The Occurrence of Diseases and Related Factors in a Center for Asylum Seekers in Italy

Self-administered EMDR therapy: potential solution for expanding the availability of psychotherapy for PTSD or unregulated recipe for disaster?

BACKGROUND

Post-traumatic stress disorder (PTSD) carries a high disease burden worldwide, yet significant barriers exist to providing and accessing treatment for PTSD, particularly in refugee populations and in low- and middle-income countries. There is emerging evidence that self-administered psychological therapies, such as those accessed via online and mobile applications, are efficacious for many mental illnesses and increase access to treatment. Online and mobile applications offering self-help tools for eye movement desensitisation reprocessing (EMDR) therapy, an internationally recommended treatment for PTSD, are already widely distributed to the public.

AIMS

To present a commentary evaluating the potential benefits and risks of self-administered EMDR therapy: first, by conducting a search for existing peer-reviewed evidence relating to self-administered EMDR therapy; second, by presenting existing evidence for other self-help psychotherapies and evaluating what additional insight this could provide into the potential efficacy, safety, tolerability and accessibility of self-administered EMDR therapy; and, third, by describing the conflicting views of EMDR experts on the topic.

METHOD

A search was conducted for articles related to internet, mobile, book or computerised self-help EMDR therapy. The following databases were searched systematically: Medline, PsycInfo, EMBASE, AMED, CINAHL, Psychology and Behavioural Sciences, Cochrane Database and the EMDR Library.

RESULTS

Only one small primary research study was found relating to self-administered EMDR therapy. The results indicated significantly reduced symptoms of PTSD, depression, anxiety, distress and disability between pre-treatment and 3 month follow-up. No serious adverse events were reported. However, substantial methodological issues were discovered.

CONCLUSIONS

There is evidence that self-administered psychotherapies, in general, can be safe, effective and highly accessible. However, controversies persist regarding the safety and potential efficacy of self-administered EMDR therapy, and more robust research is needed. It is vital that methods are found to improve worldwide access to effective PTSD treatment, particularly given the current scale of migration to flee civil unrest.

Burnout Syndrome in Reception Systems for Illegal Immigrants in the Mediterranean. A Quantitative and Qualitative Study of Italian Practitioners

Illegal immigration throughout the Mediterranean Sea is an intense and epoch-making phenomenon. This quantitative and qualitative study, based on the framework of the JD-R Model of burnout, described and assessed the risk of burnout among practitioners working in the reception system for illegal immigrants. A sample of Italian practitioners completed the Link Burnout Questionnaire (N = 193) and a semistructured interview (N = 108). The analysis of the questionnaires was carried out via ANOVA and χ2 test. The content of the interviews was examined using T-LAB. Quantitative results showed that the sample was generally at risk of burnout, and about a quarter were at severe risk. Qualitative results highlighted aspects of burnout that are specific to this working context: large workload, mental fatigue, and lack of social support; inability to understand the language and cultural differences of the immigrants; having to deal with organisational problems that come up repeatedly. This study offers coping strategies that can improve organisational health and performance of practitioners working in illegal immigration. Italy’s shape, geographical location, and geo-political role make it a case in point for the whole European continent regarding the sustainability of illegal immigration across the Mediterranean Sea.

Evaluation of the Burden of HPV-Related Hospitalizations as a Useful Tool to Increase Awareness: 2007-2017 Data from the Sicilian Hospital Discharge Records

In light of the implementation of human papillomavirus (HPV) prevention strategies, epidemiological studies in different geographical areas are required in order to assess the impact of HPV-related diseases. The purpose of the present study was to describe the burden of HPV-related hospitalizations in Sicily. A retrospective observational study estimated 43,531 hospitalizations attributable to HPV from 2007 to 2017. During the observed period, there was a decrease for all HPV-related conditions with a higher reduction, among neoplasms, for cervical cancer (annual percent change (APC) = −9.9%, p < 0.001). The median age for cervical cancer was 45 years old, with an increasing value from 43 to 47 years (p < 0.001). The age classes with greater decreases in hospital admissions for invasive cancers were women aged 35 years or more (APC range from −5.5 to −9.86) and 25–34 years old (APC = −11.87, p < 0.001) for women with cervical carcinoma in situ. After ten years for vaccine introduction and sixteen years for cervical cancer screening availability, a relatively large decrease in hospital admissions for cervical cancer and other HPV-related diseases in Sicily was observed. Some clinical characteristics of hospitalization, such as increasing age, are suggestive clues for the impact of preventive strategies, but further research is needed to confirm this relationship.

Association of the Individual and Context Inequalities on the Breastfeeding: A Study from the Sicily Region

Despite the advantages of breastfeeding being widely recognized, the economic level can have an influence on breastfeeding rates, with rich women breastfeeding longer than poor in high-income countries. In Italy, socio-economic differences affect breastfeeding start and continuation among most deprived people, such as in Southern Italy. The objective of the study was to evaluate the prevalence of the initiation and continuation of exclusive breastfeeding and its association with the levels of socio-economic deprivation in Sicily. A prospective cohort study with a two-phase survey in three breastfeeding detection times was conducted. Overall, 1,055 mothers were recruited with a mean age of 31 years. Breastfeeding decreased from 86% during hospitalization to 69% at the first month and 42% at the sixth month, yet at the same time, exclusive breastfeeding increased from 34% to 38% during hospitalization to the first month and went down to 20.2% at the sixth month. The adjusted multivariate analysis showed no association with individual inequalities. On the other hand, the context inequalities had a significant association with the risk of not following exclusive breastfeeding in the deprived class (odds ratio (OR): 2.08, confidence interval (CI) 95% 1.01-4.27) and in the very deprived class (OR: 1.83, CI 95% 1.00-3.38) at the six-month survey. These results indicate that the context inequalities begin to emerge from the return home of the mother and the child.

Through health workers' eyes: a qualitative study of health service provision for migrants at Schengen border

Background

Croatia and Slovenia were the transit countries on the Balkan route for migrants and refugees from Middle East countries in 2015 and 2016. They had to optimize health care delivery in the special circumstances in refugee camps and transit centres. Little is known about health care provision in border camps where a large number of migrants stay for only couple of hours. Previous studies emphasize that language barriers and cultural differences play a central part in the relationship between health workers and migrants inside the transit zone. The aim of the study was to identify specific characteristics of health care provision experienced by primary healthcare providers in order to prepare solutions on how to organise health care in refugee settings.

Methods

Twelve thematic interviews were conducted in the middle of the most intense migration movements to the North-West Europe between November and December 2015 with health workers from Croatia and Slovenia. Interview transcripts were read, coded, reviewed, and labelled. We used qualitative content analysis.

Results

Four themes about the health service provision for refugees at Schengen border were identified. The circumstance when mutual understanding is poor and the consultation not successful, cultural differences represent a central barrier. Participants highlighted that the importance of respecting human dignity is crucial for the provision of basic medical care for migrants in transit.

Conclusion

Successful overcoming language barriers, respecting cultural differences, humanity, susceptibility to social deprivation and traumatic experiences are the key factors important for organisation of health care in transit centers and camps. This article gives some useful tips for healthcare workers and policy makers who are participating in health services provision for migrants and other refugees. Health workers should be prepared to work in special working conditions with a lack of resources. Their work would require timely planning and reflection on the organization of more transit camps.

Trial registration

Ethical Committee of the Republic of Slovenia approved the study as a project number 112/02/16.

An Innovative Mobile Health System to Improve and Standardize Antenatal Care Among Underserved Communities: A Feasibility Study in an Italian Hosting Center for Asylum Seekers

Innovative migrant-friendly tools are needed to assist health personnel manage the high number of pregnancies within reception centers. This study tests functionality and acceptability of a new mHealth system in providing antenatal care amongst migrants. The study, carried out between 2014 and 2016, involved 150 pregnant women residing in the largest European migrant reception center in Sicily. A ticket tracking system assessed the system's functionality and a questionnaire assessed women's acceptability. The system facilitated the collection of clinical data, enabling the creation of electronic patient records and identifying 10% of pregnancies as high-risk. The application's digital format increased health providers' adherence to antenatal-care recommendations, while the graphic interface facilitated women's engagement and retention of the health education modules. The study recorded a 91.9% patient satisfaction rate. The system was efficient in providing comprehensive and high-quality antenatal care amongst migrants, facilitating the continuity of care for a population undergoing frequent relocations.

Posttraumatic stress disorder as a diagnostic entity – clinical perspectives

Throughout history the consequences of psychological trauma and characteristic symptoms have involved clinical presentations that have had different names. Since the inclusion of the category of Posttraumatic Stress Disorder (PTSD) in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) with the symptomatic triad of re-experiencing the traumatic event, avoidance behaviors, and hypervigilance, this entity has been a source of controversy. Indeed, some authors have denied its existence, even considering it a diagnostic invention. In this article we review, from the clinician's perspective, historical aspects as well as the development of the nosological classifications and the contributions from the neurosciences that allow the consideration of the full validity of this diagnosis as a form of psychobiological reaction to psychological trauma.

Effect of Positive Psychological Intervention on Posttraumatic Growth among Primary Healthcare Workers in China: A Preliminary Prospective Study

Posttraumatic growth (PTG) is defined as positive psychological change in the wake of highly challenging circumstances. Healthcare workers in particular are more vulnerable to stressors and trauma than the general population. The current study examined the use and effectiveness of a novel positive psychological intervention based on Chinese traditional culture to improve PTG in hospital healthcare workers. The intervention was provided to 579 healthcare workers at hospitals in Guilin, Shenzhen and Xiangtan. Scores on the Posttraumatic Growth Inventory (PTGI) and its subscales were significantly higher after intervention than before (p < 0.001). Of the five aspects of PTG, the aspect of "new possibilities" benefited the most from intervention (Cohen's d = 0.45). PTG in women, nurses and college graduates increased to a greater extent than other participants after intervention. It was concluded that our novel intervention is effective at improving PTG in medical staff.