Ukrainian refugees: The overview and implementation studies. Soc Sci Med 2023; 334:116221. [PMID: 37689012 DOI: 10.1016/j.socscimed.2023.116221] [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: 05/17/2023] [Revised: 08/01/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND The outbreak of war in Ukraine has contributed to the largest migration crisis in this part of Europe since the Second World War. In a short period of time, several million refugees of different ages and with different health needs have arrived in Poland. This study aims to assess the health problems of Ukrainian refugees, evaluate the barriers faced by primary care physicians (PCPs), and analyse and evaluate the system solutions available (including the use of modern information technology) to address them. METHODOLOGY For this purpose, an original questionnaire distributed to PCPs in Poland was created and a literature review of implemented system solutions was conducted. The survey was conducted between the 3rd-10th April 2022-45 days after the outbreak of the war. The survey was repeated between 20th January and February 15, 2023. RESULTS The survey was completed by 402 physicians who provided health care to refugees at that time. There were 252 respondents in the first stage of the study while 150 PCPs took part in the repeat survey. The findings of the survey revealed that the most common health problems among refugees were infections, regardless of age. The biggest barrier to providing care to refugees was the lack of available medical records and language difficulties. During the first months of the refugee influx in Poland, many - both systemic and grassroot - solutions were implemented to improve the quality of health care for refugees. CONCLUSIONS According to PCPs, the language barrier and the lack of previous medical records are key constraints when providing medical care to refugees. The health needs of refugees and the difficulties in providing care for them require constant monitoring and implementation of appropriate systemic solutions that can reduce the limitations in the daily work of medical staff.
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Affiliation(s)
- Aleksander Biesiada
- Ad Vitam Przychodnia Zdrowia Sp. z o.o. Sp. k, Poland; Polish Society of Family Medicine, Poland.
| | - Agnieszka Mastalerz-Migas
- Polish Society of Family Medicine, Poland; Department of Family Medicine, Wroclaw Medical University, 51-141, Wroclaw, Poland
| | - Mateusz Babicki
- Polish Society of Family Medicine, Poland; Department of Family Medicine, Wroclaw Medical University, 51-141, Wroclaw, Poland
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Effraimidou E, Cassimos DC, Medic S, Topalidou M, Theodoridou M, Maltezou HC. Vaccination programs for children aged up to 18 years in Europe, 2020. J Child Health Care 2023; 27:336-350. [PMID: 34844456 DOI: 10.1177/13674935211055294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although all European countries have vaccination policies for children, there are no comprehensive studies of pediatric vaccination programs in Europe. We studied vaccination programs for children in Europe. Vaccinations against diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, hepatitis B, measles, mumps, rubella, and influenza existed in 42 countries, against human papilloma virus in 41 countries, and against pneumococcus in 40 countries. In addition, the following vaccinations existed: against tuberculosis (35 countries), hepatitis A (33), meningococcus A, C, W, Y (30), rotavirus and varicella (28 countries each), meningococcus B (24), tick-born encephalitis (22), and meningococcus C (16). Mandatory vaccinations are implemented in 21 countries, mainly against diphtheria, tetanus, pertussis, poliomyelitis, H. influenzae type b, hepatitis B, measles, mumps, rubella, tuberculosis, and pneumococcus. There are significant differences among pediatric vaccination programs in Europe regarding number, schedules, indications, and regulatory frame (recommended or mandatory vaccinations). A consensus-based vaccination program for all children is needed.
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Affiliation(s)
| | | | - Snezana Medic
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Maria Topalidou
- Pediatric Clinic, Komotini General Hospital, Komotini, Greece
| | - Maria Theodoridou
- First Department of Pediatrics, University of Athens, Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
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Ramos JP, Vieira M, Pimentel C, Argel M, Barbosa P, Duarte R. Building bridges: multidisciplinary teams in tuberculosis prevention and care. Breathe (Sheff) 2023; 19:230092. [PMID: 37719241 PMCID: PMC10501709 DOI: 10.1183/20734735.0092-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/07/2023] [Indexed: 09/19/2023] Open
Abstract
People with or affected by tuberculosis (TB) experience complex social and cultural constraints that may affect treatment outcomes by impeding access to proper care or by hindering treatment adherence. Low levels of health literacy which leads to inadequate disease information; stigma, discrimination and other forms of prejudice that may result in marginalisation and ostracisation; and socioeconomic vulnerabilities that hamper one's capacity to access essential goods or increase the risk of exposure to the disease are some of the barriers highlighted. These complex hurdles are also disproportionately felt by people with or affected by TB due to gender-related inequalities that need to be properly addressed. Additionally, TB prevention and care should encompass interventions aimed at improving and promoting mental health, given that mental unhealth may further thwart treatment adherence and success. A multifaceted and multidisciplinary approach to TB is required to answer these complex barriers.
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Affiliation(s)
- João Pedro Ramos
- Departamento de Estudos das Populações, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Mariana Vieira
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | | | | | - Pedro Barbosa
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Raquel Duarte
- Departamento de Estudos das Populações, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Unidade de Investigaçao Clínica da Administraçao Regional de Saúde do Norte, Porto, Portugal
- Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Scarso S, Marchetti G, Russo ML, D’Angelo F, Tosti ME, Bellini A, De Marchi C, Ferrari C, Gatta A, Caminada S, Papaevgeniou N, Dalma N, Karnaki P, Marceca M, Declich S. Access to Vaccination for Newly Arrived Migrants: Developing a General Conceptual Framework for Understanding How to Improve Vaccination Coverage in European Countries. Int J Public Health 2023; 68:1605580. [PMID: 37609078 PMCID: PMC10440383 DOI: 10.3389/ijph.2023.1605580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
Objectives: Access to vaccination for newly arrived migrants (NAMs) is a relevant concern that requires urgent attention in EU/EEA countries. This study aimed to develop a General Conceptual Framework (GCF) for understanding how to improve vaccination coverage for NAMs, by characterizing and critically analyzing system barriers and possible strategies to increase vaccination. Methods: A theoretical conceptualization of the GCF was hypothesized based on conceptual hubs in the immunization process. Barriers and solutions were identified through a non-systematic desktop literature review and qualitative research. The GCF guided the activities and facilitated the integration of results, thereby enriching the GCF with content. Results: The study explores the vaccination of NAMs and proposes strategies to overcome barriers in their vaccination process. It introduces a framework called GCF, which consists of five interconnected steps: entitlement, reachability, adherence, achievement, and evaluation of vaccination. The study also presents barriers and solutions identified through literature review and qualitative research, along with strategies to enhance professionals' knowledge, improve reachability, promote adherence, achieve vaccination coverage, and evaluate interventions. The study concludes by recommending strategies such as proximity, provider training, a migrant-sensitive approach, and data collection to improve vaccination outcomes for NAMs. Conclusion: Ensuring equitable access to healthcare services, including vaccination, is crucial not only from a humanitarian perspective but also for the overall public health of these countries.
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Affiliation(s)
- Salvatore Scarso
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Giulia Marchetti
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Maria Laura Russo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Franca D’Angelo
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
| | - Maria Elena Tosti
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
| | - Arianna Bellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Chiara De Marchi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Caterina Ferrari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Angela Gatta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
| | - Nikoletta Papaevgeniou
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, Marousi, Greece
| | - Nadia Dalma
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, Marousi, Greece
| | - Pania Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, Marousi, Greece
| | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Roma, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
| | - Silvia Declich
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
- Italian Society of Migration Medicine (SIMM), Rome, Italy
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Meaza A, Yenew B, Amare M, Alemu A, Hailu M, Gamtesa DF, Kaba M, Medhin G, Ameni G, Gumi B. Prevalence of tuberculosis and associated factors among presumptive TB refugees residing in refugee camps in Ethiopia. BMC Infect Dis 2023; 23:498. [PMID: 37507672 PMCID: PMC10386672 DOI: 10.1186/s12879-023-08469-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) causes significant morbidity and mortality in refugee populations. Although Ethiopia is the third largest refugee-hosting country in Africa, there is limited published data on the prevalence and associated factors of TB in refugees. The objective of this study was to estimate the prevalence of bacteriologically confirmed pulmonary TB (PTB) and explore associated factors in presumptive TB refugees residing in refugee camps in Ethiopia. METHODS A facility-based cross-sectional study was conducted between February and August 2021 in refugee camps in Ethiopia. Data were collected consecutively from 610 presumptive TB refugees who attended for TB diagnosis in selected refugee camp clinics in Ethiopia. A pre-tested questionnaire was used to collect data, and sputum samples were collected from eligible study participants. The Xpert Mycobacterium tuberculosis (MTB)/Rifampicin (RIF) assay was performed on direct spot sputum samples, whereas morning sputum samples were processed and inoculated for bacteriological culture using Mycobacterium Growth Indicator Tube (MGIT) and Lowsteen Jensen (LJ) methods. The statistical software package (STATA version 14) was used for statistical analysis. A logistic regression model was used for the evaluation of the association between bacteriologically confirmed TB cases and the associated factors. Descriptive statistics were used for the expression of the results, and statistical significance was assumed at p < 0.05. RESULTS Out of 610 study participants, more than half were female (54.9%), and the mean age was 37.9 years (SD, 16.64). The prevalence of bacteriologically confirmed PTB cases among refugees residing in refugee camps in Ethiopia was 13.3% (95% CI, 10.7-16.2%) using the Xpert MTB/RIF assay and/or culture. MTB was detected in 12.8% (95% CI, 10.2-15.7%) of the individuals using the Xpert MTB/RIF assay, while culture positivity was observed in 11.6% (95% CI, 9.2-14.5%). The multivariable logistic regression model showed South Sudan origins (adjusted odds ratio, AOR = 7.74; 95% CI, 3.05-19.64), age group, 19-38 years old (AOR = 5.66; 95% CI, 1.86-17.28), and male sex (AOR = 2.69; 95% CI, 1.58-4.56) were significantly associated with the bacteriologically confirmed TB among refugees residing in refugee camps in Ethiopia. CONCLUSION The prevalence of bacteriologically confirmed PTB among presumptive TB refugees residing in refugee camps in Ethiopia was high. The national TB program should strengthen TB prevention and control activities in the refugee camps of Ethiopia. Moreover, an active TB survey program should be implemented in refugee camps in Ethiopia.
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Affiliation(s)
- Abyot Meaza
- Aklilu Lemma Institute of Pathobiology (ALIPB), Addis Ababa University (AAU), P.O. Box 1176, Addis Ababa, Ethiopia.
- Ethiopian Public Health Institute (EPHI), Swaziland Street, PO Box 1242, Addis Ababa, Ethiopia.
| | - Bazezew Yenew
- Ethiopian Public Health Institute (EPHI), Swaziland Street, PO Box 1242, Addis Ababa, Ethiopia
| | - Miskir Amare
- Ethiopian Public Health Institute (EPHI), Swaziland Street, PO Box 1242, Addis Ababa, Ethiopia
| | - Ayinalem Alemu
- Aklilu Lemma Institute of Pathobiology (ALIPB), Addis Ababa University (AAU), P.O. Box 1176, Addis Ababa, Ethiopia
- Ethiopian Public Health Institute (EPHI), Swaziland Street, PO Box 1242, Addis Ababa, Ethiopia
| | - Michael Hailu
- Ethiopian Public Health Institute (EPHI), Swaziland Street, PO Box 1242, Addis Ababa, Ethiopia
| | - Dinka Fikadu Gamtesa
- Ethiopian Public Health Institute (EPHI), Swaziland Street, PO Box 1242, Addis Ababa, Ethiopia
| | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology (ALIPB), Addis Ababa University (AAU), P.O. Box 1176, Addis Ababa, Ethiopia
| | - Gobena Ameni
- Aklilu Lemma Institute of Pathobiology (ALIPB), Addis Ababa University (AAU), P.O. Box 1176, Addis Ababa, Ethiopia
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, PO Box 15551, Al Ain, UAE
| | - Balako Gumi
- Aklilu Lemma Institute of Pathobiology (ALIPB), Addis Ababa University (AAU), P.O. Box 1176, Addis Ababa, Ethiopia
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Plakas TD, Aletras VH, Voutsa EI, Niakas D. Health-Related Quality of Life and Life Satisfaction in a Greek Refugee Accommodation Center. Cureus 2023; 15:e42005. [PMID: 37593316 PMCID: PMC10428663 DOI: 10.7759/cureus.42005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
Introduction In recent years, a large number of refugees have crossed the Greek borders. The aim of this study was to estimate the health-related quality of life (HRQoL) and life satisfaction (LS) of refugees and asylum seekers residing in the Vagiochori Accommodation Center. Methods The Short Form-36 (SF-36) survey tool and the Satisfaction With Life Scale (SWLS) were employed for the analysis. The sample consists of 144 individuals with an average age of 39.4 years, most of which are Afghans, married, and have a secondary education level. Non-parametric tests examined the association of respondents' demographics and health-related and residence-related characteristics with the physical component scale (PCS) and mental component scale (MCS) of SF-36 and SWLS. Regression analysis was used to examine the effect of these variables on dependent scales. Results HRQoL and LS of the participants were poor (median scores: PCS = 44.91, MCS = 42.05, and SWLS = 12.00). Age, gender, education, marital status, and specific health-related and residence-related characteristics were associated with HRQoL (p < 0.05). Marital status and specific health-related and residence-related characteristics were associated with SWLS. Conclusion In summary, social support, legal counseling, and a better understanding of refugees' concerns are required to improve refugees' and asylum seekers' HRQoL and LS.
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Affiliation(s)
- Thomas D Plakas
- School of Social Sciences, Hellenic Open University, Patras, GRC
| | - Vassilis H Aletras
- Department of Business Administration, University of Macedonia, Thessaloniki, GRC
| | - Eirini I Voutsa
- School of Informatics, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Dimitris Niakas
- Department of Health Economics, National and Kapodistrian University of Athens, Athens, GRC
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Ibrahim N, Zein M, Abdel Sater AH, El Khatib O, Tayyara L. Syrian Refugees Seeking Hospital Care in Beirut: A Cross-Sectional Study of Reasons for Hospital Admissions. Cureus 2023; 15:e42276. [PMID: 37605675 PMCID: PMC10440193 DOI: 10.7759/cureus.42276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Lebanon has the highest Syrian refugee density worldwide. The influx of Syrian refugees has had various impacts on Lebanon, with one of the most significant effects observed in the already exhausted healthcare system. This study aimed to determine the reasons for hospitalization among registered Syrian refugees in Beirut who were admitted to Rafik Hariri University Hospital (RHUH) between December 2017 and June 2020. METHODS Data from 7,480 diagnosed cases were collected from the RHUH archives between December 2017 and June 2020 and were analyzed using SPSS (IBM Corp., Armonk, NY, USA). The collected data included information related to demographics, admission date, primary diagnosis, and other related medical problems. Variations and correlations were then tested. RESULTS Of the cases, 73.4% were females; the mean age was 28 ± 16.23 years. Fifty-seven percent of the admitted cases were solely due to pregnancy, childbirth, and puerperium reasons, and 91.14% of the deliveries were single deliveries by cesarean section. Common reasons for hospitalization were injuries (5.8%) and diseases of the digestive system (6.8%), circulatory system (4.7%), and respiratory system (4.4%). Non-communicable diseases (NCDs) constituted 61% of all hospital admissions, while only 6.6% belonged to communicable diseases. Reasons for hospitalization and the type of diagnosed diseases were associated with gender and age groups (p-values <0.001). CONCLUSION The major reasons for hospitalization among Syrian refugees were related to pregnancies and NCDs. The burden of the Syrian refugee influx on the Lebanese healthcare system can be alleviated by improving community health education, public health services, and conditions for refugees.
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Affiliation(s)
- Nour Ibrahim
- Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Marwan Zein
- Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Ali H Abdel Sater
- Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Omar El Khatib
- Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Loubna Tayyara
- Pulmonology, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
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Fiorini G, Franchi M, Pellegrini G, Rigamonti AE, Sartorio A, Marazzi N, Corrao G, Cella SG. Characterizing non-communicable disease trends in undocumented migrants over a period of 10 years in Italy. Sci Rep 2023; 13:7424. [PMID: 37156791 PMCID: PMC10167203 DOI: 10.1038/s41598-023-34572-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/03/2023] [Indexed: 05/10/2023] Open
Abstract
Undocumented migrants represent a large part of the population in Countries of the European Union (EU) such as Italy. Their health burden is not fully understood and likely to be related mainly to chronic conditions. Information on their health needs and conditions may help to target public health interventions but is not found in national public health databases. We conducted a retrospective observational study of non-communicable disease (NCD) burden and management in undocumented migrants receiving medical care from Opera San Francesco, a non-governmental organization (NGO) in Milan, Italy. We analyzed the health records of 53,683 clients over a period of 10 years and collected data on demographics, diagnosis and pharmacological treatments prescribed. 17,292 (32.2%) of clients had one or more NCD diagnosis. The proportion of clients suffering from at least one NCD increased from 2011 to 2020. The risk of having an NCD was lower in men than women (RR = 0.88, 95% CI 0.86-0.89), increased with age (p for trend < 0.001) and changed with ethnicity. African and Asian migrants had a lower risk than Europeans of cardiovascular diseases (RR 0.62 CI 0.58-0.67, RR 0.85 CI 0.78-0.92 respectively) and mental health disorders (RR 0.66 CI 0.61-0.71, RR 0.60 CI 0.54-0.67 respectively), while the risk was higher in Latin American people (RR 1.07 CI 1.01-1.13, RR 1.18 CI 1.11-1.25). There was a higher risk of diabetes in those from Asia and Latin America (RR 1.68 CI 1.44-1.97, RR 1.39 CI 1.21-1.60). Overall, migrants from Latin America had the greatest risk of chronic disease and this was true for diabetes, cardiovascular diseases and mental health disorders. Undocumented migrants demonstrate a significantly different health burden of NCDs, which varies with ethnicity and background. Data from NGOs providing them with medical assistance should be included in structuring public health interventions aimed at the prevention and treatment of NCDs. This could help to better allocate resources and address their health needs.
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Affiliation(s)
- Gianfrancesco Fiorini
- Istituti Clinici Zucchi, GSD, Monza, Italy
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
| | - Giacomo Pellegrini
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Antonello Emilio Rigamonti
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Nicoletta Marazzi
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
| | - Silvano Gabriele Cella
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy.
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Hill JN, Krüger K, Boczor S, Kloppe T, von dem Knesebeck O, Scherer M. Patient-centredness in primary care walk-in clinics for refugees in Hamburg. BMC PRIMARY CARE 2023; 24:112. [PMID: 37149641 PMCID: PMC10163696 DOI: 10.1186/s12875-023-02060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 04/12/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND The huge increase of refugees to Germany caused a great challenge to the health system. We aimed to examine the level of patient-centredness in medical consultations with refugee patients, aided by video interpreters in primary care walk-in clinics (PCWC) in Hamburg. METHODS Videotaped consultations (N = 92) of 83 patients from 2017 to 2018 were analysed. Two raters used the Measure of Patient-Centered Communication (MPCC) and the International Classification of primary care (ICPC-2). MPCC scores with regard to patients' reason for seeking medical care and the procedures taken were explored using variance analyses adjusted for age, gender, and the duration of the consultation. The duration was further explored by Pearson correlations. RESULTS Patient-centredness of all consultations on average was 64% (95% CI 60-67) according to MPCC, with health-related issues affecting the results. The highest level of patient-centredness was achieved in psychological health issues with 79% (65-94), the lowest in respiratory ones with 55% (49-61). Longer consultations resulted in higher MPCC scores. CONCLUSIONS The level of patient-centredness varied in the addressed health issues as well as in the duration of the consultation. Despite the variation, video interpreting in consultations supports a solid patient-centredness. PRACTICE IMPLICATIONS We recommend the use of remote video interpreting services for outpatient healthcare to support patient-centred communication and to fill the gap of underrepresentation of qualified interpreters on site, regarding a high diversity of spoken languages.
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Affiliation(s)
- Josephine Nana Hill
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Katarina Krüger
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrid Boczor
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Kloppe
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bildik B, Aker M. Demographic and Clinical Characteristics of Migrant Patients Visiting the Emergency Department. Cureus 2023; 15:e39746. [PMID: 37398801 PMCID: PMC10310547 DOI: 10.7759/cureus.39746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Disasters, war, violence, and famine have driven people to migrate in search of a better life, resulting in an increasing number of health issues related to migration. Turkiye has historically been a host country for migration due to its geopolitical location for economic and educational reasons, among other reasons. Migrants frequently visit emergency departments (EDs) regarding their chronic or acute diseases. Understanding the characteristics and admission diagnosis in EDs can help healthcare providers identify areas that require attention. This study aimed to determine the demographic characteristics and most frequent reasons for migrant patients visiting the ED. Methods This retrospective cross-sectional study was conducted in the ED of a tertiary hospital in Turkiye between January 1, 2021, and January 1, 2022. Sociodemographic data and diagnoses were obtained from the hospital information system and medical records. Migrant patients who visited the ED for any reason were included, while patients with inaccessible data, no diagnosis code, or missing information were excluded. Data were analyzed using descriptive statistical methods and compared using the Mann-Whitney U test, Student's t-test, and Chi-squared test. Results Out of 3865 migrant patients, 2186 (56.6%) were male, and the median age was 22 (17-27) years. Most patients (74.5%) were from the Middle East, and 16.6% were from Africa. The most common reasons for visiting the hospital were R00-99 "Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified" (45.6%); M00-99 "Diseases of the musculoskeletal system and connective tissue" (29.2%); and J00-99 "Diseases of the respiratory system" (23.1%). Among the African patients, 82.7% were students, while 85.4% of Middle Eastern patients were non-students. The number of visits differed significantly between regions, with Middle Easterners visiting more frequently than Africans and Europeans. Conclusion The majority of the patients were from the Middle East. Also, patients from the Middle East had more visits and a higher likelihood of being hospitalized than patients from other regions. The sociodemographic characteristics of migrant patients visiting ED and information about their diagnoses can help determine the profile of patients that emergency physicians are likely to encounter.
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Affiliation(s)
- Busra Bildik
- Emergency Medicine, Karabuk Training and Research Hospital, Karabuk, TUR
| | - Mert Aker
- Cardiology, Karabuk Training and Research Hospital, Karabuk, TUR
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The Presence and Profile of Neurological Conditions and Associated Psychiatric Comorbidities in U.S. Resettled Refugees: A Retrospective Single Center Study. J Immigr Minor Health 2023; 25:365-373. [PMID: 36251204 DOI: 10.1007/s10903-022-01409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 10/24/2022]
Abstract
Refugees are a vulnerable, growing population who confront a myriad of traumas leading to their forced migration. Although psychiatric illnesses of resettled refugees are well-documented, there is a paucity of studies characterizing their neurological disease profiles. This study aimed to characterize the frequency and range of neurological disorders in a sample of resettled refugees receiving care at a community health center in Massachusetts, U.S.A. We performed a retrospective medical record review of adult (≥ 18 years) resettled refugees between May 2001 and December 2012 at a community health center in Northeast Massachusetts. Sociodemographic and clinical characteristics pertaining to neuropsychiatric health were collected from medical records using a standardized data extraction tool. Group comparisons between those with and without neurological illness and associated sociodemographic and psychiatric characteristics were evaluated using χ2 and independent samples two-tailed t-tests. In our sample (n = 779), 53.3% (n = 415) were male and 48.8% (n = 380) were from the African continent. The mean age was 33.2 ± 12.4 years (range 18-85). 36.8% were diagnosed with at least one neurological disorder and 18.1% with more than one neurological illness. The most common diagnoses were headaches (28.3%), sleep disorders (11.2%), cognitive impairment/ dementia (5.5%), and head trauma (5.5%). Exploratory analyses revealed that participants with neurological illness were more likely to be older (p < .001), female (p = .002), and diagnosed with co-morbid psychiatric diagnoses (p < .001) than those without neurological illness. Neurological disorders frequently co-occur with psychiatric comorbidities among U.S. resettled adult refugees. Standard refugee health assessments should incorporate screening and treatment for neurological illnesses.
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Delilovic S, Hagström A, Shedrawy J, Hollander AC, Lönnroth K, Hasson H. Is legal status associated with mental illness among newly arrived refugees in Sweden: an epidemiological study. BMC Psychiatry 2023; 23:197. [PMID: 36964504 PMCID: PMC10039579 DOI: 10.1186/s12888-023-04679-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 03/14/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND There are about 80 million forcibly displaced people globally. Migrants are at heightened risk for mental illness compared to host country populations. While previous research highlights the need to adequately assess mental illness, few have taken the diversity among newly arrived migrants into account. This study aims to estimate the prevalence and associated risk factors of mental illness among asylum seekers, quota and other refugees in Stockholm, Sweden. METHODS Using a cross-sectional design, data was collected as part of a mental health screening initiative integrated into routine health examinations in two health care clinics in Stockholm. Screening was done with the Refugee Health Screener, RHS-13, a validated instrument for assessing mental health in refugee populations. RESULTS A total of 1163 individuals were eligible for screening, of whom 566 participated (response rate 48.6%). Among the participants, 47.9% indicated symptoms of mental illness. Compared with asylum seekers, the risk of mental illness was lower among quota and other refugees (adjusted odds ratio 0.60, 95% confidence interval 0.37-1.00). Female sex, higher age, coming from a middle-income country and low probability of being granted asylum were significant predictors of mental illness. CONCLUSION Refugee legal status is associated with mental illness. Asylum seekers are at greater risk of mental illness compared to quota and other refugees. Our findings call for screening for mental illness among newly arrived migrants, especially among those with pending residence permits.
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Affiliation(s)
- Sara Delilovic
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, (LIME) Karolinska Institutet (KI), Karolinska Institutet, Region Stockholm, 171 77, Sweden.
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Region Stockholm, Sweden.
| | - Ana Hagström
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, (LIME) Karolinska Institutet (KI), Karolinska Institutet, Region Stockholm, 171 77, Sweden
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Region Stockholm, Sweden
| | - Jad Shedrawy
- Social medicine, infectious diseases and migration, Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Anna Clara Hollander
- Epidemiology of Psychiatric Conditions, Substance use and Social Environment (EPiCSS), Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Knut Lönnroth
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Region Stockholm, Sweden
- Social medicine, infectious diseases and migration, Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Henna Hasson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, (LIME) Karolinska Institutet (KI), Karolinska Institutet, Region Stockholm, 171 77, Sweden
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Region Stockholm, Sweden
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Prusaczyk A, Bogdan M, Vinker S, Gujski M, Żuk P, Kowalska-Bobko I, Karczmarz S, Oberska J, Lewtak K. Health Care Organization in Poland in Light of the Refugee Crisis Related to the Military Conflict in Ukraine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3831. [PMID: 36900836 PMCID: PMC10001563 DOI: 10.3390/ijerph20053831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Poland is witnessing a migration crisis caused by the ongoing military conflict in Ukraine. In addition to housing and necessities, 1.8 million Ukrainians that had taken refuge in Poland must have access to medical care. We aim to propose a strategy for implementing the changes in the Polish health care system in response to the Ukrainian refugee crisis. METHODS A literature review on organizational changes in the functioning of health care systems during the migration crises worldwide in recent years and brainstorming in order to develop a strategy for implementing changes in the Polish health care system in response to the Ukrainian refugee crisis. RESULTS The proposed strategy for implementing the changes in the Polish health care system is based on building health care resilience and adaptation to different crises. The operational objectives of organization-related activities are: (1) preparation of medical facilities to provide help for refugees, (2) development and implementation of the communication system, (3) implementation of available digital solutions, (4) organization of the diagnostic and medical services, (5) and implementation of changes in the management of medical facilities. CONCLUSIONS Urgent reorganization is required to respond to an unavoidable increase in the demand for health care services.
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Affiliation(s)
| | - Magdalena Bogdan
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Mariusz Gujski
- Department of Public Health, Medical University of Warsaw, 00-097 Warsaw, Poland
| | - Paweł Żuk
- Medical and Diagnostic Center, 08-110 Siedlce, Poland
| | - Iwona Kowalska-Bobko
- Institute of Public Health, Faculty of Health Science, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | | | - Joanna Oberska
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland
| | - Katarzyna Lewtak
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland
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Rost M, De Clercq E, Arnold L, Rakic M. Interventions to enhance cross-cultural competence in oncology: A meta-analysis of effectiveness studies and a qualitative review. Eur J Oncol Nurs 2023; 64:102277. [PMID: 36944274 DOI: 10.1016/j.ejon.2023.102277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/24/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Cross-cultural competence of healthcare providers is crucial to create a culturally safe environment. Cancer poses special challenges to cross-culturally competent communication and decision-making. Yet, no research synthesis on cross-cultural competence interventions has focused specifically on oncology. METHODS We conducted a meta-analysis and qualitative review of literature on the effectiveness of cross-cultural competence interventions in oncology. No limitations were placed on publication date, language, oncology setting, or geographic region. Of 1.565 citations identified, 15 articles met the inclusion criteria. Information on study design, samples, measured outcomes, and effectiveness statistics were coded. Average weighted effects were calculated applying meta-analysis methodology. RESULTS Studies were published between 2000 and 2020; more than half in the last seven years; two thirds in the USA. Overall study quality was at a low to moderate level, notably only one study provided a control-group-design. In sum, nurses constituted the largest occupational group among participants. Results of the meta-analysis indicate that cross-cultural competence interventions have differential effects. While the overall effect of cross-cultural competence interventions was not statistically significant, results showed that the cross-cultural competence dimensions of knowledge and behavior did improve. Effects beyond that remain unclear. CONCLUSIONS We provide valuable information on research gaps. The lack of studies and insufficient methodological rigor of available studies show that more research is needed to support the claim that interventions actually improve the various dimensions of cross-cultural competence in oncology. To build a stronger evidence base, it is necessary to include patient-reported outcomes and to center their experiences in future research.
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Affiliation(s)
- Michael Rost
- Institute for Biomedical Ethics, University of Basel, 4056, Switzerland.
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, 4056, Switzerland
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller-University of Jena, 07743, Germany
| | - Milenko Rakic
- Institute for Biomedical Ethics, University of Basel, 4056, Switzerland
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Mroue T, Heras B, Soriano JM, Morales-Suarez-Varela M. Prevalence of Malnutrition among Syrian Refugee Children from Lebanon. Life (Basel) 2023; 13:life13020453. [PMID: 36836811 PMCID: PMC9961820 DOI: 10.3390/life13020453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Today, the situation of Syrian refugees is one of the world's worst humanitarian crises. To estimate the prevalence of malnutrition among pediatric populations of Syrian refugees, 176 Syrian refugee children, with stays of more than two years at three refugee camps (Zalhé, Deddeh, and Kfar Jouz) or from the town of Yohmor, Lebanon were authorized by their parents to participate in this study. The children were anthropometrically evaluated and height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and weight-for-height (WHZ) Z-scores were obtained and compared with WHO standards. Furthermore, mid-upper arm circumference (MUAC) was analyzed for screening children 6-59 months old. According to the anthropometric measures, no child met the criteria for chronic, global, acute malnutrition (CGAM), severe acute malnutrition (SAM), or moderate acute malnutrition (MAM). In the total sample, 49.4% of participants were moderately thin, with girls presenting a higher prevalence of thinness than that of boys. Thus, the absence of high rates of malnutrition was verified despite the magnitude of the Syrian refugee's problem. The data provided by this study identify the need to carry out further research to assess anthropometric growth and nutritional status among long-staying refugee children in order to prevent any health issues that may arise in the future.
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Affiliation(s)
- Tamara Mroue
- Observatory of Nutrition and Food Safety for Developing Countries, Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Paterna, Spain
| | - Betlem Heras
- Observatory of Nutrition and Food Safety for Developing Countries, Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Paterna, Spain
| | - Jose M. Soriano
- Observatory of Nutrition and Food Safety for Developing Countries, Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Paterna, Spain
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, Health Research Institute La Fe-University of Valencia, 46026 Valencia, Spain
- Correspondence: ; Tel.: +34-963543056
| | - María Morales-Suarez-Varela
- Unit of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, University of Valencia, 46100 Burjassot, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, 28029 Madrid, Spain
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Evaluation of Two Different Strategies for Schistosomiasis Screening in High-Risk Groups in a Non-Endemic Setting. Trop Med Infect Dis 2023; 8:tropicalmed8010044. [PMID: 36668951 PMCID: PMC9862038 DOI: 10.3390/tropicalmed8010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
A consensus on the recommended screening algorithms for schistosomiasis in asymptomatic high-risk subjects in non-endemic areas is lacking. The objective of this study was to evaluate the real-life performance of direct microscopy and ELISA serology for schistosomiasis screening in a high-risk population in a non-endemic setting. A retrospective cohort study was conducted in two out-patient Tropical Medicine units in Barcelona (Spain) from 2014 to 2017. Asymptomatic adults arriving from the Sub-Saharan region were included. Schistosomiasis screening was conducted according to clinical practice following a different strategy in each setting: (A) feces and urine direct examination plus S. mansoni serology if non-explained eosinophilia was present and (B) S. mansoni serology plus uroparasitological examination as the second step in case of a positive serology. Demographic, clinical and laboratory features were collected. Schistosomiasis cases, clinical management and a 24 month follow-up were recorded for each group. Four-hundred forty individuals were included. The patients were mainly from West African countries. Fifty schistosomiasis cases were detected (11.5% group A vs. 4 % group B, p = 0.733). When both microscopic and serological techniques were performed, discordant results were recorded in 18.4% (16/88). Schistosomiasis cases were younger (p < 0.001) and presented eosinophilia and elevated IgE (p < 0.001) more frequently. Schistosomiasis is a frequent diagnosis among high-risk populations. Serology achieves a similar performance to direct diagnosis for the screening of schistosomiasis in a high-risk population.
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Atayoglu AT, Firat Y, Kaya N, Basmisirli E, Capar AG, Aykemat Y, Atayolu R, Khan H, Guner Atayoglu A, Inanc N. Evaluation of Nutritional Status with Healthy Eating Index (HEI-2010) of Syrian Refugees Living Outside the Refugee Camps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:849. [PMID: 36613171 PMCID: PMC9819415 DOI: 10.3390/ijerph20010849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/29/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Nutrition is a public health issue. Amongst populations of refugees, unmet nutritional needs have been identified. The aim of this study was to evaluate the nutritional status of Syrian refugees living outside the refugee camps in Kayseri, Turkey. Socio-demographic data and anthropometric measurements of the refugees were collected. The relationship between diet quality, which was assessed through the Healthy Eating Index (HEI-2010), and factors (including the duration of time spent outside the refugee camp, income, obesity, and waist circumference) were measured. Four hundred refugees participated in this study. The majority of refugees (77.8%) reported a 'poor' diet, with the remaining filling into the 'needs improvement' based on HEI-2010 scores. The average consumption of fruits in the study group was 101.9 g per day (g/day), while the average consumption of vegetables was 142.2 g/day. When the relationships were examined between BMI, HEI-2010 score, the time spent as a refugee, and waist circumference, statistically significant relationships were found (p < 0.001). In the linear regression analysis based on these relationships, when the results were adjusted for age and gender factors, it was observed that for every year spent as a refugee, BMI score increased by 0.17 units, and waist circumference increased by 1.14 units (p < 0.05). As a result, this study showed that refugees have low-income-related nutritional risks. In conclusion, ensuring that refugees have access to adequate nutrient-rich food is essential; therefore, analyzing and improving nutritional standards for refugees are suggested to be part of the strategies of the public and primary health care systems.
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Affiliation(s)
- Ali Timucin Atayoglu
- Department of Family Medicine, International School of Medicine, Istanbul Medipol University, Istanbul 34815, Turkey
| | - Yagmur Firat
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Erciyes University, Kayseri 38280, Turkey
| | - Nese Kaya
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Nuh Naci Yazgan University, Kayseri 38170, Turkey
| | - Eda Basmisirli
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Nuh Naci Yazgan University, Kayseri 38170, Turkey
| | - Asli Gizem Capar
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Nuh Naci Yazgan University, Kayseri 38170, Turkey
| | - Yusuf Aykemat
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Nuh Naci Yazgan University, Kayseri 38170, Turkey
| | - Rumeysa Atayolu
- Department of Nutrition and Dietetics, School of Health Sciences, Istanbul Medipol University, Istanbul 34810, Turkey
| | - Hammad Khan
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA 95616, USA
| | - Ayten Guner Atayoglu
- Department of Family Medicine, Beylikduzu State Hospital, Istanbul 34500, Turkey
| | - Neriman Inanc
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Nuh Naci Yazgan University, Kayseri 38170, Turkey
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Maurelli MP, Pepe P, Gualdieri L, Bosco A, Cringoli G, Rinaldi L. Improving Diagnosis of Intestinal Parasites Towards a Migrant-Friendly Health System. CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Purpose of Review
This study describes the results obtained by the World Health Organization (WHO) collaborating centre (CC) for the diagnosis of intestinal helminths and protozoa (WHO CC ITA-116) during the first 2 years of its activity on (i) the prevalence of intestinal parasites in migrants in southern Italy and (ii) the development and application of new diagnostic tools for intestinal helminths (e.g. FLOTAC, Mini-FLOTAC Kit 200 tests, Kubic FLOTAC microscope (KFM)).
Recent Findings
Almost 23.3% of migrants examined were positive for at least one intestinal parasite. Moreover, a significant correlation was found between the duration of stay in Italy and positivity for intestinal parasites. The results of the comparison between diagnostic techniques showed a perfect agreement between FLOTAC and Mini-FLOTAC Kit 200 tests whereas no statistically significant differences were found between the count of helminth eggs obtained by Mini-FLOTAC with optical microscope and KFM.
Summary
The results obtained by WHO CC ITA-116 during the first 2 years of its activity provide important information on innovations in parasitological diagnosis and add data to the parasitological scenario of migrants arriving in southern Italy, highlighting the importance of regular parasitological monitoring.
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Predictors of Interrupted Healthcare Coverage in a National Sample of US Refugees. J Racial Ethn Health Disparities 2022; 9:2090-2097. [PMID: 34585361 DOI: 10.1007/s40615-021-01147-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Many refugees that resettled into the United States (US) arrive with psychological and physical distress. Their health needs are often met with inadequate healthcare. A variety of barriers negatively affect their healthcare access. Knowledge of demographic and social predictors related to key healthcare access components among refugees is limited. This study examines potential predictors of interrupted healthcare coverage-one key component of healthcare access-among refugees living in the US. METHODS Using the 2016 Annual Survey of Refugees (ASR)nation-wide data collected from 4037 refugees, multiple logistic regression methods were utilized to identify socio-demographic predictors of interrupted healthcare coverage. Interrupted healthcare coverage was defined as one or more months in the past 12 months without coverage by Refugee Medical Assistance (RMA), Medicaid, or private health insurance. RESULTS The following five socio-demographic factors were associated with a higher likelihood of interrupted healthcare coverage: Male gender, 20-49 years of age, lack of marriage, resettlement into the south or Midwest, and poor or no current English proficiency. Refugees with no job were less likely to have interrupted coverage compared to employed refugees. DISCUSSION The increased likelihood of interrupted coverage among refugees with poor or no English proficiency supports the belief that limited English proficiency is a barrier to healthcare insurance enrollment. The increased likelihood of interrupted coverage for refugees resettled in the South is consistent with prior literature. In view of clear regional differences, further consideration of the effect of policy differences on refugees living in the US is worthwhile. The findings may help early refugee contacts risk stratify and more effectively allocate limited resources and assist policy makers as they amend and update programs linked to refugee healthcare access (e.g., RMA).
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Hart PL, Zahos H, Salt N, Schofield R, Mahroof-Shaffi S, Simonek T, Harkensee C. Lessons to learn from the analysis of routine health data from Moria Refugee Camp on Lesvos, Greece. J Public Health (Oxf) 2022:6840101. [DOI: 10.1093/pubmed/fdac127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/04/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
Refugees in humanitarian settings commonly experience many health needs and barriers to access healthcare; health data from these settings are infrequently reported, preventing effective healthcare provision. This report describes health needs of refugees in Moria Camp on Lesvos, Greece—Europe’s largest refugee camp.
Methods
A set of routinely collected service data of 18 131 consultations of 11 938 patients, attending a primary care clinic in the camp over 6 months in 2019–20, was analysed retrospectively, focusing on chronic health conditions.
Results
The most frequent chronic conditions were musculoskeletal pain (25.1%), mental health (15.9%), cardiac (12.7%) and endocrine conditions (8.9%). In all, 70.4% of consultations were for acute health problems, with high rates of injuries and wounds (20.8%), respiratory infections (12.5%), gastroenteritis (10.7%) and skin problems (9.7%), particularly scabies.
Conclusions
The prevalence of acute and chronic health problems is high in this setting, with some likely attributable to the deplorable living conditions in the camp. Despite its magnitude, the interpretability of routine health data is limited. A research agenda is identified, and a framework for chronic disease management in refugee camps is proposed.
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Affiliation(s)
- Paul L Hart
- 22603 Esplanada Circle W, Boca Raton , FL 33433 , USA
| | - Helen Zahos
- Griffith University School of Nursing and Midwifery, , Gold Coast, 1 Hospital Boulevard, Southport, QLD 4215 , Australia
| | - Nicola Salt
- Wandsworth Care Commissioning Group Balham Park Surgery, , 236 Balham High Road, London, SW17 7AW , UK
| | - Roger Schofield
- Shalom House Palliative Care Centre , St David’s, Pembrokeshire, SA62 6BP , UK
| | | | | | - Christian Harkensee
- Gateshead Health NHS Foundation Trust , Queen Elizabeth Avenue, Gateshead, NE9 6SX , UK
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Adachi M, Takemura S. Outcomes of systemic screening for syphilis, gonorrhoea and Chlamydia trachomatis among immigrant visa applicants migrating from Japan to the US in 2016-2019. J Travel Med 2022; 29:6649719. [PMID: 35880852 DOI: 10.1093/jtm/taac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022]
Abstract
Identifying sexually transmitted infections is a public health task. Screening at the time of migration detected asymptomatic infections over a range of ages. Reporting infection rates may serve to establish a benchmark for risk assessments. All sexually active people who have never had sexually transmitted infection tests should be offered sexually transmitted infection tests.
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Affiliation(s)
| | - Shizuki Takemura
- Clinic Kobe, Kobe, Hyogo Prefecture, Japan.,Omi Medical Center, Department of Pathology, Kusatsu, Shiga, Japan
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Zenner D, Méndez AR, Schillinger S, Val E, Wickramage K. Health and illness in migrants and refugees arriving in Europe: analysis of the electronic Personal Health Record system. J Travel Med 2022; 29:6541145. [PMID: 35238944 PMCID: PMC9635060 DOI: 10.1093/jtm/taac035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/10/2022] [Accepted: 03/01/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The electronic Personal Health Record (ePHR) is a health information system that registers health data on newly arriving migrants and was implemented in eight European countries (Bulgaria, Croatia, Cyprus, Greece, Italy, Romania, Serbia and Slovenia). This is a cross-sectional study aimed to describe the health problems and health status of all migrants attended at health clinics as part of the health assessment programme established in the reception centres (2016-2019). METHODS Data were collected on demographics, clinical and laboratory findings and diagnostics performed, including medical records. We classified all diseases using pre-specified algorithms according to information on pre-specified variables from the ePHR questionnaire, ICD-10 codes, positive laboratory findings or review of medical records. Crude proportions were calculated and odds ratios (OR) estimated using logistic regression modelling. RESULTS The ePHR dataset contained a total of 19 564 clinical episodes in 14 436 individuals, recorded between January 2016 and October 2019. Most individuals (75%) were refugees or asylum seekers (22%) from 92 different nationalities. There were 2531/19 564 (12.9%) infectious diseases episodes reported during the study period, being 1283/2531 (50.7%) of them pharyngo-tonsillitis, 529 (20.9%) scabies, 158 (6.2%) viral hepatitis and 156(6.1%) lower respiratory infections. There were 2462 (17.1%) individuals with non-communicable diseases reported; including 821 (5.7%) cardiovascular diseases, 1183 (8.2%) neurological condition, 644 (4.5%) Diabetes mellitus and 212 (1.5%) kidney disease cases. Having Diabetes Mellitus (adjusted OR, aOR 3.3, [95% confidence interval, CI 2.7-4.1], P < 0.001), and neurological disorders (aOR 1.8, [95% CI 1.4-2.2], P < 0.001) were associated with cardiovascular disorders in the multivariable logistic regression model.Mental health problems were reported in 641/14 436 (4.4%) individuals and were associated with increasing age. Furthermore, 610 episodes of acute injuries were reported among 585/14 436 (4.1%) people, 517 (88.4%) of them in men (P < 0.001). CONCLUSIONS The ePHR is a valuable tool to efficiently collect health-related data to better address migrant health issues. We described a mostly healthy population with many acute infectious disease episodes particularly in children, but also with significant number of chronic conditions and less frequent injuries or mental health problems.
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Affiliation(s)
- Dominik Zenner
- Global Public Health Unit, Wolfson Institute of Population Health, 58 Turner St, London E1 2AB, UK
| | - Ana Requena Méndez
- Department of Medicine-Solna, Karolinska Institutet, 171 65 Solna, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Barcelona Institute for Global Health (ISGlobal Campus Clinic), Barcelona 08036, Spain
| | - Steffen Schillinger
- Migration Health Division, International Organization for Migration, 1226. Manila, Philippines
| | - Elena Val
- Migrant Health Division, International Organization for Migration, Regional Office for the EU/EAA and NATO B-1000 Brussels, Belgium
| | - Kolitha Wickramage
- Migration Health Division, International Organization for Migration, 1226. Manila, Philippines
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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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Babacan T, Yılmaz TE, Babacan MT, Kasım İ, Yılmaz T, Şencan İ, Özkara A. Evaluation of immigrant health services in Turkey: a single-center study. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jolof L, Rocca P, Mazaheri M, Okenwa Emegwa L, Carlsson T. Experiences of armed conflicts and forced migration among women from countries in the Middle East, Balkans, and Africa: a systematic review of qualitative studies. Confl Health 2022; 16:46. [PMID: 36071504 PMCID: PMC9450290 DOI: 10.1186/s13031-022-00481-x] [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: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background A significant proportion of the global population is displaced, many being women. Qualitative studies can generate in-depth findings that will contribute to an understanding of their experiences, but there is a need for further synthetization efforts. The aim was to provide a comprehensive perspective about adult women’s experiences of armed conflicts and forced migration, focusing on women in or from countries in the Middle East, Balkans, or Africa. Methods Systematic review of English reports presenting empirical qualitative studies published in scientific journals 1980 or later, utilizing searches performed in September 2021 within three databases combined with manual screening. Of the 3 800 records screened in total, 26 were included. Methodological details and quality were appraised using pre-specified extraction and appraisal tools. The findings within the included reports were analyzed with thematic analysis. Results Most reports utilized interviews, including in total 494 participants, and were appraised as having insignificant methodological limitations. The first theme concerns changed living conditions, involving reduced safety, insufficient access to resources meeting basic needs, forced migration as a last resort, and some positive effects. The second theme concerns the experienced health-related consequences, involving psychological distress, risks during pregnancy and childbirth, exposure to violence and discrimination as a woman, as well as a lack of adequate healthcare services and social support. The third theme concerns the resources and strategies that enhance resilience, involving social support and family life, as well as utilization of internal resources and strategies. Conclusion When experiencing armed conflicts and forced migration, women face significant challenges related to changed living conditions and are exposed to health-related consequences. Consistently, women are targets of severe structural and personal violence, while lacking access to even the most basic healthcare services. Despite facing considerable hardships, these women display extraordinary resilience and endurance by finding strength through social support and internal resources. Synthesized qualitative research illustrates that women value social support, including peer support, which is a promising intervention that needs to be evaluated in future experimental studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-022-00481-x.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected By War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected By War and Torture, Malmö, Sweden
| | - Monir Mazaheri
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Leah Okenwa Emegwa
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden. .,The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Matsangos M, Ziaka L, Exadaktylos AK, Klukowska-Rötzler J, Ziaka M. Health Status of Afghan Refugees in Europe: Policy and Practice Implications for an Optimised Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159157. [PMID: 35954518 PMCID: PMC9368211 DOI: 10.3390/ijerph19159157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 02/05/2023]
Abstract
Four decades of civil war, violence, and destabilisation have forced millions of Afghans to flee their homes and to move to other countries worldwide. This increasing phenomenon may challenge physicians unfamiliar with the health status of this population, which may be markedly different from that of the host country. Moreover, several factors during their migration, such as transport in closed containers, accidental injuries, malnutrition, and accommodation in detention centres and refugee camps have a major influence on the health of refugees. By taking into account the variety of the specific diseases among migrant groups, the diversity of the origins of refugees and asylum seekers, and the increasing numbers of Afghan refugees, in this review we focus on the population of Afghans and describe their health status with the aim of optimising our medical approach and management. Our literature review shows that the most prevalent reported infections are tuberculosis and other respiratory tract infections and parasitic diseases, for example leishmaniasis, malaria, and intestinal parasitic infections. Anaemia, hyperlipidaemia, arterial hypertension, diabetes, smoking, overweight, malnutrition, low socioeconomic status, and poor access to healthcare facilities are additional risk factors for non-communicable diseases among Afghan refugees. With regards mental health issues, depression and post-traumatic stress disorder (PTSD) are the most common diagnoses and culture shock and the feeling of being uprooted modulate their persistence. Further research is needed in order to provide us with extensive, high-quality data about the health status of Afghan refugees. The main objective of this review is to identify protective factors which could ensure key health concepts and good clinical practice.
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Affiliation(s)
- Michael Matsangos
- Department of General Surgery, Insel Gruppe AG, Kreditorenbuchhaltung, Freiburgstrasse 18, 3010 Bern , Switzerland;
| | - Laoura Ziaka
- Department of Special Needs Education, University of Oslo, 0315 Oslo, Norway;
| | - Artistomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland; (A.K.E.); (J.K.-R.)
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland; (A.K.E.); (J.K.-R.)
| | - Mairi Ziaka
- Department of Internal Medicine, General Hospital of Thun, 3600 Thun, Switzerland
- Correspondence:
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Self-rated health and quality of life among Syrian refugees in Ireland - data from a cross-sectional study. BMC Public Health 2022; 22:1202. [PMID: 35705914 PMCID: PMC9202096 DOI: 10.1186/s12889-022-13610-1] [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: 03/23/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION As a response to the humanitarian crisis in Syria, the Irish government agreed to accept up to 4000 refugees for resettlement in Ireland in 2016. Prior to their arrival in Ireland, health screening was carried out by the International Organisation for Migration. However, no population-level measurement of the health status or needs takes place in Ireland to inform policy or health services requirements. METHODS Cross-sectional data from a self-completed questionnaire among 194 Syrian Refugees aged 16 years and older resident in reception centres in Ireland in 2017/2018 is reported upon. The questionnaire measured self-reported health including quality of life and all study material were available in English and Arabic. The data was examined applying descriptive statistics and regression analysis. RESULTS Syrian Refugees in Ireland consist of a relatively young cohort; in this study the majority of participants were younger than 35 years (69.5%). Two-thirds of the respondents reported their overall health status to be good or very good. The most common health condition was found to be headache and the most common medications used were painkillers. Chronic pain was experienced by one quarter of respondents; 27.5% were considered as suffering from anxiety and 10.0% had symptoms compatible with post-traumatic stress disorder (PTSD). A significant relationship was observed between chronic pain and self-rated health, as well as between chronic pain and anxiety. Quality of life (QoL) scores were lowest for the QoL environment domain. CONCLUSIONS Chronic pain is relatively widespread among these young and otherwise healthy refugees. Psychological distress and trauma are important factors in respondents' quality of life scores. Chronic pain is associated with one's mental health. Our findings and the literature suggests that the diagnosis and treatment of pain and providing care in a culturally sensitive manner should be a priority and included in the preparation and training of the relevant care providers. Additionally, the impact of living conditions on quality of life should not be underestimated.
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