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Pach S, Ritz N, Eisen S. Optimizing Early Diagnosis of Infectious Diseases in Migrant and Refugee Children: An Overview of Best Practices and Strategies. Pediatr Infect Dis J 2024; 43:e278-e281. [PMID: 38830140 DOI: 10.1097/inf.0000000000004406] [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] [Indexed: 06/05/2024]
Affiliation(s)
- Sophie Pach
- From the Paediatrics Department, Whittington Hospital, London, United Kingdom
| | - Nicole Ritz
- Paediatrics Department, Children's Hospital Central Switzerland & Faculty of Health Science and Medicine, University of Lucerne, Lucerne
- Mycobacterial and Migrant Health Research and Department for Clinical Research, University of Basel University Children's Hospital Basel, Basel, Switzerland
| | - Sarah Eisen
- Paediatrics Department, University College London Hospitals, Hospital of Tropical Diseases
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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2
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Smith C, Boylen S, Mutch R, Cherian S. Hear Our Voice: Pediatric Communication Barriers From the Perspectives of Refugee Mothers With Limited English Proficiency. J Pediatr Health Care 2024; 38:114-126. [PMID: 38429024 DOI: 10.1016/j.pedhc.2023.12.009] [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: 08/24/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Adverse health outcomes are more common for health consumers with limited English proficiency (LEP). This study examines the consumer experience of refugee mothers with LEP when communicating with paediatric health services. METHOD A community-based participatory qualitative study engaging participants from refugee-like backgrounds. Focus groups and in-depth individual interviews (using professional interpreters) were conducted in community settings and analysed using Grounded Theory principles. RESULTS Fifty ethnolinguistically diverse participants reported universal communication barriers; (i) "Negative health care experiences" (fear, helplessness, lack of safety, trust and dignity), (ii) "Ineffective health service communication and adverse outcomes", (iii) "Logistical access barriers" and (iv) self-sourced solutions". The "importance of professional interpreter utilisation" and subsequent "sense of empowerment" was unanimous. CONCLUSIONS This study highlights gaps in current health interactions which negatively impact care, inclusion, and culturally safe engagement. Recommendations include orgainzational reform enhancing language services, increased cultural competency, long term support, and research with LEP populations.
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Affiliation(s)
- Cassie Smith
- Cassie Smith, Paediatric Advanced Trainee (General Paediatrics and Gastroenterology) Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Western Australia, Australia.
| | - Susan Boylen
- Susan Boylen, Senior Lecturer & 1(st) Year Academic Advisor, School of Nursing and Midwifery, University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Raewyn Mutch
- Raewyn Mutch, General Paediatrician (Refugee Health Service and General Paediatrics), Department of General Paediatrics, Perth Children's Hospital, Child and Adolescent Health Service, and Clinical Associate Professor Division of Paedaitrics, University of Western Australia, Perth, Western Australia, Australia
| | - Sarah Cherian
- Sarah Cherian, Clinical Associate Professor, Division of Paediatrics, University of Western Australia, and General Paediatrician and Clinical Lead Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Child and Adolescent Health Service, and Honorary Research Associate, Wesfarmers Centre for Vaccines and Immunity, Telethon Kids Institute, Perth, Western Australia, Australia
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3
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Comelli A, Genovese C, Gobbi F, Brindicci G, Capone S, Corpolongo A, Crosato V, Mangano VD, Marrone R, Merelli M, Prato M, Santoro CR, Scarso S, Vanino E, Marchese V, Antinori S, Mastroianni C, Raglio A, Bruschi F, Minervini A, Donà D, Garazzino S, Galli L, Lo Vecchio A, Galli A, Dragoni G, Cricelli C, Colacurci N, Ferrazzi E, Pieralli A, Montresor A, Richter J, Calleri G, Bartoloni A, Zammarchi L. Schistosomiasis in non-endemic areas: Italian consensus recommendations for screening, diagnosis and management by the Italian Society of Tropical Medicine and Global Health (SIMET), endorsed by the Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), the Italian Society of Parasitology (SoIPa), the Italian Society of Gastroenterology and Digestive Endoscopy (SIGE), the Italian Society of Gynaecology and Obstetrics (SIGO), the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV), the Italian Society of General Medicine and Primary Care (SIMG), the Italian Society of Infectious and Tropical Diseases (SIMIT), the Italian Society of Pediatrics (SIP), the Italian Society of Paediatric Infectious Diseases (SITIP), the Italian Society of Urology (SIU). Infection 2023; 51:1249-1271. [PMID: 37420083 PMCID: PMC10545632 DOI: 10.1007/s15010-023-02050-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/08/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Agnese Comelli
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Genovese
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- II Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
- University of Brescia, Brescia, Italy
| | - Gaetano Brindicci
- AOU Consorziale Policlinico di Bari, Infectious Diseases Unit, Bari, Italy
| | - Susanna Capone
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Verena Crosato
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Dianora Mangano
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Rosalia Marrone
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Marco Prato
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Salvatore Scarso
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Elisa Vanino
- Unit of Infectious Diseases, Ospedale "Santa Maria delle Croci", AUSL Romagna, Ravenna, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annibale Raglio
- Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), Milan, Italy
| | - Fabrizio Bruschi
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Urology, University of Florence, Florence, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvia Garazzino
- Paediatric Infectious Disease Unit, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Paediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Claudio Cricelli
- Health Search-Istituto di Ricerca della SIMG (Italian Society of General Medicine and Primary Care), Florence, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrico Ferrazzi
- Department of Woman, New-Born and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalisa Pieralli
- Ginecologia Chirurgica Oncologica, Careggi University and Hospital, Florence, Italy
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Joachim Richter
- Institute of International Health, Charité Universitätsmedizin, Corporate Member of Freie und Humboldt Universität Berlin and Berlin Institute of Health, Berlin, Germany
| | - Guido Calleri
- Amedeo Di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
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Tosif S, Graham H, Kiang K, Laemmle-Ruff I, Heenan R, Smith A, Volkman T, Connell T, Paxton G. Health of children who experienced Australian immigration detention. PLoS One 2023; 18:e0282798. [PMID: 36893157 PMCID: PMC9997934 DOI: 10.1371/journal.pone.0282798] [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: 10/27/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Australian immigration policy resulted in large numbers of children being held in locked detention. We examined the physical and mental health of children and families who experienced immigration detention. METHODS Retrospective audit of medical records of children exposed to immigration detention attending the Royal Children's Hospital Immigrant Health Service, Melbourne, Australia, from January 2012 -December 2021. We extracted data on demographics, detention duration and location, symptoms, physical and mental health diagnoses and care provided. RESULTS 277 children had directly (n = 239) or indirectly via parents (n = 38) experienced locked detention, including 79 children in families detained on Nauru or Manus Island. Of 239 detained children, 31 were infants born in locked detention. Median duration of locked detention was 12 months (IQR 5-19 months). Children were detained on Nauru/Manus Island (n = 47/239) for a median of 51 (IQR 29-60) months compared to 7 (IQR 4-16) months for those held in Australia/Australian territories (n = 192/239). Overall, 60% (167/277) of children had a nutritional deficiency, and 75% (207/277) had a concern relating to development, including 10% (27/277) with autism spectrum disorder and 9% (26/277) with intellectual disability. 62% (171/277) children had mental health concerns, including anxiety, depression and behavioural disturbances and 54% (150/277) had parents with mental illness. Children and parents detained on Nauru had a significantly higher prevalence of all mental health concerns compared with those held in Australian detention centres. CONCLUSION This study provides clinical evidence of adverse impacts of held detention on children's physical and mental health and wellbeing. Policymakers must recognise the consequences of detention, and avoid detaining children and families.
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Affiliation(s)
- Shidan Tosif
- Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
- Infection and Immunity, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hamish Graham
- Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
- Infection and Immunity, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karen Kiang
- Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | - Ingrid Laemmle-Ruff
- Infection and Immunity, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Rachel Heenan
- Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | - Andrea Smith
- Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | - Thomas Volkman
- Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tom Connell
- Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georgia Paxton
- Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
- Infection and Immunity, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Zammarchi L, Botta A, Tilli M, Gobbi F, Bartoloni A, Boccalini S. Presumptive treatment or serological screening for schistosomiasis in migrants from Sub-Saharan Africa could save both lives and money for the Italian National Health System: results of an economic evaluation. J Travel Med 2023; 30:6845442. [PMID: 36420915 DOI: 10.1093/jtm/taac140] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/20/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Schistosomiasis can lead to severe irreversible complications and death if left untreated. Italian and European guidelines recommend serological screening for this infection in migrants from Sub-Saharan Africa (SSA). However, studies on clinical and economic impact of this strategy in the Italian and European settings are lacking. This study aims to compare benefits and costs of different strategies to manage schistosomiasis in migrants from SSA to Italy. METHODS A decision tree and a Markov model were developed to assess the health and economic impacts of three interventions: (i) passive diagnosis for symptomatic patients (current practice in Italy); (ii) serological screening of all migrants and treating those found positive and (iii) presumptive treatment for all migrants with praziquantel in a single dose. The time horizon of analysis was one year to determine the exact expenses, and 28 years to consider possible sequelae, in the Italian health-care perspective. Data input was derived from available literature; costs were taken from the price list of Careggi University Hospital, Florence, and from National Hospitals Records. RESULTS Assuming a population of 100 000 migrants with schistosomiasis prevalence of 21·2%, the presumptive treatment has a greater clinical impact with 86.3% of the affected being cured (75.2% in screening programme and 44.9% in a passive diagnosis strategy). In the first year, the presumptive treatment and the screening strategy compared with passive diagnosis prove cost-effective (299 and 595 cost/QALY, respectively). In the 28-year horizon, the two strategies (screening and presumptive treatment) compared with passive diagnosis become dominant (less expensive with more QALYs) and cost-saving. CONCLUSION The results of the model suggest that presumptive treatment and screening strategies are more favourable than the current passive diagnosis in the public health management of schistosomiasis in SSA migrants, especially in a longer period analysis.
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Affiliation(s)
- Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marta Tilli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Florence, Italy
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Moore N, Abid A, Ren S, Robinson K, Middleton P. Multicultural emergency medicine epidemiology: A health economic analysis of patient visits. Emerg Med Australas 2023; 35:126-132. [PMID: 36191927 PMCID: PMC10092109 DOI: 10.1111/1742-6723.14085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE There is growing evidence to suggest that culturally and linguistically diverse (CALD) patients cost the health system more than non-CALD patients because of a higher burden of disease and increased resource consumption. The present study aimed to compare the ED resource utilisation of CALD and non-CALD patients at a tertiary hospital in Sydney, Australia. METHODS The total ED resource utilisation was calculated by separating each visit into diagnostic test cost and time spent in ED components. The time component was calculated using the product of the total length of stay and a resource cost per unit time measure. Diagnostic tests were costed using the Australian Medicare Benefit Schedule. A generalised additive model was developed to estimate the isolated effect of CALD status on the resource utilisation during an ED visit. RESULTS CALD patients had a higher median resource utilisation than non-CALD patients ($736.93 vs $701.36, P < 0.0001); however, the generalised additive model demonstrated that CALD status was not independently associated with increased resource utilisation. CONCLUSION CALD status is not an independent influence on ED resource utilisation but other explanatory variables such as increased age and altered case-mix appear to have a much greater influence. There may, however, be other reasons to consider CALD loading such as equity in healthcare and to address poorer overall health outcomes for CALD patients.
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Affiliation(s)
- Nicholas Moore
- Emergency Department, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Ali Abid
- South Western Sydney Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Shiquan Ren
- South Western Sydney Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,ICT Services, South Western Sydney Local Health District, NSW Health, Sydney, New South Wales, Australia
| | - Kent Robinson
- Emergency Department, Liverpool Hospital, Sydney, New South Wales, Australia.,Macarthur Clinical School, Western Sydney University, Sydney, New South Wales, Australia
| | - Paul Middleton
- Emergency Department, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Emergency Department, South Western Emergency Research Institute, Sydney, New South Wales, Australia
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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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Jawahar Z, Elmer S, Hawkins M, Osborne RH. Application of the optimizing health literacy and access (Ophelia) process in partnership with a refugee community in Australia: Study protocol. Front Public Health 2023; 11:1112538. [PMID: 36895685 PMCID: PMC9989023 DOI: 10.3389/fpubh.2023.1112538] [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: 11/30/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
Refugees experience health inequities resulting from multiple barriers and difficulties in accessing and engaging with services. A health literacy development approach can be used to understand health literacy strengths, needs, and preferences to build equitable access to services and information. This protocol details an adaptation of the Ophelia (Optimizing Health Literacy and Access) process to ensure authentic engagement of all stakeholders to generate culturally appropriate, needed, wanted and implementable multisectoral solutions among a former refugee community in Melbourne, Australia. The Health Literacy Questionnaire (HLQ), widely applied around the world in different population groups, including refugees, is usually the quantitative needs assessment tool of the Ophelia process. This protocol outlines an approach tailored to the context, literacy, and health literacy needs of former refugees. This project will engage a refugee settlement agency and a former refugee community (Karen people origin from Myanmar also formerly knowns as Burma) in codesign from inception. A needs assessment will identify health literacy strengths, needs, and preferences, basic demographic data and service engagement of the Karen community. This community will be engaged and interviewed using a semi-structured interview based on the Conversational Health Literacy and Assessment Tool (CHAT) will cover supportive professional and personal relationships, health behaviors, access to health information, use of health services, and health promotion barriers and support. Using the needs assessment data, vignettes portraying typical individuals from this community will be developed. Stakeholders will be invited to participate in ideas generation and prioritization workshops for in-depth discussion on what works well and not well for the community. Contextually and culturally appropriate and meaningful action ideas will be co-designed to respond to identified health literacy strengths, needs, and preferences of the community. This protocol will develop and test new and improved methods that are likely to be useful for community-based organizations and health services to systematically understand and improve communication, services and outcomes among disadvantaged groups, particularly migrants and refugees.
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Affiliation(s)
- Zaman Jawahar
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Shandell Elmer
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, VIC, Australia
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9
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Malaria parasite prevalence in Sub-Saharan African migrants screened in Sweden: a cross-sectional study. Lancet Reg Health Eur 2023; 27:100581. [PMID: 37069854 PMCID: PMC10105256 DOI: 10.1016/j.lanepe.2022.100581] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Background Asymptomatic infections with malaria parasites are common in populations in endemic areas. These infections may persist in migrants after arrival in a non-endemic area. Screening to find and clear these infections is generally not implemented in non-endemic countries, despite a potential negative health impact. We performed a study to evaluate the Plasmodium parasite prevalence in migrants living in Sweden. Methods Adults and children born in Sub-Saharan Africa (SSA) were invited in the study between April 2019 and June 2022 at 10 different sites, mainly as part of the national Migrant Health Assessment Program in Stockholm and Västerås, Sweden. Rapid diagnostic tests (RDT) and real-time PCR were used to detect malaria parasites. Prevalence and test sensitivity were calculated with 95% confidence intervals (CI). Univariate and multivariable logistic regression were used to evaluate associations with PCR positivity. Findings In total, 789 individuals were screened for Plasmodium spp. of which 71 (9.0%) were positive by PCR and 18 (2.3%) also by RDT. When performed during the national screening program, 10.4% was PCR positive. A high prevalence was detected in migrants with Uganda as the country of last residence, 53/187 (28.3%), and in this group the prevalence was highest in children, 29/81 (35.8%). Among the PCR positive, 47/71 (66.2%) belonged to families with at least one other member testing positive (odds ratio [OR] 43.4 (95% CI 19.0-98.9), and the time lived in Sweden ranged between 6 and 386 days. Interpretation A high malaria parasite prevalence was found in migrants from SSA, particularly in children offered screening in Stockholm, Sweden during the study period. Awareness of asymptomatic malaria infection is needed and screening for malaria in migrants arriving from high endemic countries should be considered. Funding The Swedish Research Council, Stockholm County Council and Centre for Clinical Research, Västmanland, Sweden.
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10
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Gruner D, Feinberg Y, Venables MJ, Shanza Hashmi S, Saad A, Archibald D, Pottie K. An undergraduate medical education framework for refugee and migrant health: Curriculum development and conceptual approaches. BMC MEDICAL EDUCATION 2022; 22:374. [PMID: 35578195 PMCID: PMC9109444 DOI: 10.1186/s12909-022-03413-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND International migration, especially forced migration, highlights important medical training needs including cross-cultural communication, human rights, as well as global health competencies for physical and mental healthcare. This paper responds to the call for a 'trauma informed' refugee health curriculum framework from medical students and global health faculty. METHODS We used a mixed-methods approach to develop a guiding medical undergraduate refugee and migrant health curriculum framework. We conducted a scoping review, key informant interviews with global health faculty with follow-up e-surveys, and then, integrated our results into a competency-based curriculum framework with values and principles, learning objectives and curriculum delivery methods and evaluation. RESULTS The majority of our Canadian medical faculty respondents reported some refugee health learning objectives within their undergraduate medical curriculum. The most prevalent learning objective topics included access to care barriers, social determinants of health for refugees, cross-cultural communication skills, global health epidemiology, challenges and pitfalls of providing care and mental health. We proposed a curriculum framework that incorporates values and principles, competency-based learning objectives, curriculum delivery (i.e., community service learning), and evaluation methods. CONCLUSIONS The results of this study informed the development of a curriculum framework that integrates cross-cultural communication skills, exploration of barriers towards accessing care for newcomers, and system approaches to improve refugee and migrant healthcare. Programs should also consider social determinants of health, community service learning and the development of links to community resettlement and refugee organizations.
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Affiliation(s)
- Douglas Gruner
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
| | - Yael Feinberg
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
| | - Maddie J. Venables
- Department of Family Medicine, C.T. Lamont Primary Health Care Centre, University of Ottawa, Ottawa, ON Canada
| | - Syeda Shanza Hashmi
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Ammar Saad
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - Douglas Archibald
- Department of Family Medicine, C.T. Lamont Primary Health Care Centre, University of Ottawa, Ottawa, ON Canada
- Bruyere Research Insitute, Ottawa, ON Canada
| | - Kevin Pottie
- Department of Family Medicine, C.T. Lamont Primary Health Care Centre, University of Ottawa, Ottawa, ON Canada
- Institut Savoir Montfort, Ottawa, ON Canada
- Family Medicine, Western University, London, ON Canada
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11
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Kunin M, Timlin M, Lemoh C, Sheffield DA, Russo A, Hazara S, McBride J. Improving screening and management of latent tuberculosis infection: development and evaluation of latent tuberculosis infection primary care model. BMC Infect Dis 2022; 22:49. [PMID: 35022023 PMCID: PMC8756639 DOI: 10.1186/s12879-021-06925-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background In Australia, demand for specialist infectious diseases services exceeds capacity to provide timely management of latent tuberculosis infection (LTBI) in areas of high refugee and asylum seeker settlement. A model for treating LTBI patients in primary care has been developed and piloted in a refugee-focused primary health service (Monash Health Refugee Health and Wellbeing [MHRHW]) and a universal primary care clinic. This study reports on the development and evaluation of the model, focusing on the model feasibility, and barriers and enablers to its success. Methods A convergent mix-methods design was used to evaluate the model for treating LTBI patients in primary care, where a prospective cohort study of patients commencing treatment either at MHRHW or the universal primary care clinic determined the model feasibility, while focus groups with clinicians directly involved in treating these patients explored barriers and enablers to sustainability and success of the model. Results From January 2017 to April 2018, 65 patients with confirmed LTBI presented at participating clinics. Treatment was accepted by 31 (48%) patients, of whom 15(48%) were treated at MHRHW and 16 (52%) at the universal primary care clinic. The 6-months’ treatment completion rate was higher at MHRHW compared to the universal primary care clinic (14 (93%) compared to 9 (56%) respectively, p = 0.0373). Reasons for non-completion included adverse reaction, opting out and relocation. At the completion of the pilot, 15 clinicians participated in two focus groups. Clinicians identified barriers and enablers for successful LTBI management at patient, provider, organisational and clinical levels. While barriers for treatment completion and adherence were consistent across the two pilot sites, enablers, such as resources to facilitate patient education and follow-up, were available only at MHRHW. Conclusion Screening and management of LTBI patients can be achieved within the primary care setting, considerate of barriers and enablers at patient, provider, organisational and clinical levels. Upscaling of a primary care response to the management of LTBI will require supporting primary care clinics with resources to employ dedicated clinical staff for patient education, follow-up communication and monitoring medication adherence. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06925-8.
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12
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Hansen M, Bowden E, Currie BJ, Ward L, Andrews RM, Dhurrkay RG, Gurruwiwi GG, Kearns T. Strongyloides stercoralis seropositivity is not associated with increased symptoms in a remote Aboriginal community. Intern Med J 2021; 51:1286-1291. [PMID: 32372503 DOI: 10.1111/imj.14884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Strongyloides stercoralis is a soil-transmitted helminth, endemic in remote Aboriginal and Torres Strait Islander communities in northern Australia with estimates of prevalences up to 60%. Hyperinfection in the setting of immunosuppression is a rare, but well recognised cause of significant morbidity and mortality. However, the morbidity associated with chronic uncomplicated infection is less well characterised. AIMS To measure the prevalence of symptoms potentially attributable to S. stercoralis infection and their association with seropositivity. METHODS This retrospective matched case-control study reviewed records of primary healthcare presentations for symptoms in the 12 months before and after an ivermectin mass drug administration (MDA) in a remote Aboriginal community. RESULTS One hundred and seventy-five S. stercoralis seropositive cases were matched with 175 seronegative controls. The most frequently reported symptom overall in the 12 months prior to the MDA was cough followed by abdominal pain, weight loss/malnutrition, diarrhoea and pruritis. Seropositive cases were not more likely than matched controls to have symptoms typically attributed to strongyloidiasis. In the seropositive cohort, we found no difference in symptoms in the 12 months before and after an ivermectin MDA despite a reduction in seroprevalence. CONCLUSION We found no evidence to suggest that S. stercoralis seropositivity was associated with increased symptoms when compared to matched seronegative controls. Treatment with ivermectin did not reduce symptoms in seropositive cases. Without evidence to support that population-based screening or treatment programmes reduce symptoms, the emphasis must remain on identifying and managing those few individuals with immunosuppression that predisposes them to potentially life-threatening hyperinfection.
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Affiliation(s)
- Martin Hansen
- Infectious Diseases Department, Royal Darwin Hospital, Northern Territory, Australia
| | - Emily Bowden
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Bart J Currie
- Infectious Diseases Department, Royal Darwin Hospital, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Linda Ward
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | | | - Therese Kearns
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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13
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Shishehgar S, Gholizadeh L, DiGiacomo M, Davidson PM. A qualitative study of experiences of asylum-seeker women of living in detention centres: confinement versus safety. Contemp Nurse 2021; 57:51-64. [PMID: 33970795 DOI: 10.1080/10376178.2021.1927771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Iranian asylum seekers are amongst the highest number of boat arrivals to Australia who have been subject to compulsory detention. Women face more health-threatening problems rather than men in detention, yet, remain understudied in health research. This study aimed to inform healthcare providers about the experiences of living in immigration detentions, which might affect asylum seekers' mental health. METHOD A qualitative study using semi-structured interviews and thematic analysis. RESULTS 17 participants shared their experiences: Living in a prison-like environment was a punishment for their boat arrival and violated their privacy and dignity. In contrast, a sense of security, free access to healthcare services, and building social networks were positive aspects of short-term detention. CONCLUSION To prevent further trauma, living conditions in detention must be conducive to promoting coping and adjustment. The length of detention should be minimised and limited to preparing asylum seekers for facing a new socio-cultural environment.
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Affiliation(s)
- Sara Shishehgar
- Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia
| | - Leila Gholizadeh
- Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia
| | - Michelle DiGiacomo
- Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia
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14
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Sforza S, Tuccio A, Zammarchi L, Verrienti P, Rinaldi F, Tilli M, Di Maida F, Mari A, Masieri L, Carini M, Bartoloni A, Minervini A. Urological management and surgical procedures in migrants from Sub-Saharan Africa with urogenital schistosomiasis. Actas Urol Esp 2021; 45:309-319. [PMID: 33685664 DOI: 10.1016/j.acuro.2020.03.016] [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: 01/08/2020] [Revised: 03/12/2020] [Accepted: 03/22/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES An increasing number of urogenital schistosomiasis (UGS) is being diagnosed in Europe following the unprecedented migratory flux from Sub-Saharan Africa (SSA). This phenomenon represent a challenge for urologists working in a non-endemic area. The aim of this study is to describe the urological management and the surgical procedures of patients with UGS in a tertiary referral centre. PATIENTS All subjects from SAA diagnosed with UGS from January 2011 to November 2018 were enrolled retrospectively. Detailed data of patients with UGS undergoing to urological procedures were collected and analysed. RESULTS Thirty patients were diagnosed with UGS, among them 12 (42.8%) were submitted to surgery. The most common surgical procedure was trans urethral resection of bladder (TURB) for suspected lesions persisted after praziquantel treatment performed in 7cases (58%). Other surgical procedure were TURB and concomitant ureteroscopy with laser fragmentation for suspected bladder neoplasm with renal stone, endoscopic lithotripsy and percutaneous nephrolithotomy for bladder and renal stones, laparoscopic nephrectomy for end-stage kidney disease, placement of bilateral nephrostomy for hydroureteronephrosis, explorative testicular surgery for a suspected testicular torsion in one case each. Four patients (33%) were lost at the follow up. CONCLUSION An increasing number of migrants from SSA diagnosed with UGS has been observed. Some patients required a surgical intervention for suspected neoplastic lesions or end-stage organ damage. It was particularly difficult to perform a regular follow-up in several patients. Further multicentric studies are needed to reach a proper standard in diagnosis, treatment and follow-up of subjects with UGS.
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Affiliation(s)
- S Sforza
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florencia, Italia
| | - A Tuccio
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florencia, Italia.
| | - L Zammarchi
- Infectious and Tropical Diseases Unit, Careggi Hospital, University of Florence, Florencia, Italia; Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, University of Florence, Florencia, Italia
| | - P Verrienti
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florencia, Italia
| | - F Rinaldi
- Infectious and Tropical Diseases Unit, Careggi Hospital, University of Florence, Florencia, Italia; Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, University of Florence, Florencia, Italia
| | - M Tilli
- Infectious and Tropical Diseases Unit, Careggi Hospital, University of Florence, Florencia, Italia; Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, University of Florence, Florencia, Italia
| | - F Di Maida
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florencia, Italia
| | - A Mari
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florencia, Italia
| | - L Masieri
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florencia, Italia
| | - M Carini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florencia, Italia
| | - A Bartoloni
- Infectious and Tropical Diseases Unit, Careggi Hospital, University of Florence, Florencia, Italia; Referral Centre for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, University of Florence, Florencia, Italia
| | - A Minervini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florencia, Italia
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15
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Leblanc C, Brun S, Bouchaud O, Izri A, Ok V, Caseris M, Sorge F, Pham LL, Paugam A, Paris L, Jaureguiberry S, Bloch-Queyrat C, Boubaya M, Faye A, Mariani P, de Pontual L. Imported schistosomiasis in Paris region of France: A multicenter study of prevalence and diagnostic methods. Travel Med Infect Dis 2021; 41:102041. [PMID: 33785455 DOI: 10.1016/j.tmaid.2021.102041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There are few data on imported schistosomiasis - especially in children. The objectives of the present study were to estimate the prevalence of imported schistosomiasis in at-risk children in the greater Paris region of France and to compare diagnostic methods. METHOD Children at risk of schistosomiasis who consulted or were hospitalized in four hospitals in the greater Paris region were prospectively included. Clinical and laboratory data were collected. Urine and feces samples were screened for Schistosoma spp. using microscopy, a point-of-care circulating cathodic antigen and a real-time polymerase chain reaction assay. Serum samples were screened using Western blot, ELISA, indirect hemagglutination, and immunochromatographic assays. The diagnosis was characterized as confirmed (positive microscopy analysis) and as suspected (positive ELISA and Western blot assays). The prevalence of schistosomiasis and the tests' performances were estimated using the latent class method. RESULTS A total of 114 children were included. Most of the children were newly arrived migrants from sub-Saharan Africa. The mean age was 13.2 years-old. There were 12 (10.5%) confirmed cases and 13 (11.4%) suspected cases. Half of the confirmed and suspected cases were asymptomatic. The prevalence was 24.3%. The ELISA and the Western blot assays presented the same sensitivity (83%) and specificity (99%). The serum immunochromatographic assay also showed good performance. CONCLUSIONS The high prevalence of imported schistosomiasis among at-risk children in the greater Paris region confirms the need for systematic screening. A serum immunochromatographic assay appears to be one of the most effective screening methods for a low cost.
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Affiliation(s)
- Claire Leblanc
- Department of Pediatrics, AP-HP University Paris 13, Jean Verdier Hospital, Bondy, France.
| | - Sophie Brun
- Department of Parasitology-Mycology, AP-HP University Paris 13, Avicenne Hospital, Bobigny, France
| | - Olivier Bouchaud
- Department of Infectious and Tropical Diseases, AP-HP University Paris 13, Avicenne Hospital, Bobigny, France
| | - Arezki Izri
- Department of Parasitology-Mycology, AP-HP University Paris 13, Avicenne Hospital, Bobigny, France
| | - Vichita Ok
- Department of Parasitology-Mycology, AP-HP University Paris 13, Avicenne Hospital, Bobigny, France
| | - Marion Caseris
- Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP University Paris Diderot, Robert Debré Hospital, Paris, France
| | - Fréderic Sorge
- Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP University Paris Descartes, Necker-Enfants Malades Hospital, Paris, France
| | - Luu-Ly Pham
- Department of Pediatrics, AP-HP University Paris 13, Jean Verdier Hospital, Bondy, France
| | - André Paugam
- Department of Parasitology-Mycology, AP-HP University Paris Descartes, Cochin Hospital, Paris, France
| | - Luc Paris
- Department of Parasitology-Mycology, AP-HP Sorbonne Université, Pitié-Salpétrière Hospital, Paris, France
| | - Stéphane Jaureguiberry
- Department of Infectious and Tropical Diseases, AP-HP University Paris -Sud Saclay, Kremlin Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Coralie Bloch-Queyrat
- Department of Clinical Research, AP-HP University Paris 13, Avicenne Hospital, Bobigny, France
| | - Marouane Boubaya
- Department of Clinical Research, AP-HP University Paris 13, Avicenne Hospital, Bobigny, France
| | - Albert Faye
- Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP University Paris Diderot, Robert Debré Hospital, Paris, France
| | - Patricia Mariani
- Department of Microbiology, AP-HP University Paris Diderot, Robert Debré Hospital, Paris, France
| | - Loïc de Pontual
- Department of Pediatrics, AP-HP University Paris 13, Jean Verdier Hospital, Bondy, France
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16
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Health assessment for migrants and asylum seekers upon arrival and while hosted in reception centres: Italian guidelines. Health Policy 2020; 125:393-405. [PMID: 33461797 DOI: 10.1016/j.healthpol.2020.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND During 2016-17, national guidelines were developed in order to provide evidence-based recommendations on health assessments for migrants and asylum seekers upon their arrival in Italy. METHODS Scientific literature published between 2005 and 2016 was searched in different databases. A free search was also performed on international organizations' websites in order to identify additional relevant documents. A multidisciplinary panel discussed the resulting evidence and formulated recommendations. RESULTS Evidence-based recommendations were formulated: signs and symptoms of specific diseases should to be actively searched for active TB, malaria, STI, intestinal parasites, diabetes, anaemia. In case of other health conditions (latent TB, HIV, HBV, HCV, STI, strongyloides, schistosoma, diabetes), testing should be offered to asymptomatic subjects coming from endemic areas or exposed to risk factors. Mass screening is recommended for anaemia and hypertension; a pregnancy test should be considered, while inclusion in cervical cancer screening and vaccination programs is recommended. A modulated, progressive approach was developed, covering an initial evaluation during rescue operations, a full medical examination at first line reception stage and the referral to national health services during second line reception. CONCLUSIONS It is important to produce and periodically update guidelines on these issues and local peculiarities should be taken into account in their design and implementation. Guidelines can not only support economic sustainability, but also counteract stigmatization dynamics.
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Abstract
The initial assessment of immigrant and refugee patients, including which health concerns to address and which infectious diseases may benefit from early screening, may present challenges to clinicians. Evidence-based research suggests certain infectious diseases should be screened for and treated in refugees. Overseas refugee preemptive treatment programs have reduced the burden of some diseases but have not removed the value of in-country screening programs. This article provides discussion of a series of common tropical and infectious diseases providing refugee and geographic contexts and links to international resources that have been developed to improve the care of newly arriving immigrants and refugees.
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18
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O'Mara B, Carey G, Weier M. Community-based health promotion about alcohol and other drugs in a multicultural Australia-what works? A review of evidence. HEALTH EDUCATION RESEARCH 2020; 35:437-449. [PMID: 33090214 DOI: 10.1093/her/cyaa027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
Refugee and migrant communities from culturally and linguistically diverse backgrounds in Australia experience dependency, stigma, isolation, mental health issues, family issues and other problems associated with alcohol and other drugs. Yet, refugee and migrant communities also face major linguistic, cultural and technological barriers to health promotion about drug-related problems. The aim of this review is to identify effective techniques and approaches for health promotion that reduces the risk of problems with drugs in culturally and linguistically inclusive ways. To identify what is effective, the Medline/PubMed database was systematically searched for health promotion literature published between 2008 and 2018. Grey literature from relevant agencies was also searched. The review considered both quantitative and qualitative outcome measures, and assessed studies using the Critical Appraisal Skills Programme quality assessment tool. Three studies met inclusion criteria, with weak evaluations. The studies demonstrated effective community engagement, but do not provide conclusive evidence of what is effective drug-related health promotion. The review's findings point to an important knowledge gap. More rigorous research and evaluation are required to identify effective health promotion for reducing drug-related issues with a larger, more diverse range of refugee and migrant communities.
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Affiliation(s)
- Ben O'Mara
- Department of Media and Communication, Faculty of Health, Arts and Design, Swinburne University, John Street, Hawthorn, Melbourne, Victoria, 3122, Australia
| | - Gemma Carey
- Centre for Social Impact, Business School, University of New South Wales, High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Megan Weier
- Centre for Social Impact, Business School, University of New South Wales, High Street, Kensington, Sydney, NSW, 2052, Australia
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19
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Muhi S, Ko DK, McGuinness SL, Biggs BA, Mahanty S, Delany C. A mixed-method analysis of screening for Strongyloides stercoralis prior to immunosuppression: A problem of limited bandwidth? Intern Med J 2020; 52:790-799. [PMID: 32687250 DOI: 10.1111/imj.14991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Guidelines recommend screening for strongyloidiasis prior to immunosuppression in those at epidemiological risk, as hyperinfection following immunosuppression is often fatal. The uptake of this recommendation is unknown, and we aimed to explore this in our setting. AIMS Determine the proportion of adult patients at epidemiological risk for strongyloidiasis who were screened prior to immunosuppression at the Royal Melbourne Hospital, Explore the factors that influenced clinicians' decision to screen for strongyloidiasis prior to immunosuppression. METHODS This study used a mixed-methods approach. First, a 12-month (1 January 2018 to 1 January 2019) retrospective observational study was used to quantify the proportion of those at epidemiological risk who were screened prior to immunosuppression, while also identifying variables that were positively or negatively associated with screening. Second, clinicians from relevant specialties were recruited for focus group sessions to explore factors that influenced their decision to screen according to an interpretivist framework. RESULTS 230 newly immunosuppressed patients at epidemiological risk of strongyloidiasis were identified, of whom 87 (37.8%) were screened prior to immunosuppression. In multivariate analysis, older patients, outpatients and people from non-English speaking backgrounds were significantly less likely to be screened. In focus groups, a number of barriers and enablers to screening were identified. Notably, clinicians reported that a major barrier was the cognitive load required to clinically reason about this uncommon disease, in addition to other priorities. CONCLUSION We identified many missed opportunities to screen patients at risk of hyperinfection, particularly those most vulnerable. To improve screening, this study highlights the importance of reducing cognitive load by using decision-support tools, which may facilitate screening in vulnerable patients and in time-constrained settings. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stephen Muhi
- The Royal Melbourne Hospital, Victorian Infectious Diseases Service
| | - Dong-Kyoon Ko
- The Royal Melbourne Hospital, Victorian Infectious Diseases Service
| | - Sarah L McGuinness
- Department of Infectious Diseases at the Alfred Hospital.,School of Public Health and Preventative Medicine, Monash University
| | - Beverley-Ann Biggs
- The Royal Melbourne Hospital, Victorian Infectious Diseases Service.,Department of Medicine at the Peter Doherty Institute, University of Melbourne
| | | | - Clare Delany
- Department of Medical Education at The University of Melbourne
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20
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Zammarchi L, Tilli M, Botta A, Buonfrate D, Bartoloni A, Boccalini S. Strategies for management of strongyloidiasis in migrants from Sub-Saharan Africa recently arrived in Italy: A cost-effectiveness analysis. Travel Med Infect Dis 2020; 36:101561. [PMID: 31982632 DOI: 10.1016/j.tmaid.2020.101561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Italian and the European Centre for Disease Control and Prevention guidelines both recommend a systematic serological screening for strongyloidiasis in sub-Saharan migrants (SSA), however, studies on clinical and economic impact of this strategy in the Italian and European settings are lacking. METHODS A population of 100,000 migrants from SSA to Italy was considered and a Markov decision tree model was developed to assess the clinical and economic impact of two interventions for strongyloidiasis compared with the current practice (passive diagnosis of symptomatic cases): a) universal serological screening and treatment with ivermectin in case of positive test b) universal presumptive treatment with ivermectin. One and 10-year time horizon in the health-care perspective were considered. RESULTS In the one and 10-year time horizon respectively the costs for passive diagnosis was €1,164,169 and €9,735,908, those for screening option was € 2,856,011 and € 4,959,638 and those for presumptive treatment was €3,538,474 and € 4,883,272. Considering the cost per cured subject in the one-year time horizon, screening appears more favorable (€209.53), than the other two options (€232.55 per presumptive treatment and €10,197.29 per current strategy). Incremental cost-effectiveness ratio (ICERs) of screening strategy and presumptive treatment were respectively 265.27 and 333.19. The sensitivity analysis identified strongyloidiasis' prevalence as the main driver of ICER. CONCLUSIONS Compared to the current practice (passive diagnosis) both screening and presumptive treatment strategies are more favorable from a cost-effectiveness point of view, with a slight advantage of the screening strategy in a one-year time horizon.
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Affiliation(s)
- Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
| | - Marta Tilli
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Italy
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Page WA, Judd JA, MacLaren DJ, Buettner P. Integrating testing for chronic strongyloidiasis within the Indigenous adult preventive health assessment system in endemic communities in the Northern Territory, Australia: An intervention study. PLoS Negl Trop Dis 2020; 14:e0008232. [PMID: 32401755 PMCID: PMC7219702 DOI: 10.1371/journal.pntd.0008232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 03/18/2020] [Indexed: 01/29/2023] Open
Abstract
Background The life-threatening clinical manifestations of strongyloidiasis are preventable with early detection and effective treatment. The aim of this study was to assess if there was an increase to the number and proportion of persons tested for chronic strongyloidiasis, as a result of integrating Strongyloides stercoralis serology into the existing preventive health assessment system in four Aboriginal health services in endemic communities. Methodology A prospective, longitudinal, before-and-after intervention study was conducted in four Aboriginal health services in remote endemically infected communities in the Northern Territory, Australia, from July 2012 to December 2016. The electronic patient information and recall systems enabled the integration of Strongyloides stercoralis serology into the adult preventive health assessment. Strongyloides reports for each health service were extracted half-yearly to examine the number and proportion of persons tested for chronic strongyloidiasis during the study and to measure the effect of the intervention. Principal findings The number and proportion of persons tested increased significantly during the study. From a total resident population of 3650 Indigenous adults over 15 years of age, 1686 persons (47.4%) were tested. The percentage of adults who had at least one serology test increased in all four health services to between 41% (446/1086) and 81.9% (172/210). Of the 1686 persons tested, 680 positive cases of chronic strongyloidiasis (40.3%) were identified. Conclusions/Significance This population health systems intervention increased the number and proportion of persons tested for chronic strongyloidiasis in four health services in endemically infected communities. This intervention is relevant to other health services with high-risk populations. Strongyloidiasis is a neglected tropical disease that is endemic in some Aboriginal communities in the Northern Territory. This study asks if the number and proportion of persons tested for chronic strongyloidiasis can be increased by incorporating a Strongyloides serology test into the existing routine Indigenous adult preventive health assessment system in remote endemic communities. This study demonstrated that integrating Strongyloides serology test within the Indigenous adult preventive health assessment system does increase the number and proportion of people tested in endemic communities. This intervention means that life-threatening clinical complications of strongyloidiasis can be prevented by early detection and treatment. Primary health care services have an important role in increased testing in this high-risk population. Primary health care clinicians incorporated chronic strongyloidiasis with other preventable chronic and infectious diseases. The sustainable population health systems-based approach successfully increased coverage by integrating testing for chronic strongyloidiasis into the adult preventive health assessment in health services in remote Indigenous Australian endemic communities, utilising the electronic health record system. The Strongyloides report developed to measure the change in clinical practice would be replicable in other health services with high risk populations.
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Affiliation(s)
- Wendy A. Page
- Miwatj Health Aboriginal Corporation, Nhulunbuy, Northern Territory, Australia
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
- * E-mail:
| | - Jenni A. Judd
- School of Health, Medical and Applied Sciences, Division of Higher Education, Central Queensland University, Bundaberg, Queensland, Australia
- Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg, Queensland, Australia
- Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - David J. MacLaren
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Petra Buettner
- Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
- Tropical Health Solutions, Queensland, Australia
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22
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Sequeira-Aymar E, diLollo X, Osorio-Lopez Y, Gonçalves AQ, Subirà C, Requena-Méndez A. [Recommendations for the screening for infectious diseases, mental health, and female genital mutilation in immigrant patients seen in Primary Care]. Aten Primaria 2020; 52:193-205. [PMID: 31029458 PMCID: PMC7063148 DOI: 10.1016/j.aprim.2019.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 12/15/2022] Open
Abstract
Immigrant health status may be improved if certain health conditions are identified early through the implementation of a screening program. This document presents the recommendations resulting from the Screening in immigrant population project (CRIBMI) aimed at implementing a screening program for infectious diseases (HIV, HBV, HCV, tuberculosis, strongyloidiasis, schistosomiasis and Chagas disease), as well as female genital mutilation and mental health (MH) in migrant population at Primary Care level. Screening recommendations were based on: coming from an endemic country for strongyloidiasis, schistosomiasis, and Chagas diseases; on a threshold level of prevalence for HIV (> 1%), HBV (> 2%), and HCV (> 2%), and on incidence (> 50 cases/100,000-inhabitants) for active tuberculosis in immigrants with < 5 years in Europe. Exploring the risk of FGM is recommended in women from countries where this practice is prevalent. Evaluation of MH status is recommended for people from areas of conflict and violence.
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Affiliation(s)
- Ethel Sequeira-Aymar
- CAPSBE Casanova, Grupo transversal de investigación en AP IDIBAPS, grupo COCOOPSI CAMFIC, Barcelona, España.
| | - Ximena diLollo
- Fundació Clínic per la Recerca Biomédica, Barcelona, España; Instituto de Salud Global de Barcelona, Barcelona, España
| | - Yolanda Osorio-Lopez
- ESMES (equipo Salut Mental Sense Sostre) y programa SATMI (Programa d'atenció en Salut Mental per població immigrada), Parc Sanitari Sant Joan de Déu, Barcelona, España
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Tarragona, España; Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L'Ebre, Institut Català de la Salut, Tortosa, Tarragona, España
| | - Carme Subirà
- Servicio de Medicina Tropical, Hospital Clínic de Barcelona, Barcelona, España; Instituto de Salud Global de Barcelona, Barcelona, España
| | - Ana Requena-Méndez
- Servicio de Medicina Tropical, Hospital Clínic de Barcelona, Barcelona, España; Instituto de Salud Global de Barcelona, Barcelona, España
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23
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Janda A, Eder K, Fressle R, Geweniger A, Diffloth N, Heeg M, Binder N, Sitaru AG, Rohr J, Henneke P, Hufnagel M, Elling R. Comprehensive infectious disease screening in a cohort of unaccompanied refugee minors in Germany from 2016 to 2017: A cross-sectional study. PLoS Med 2020; 17:e1003076. [PMID: 32231358 PMCID: PMC7108686 DOI: 10.1371/journal.pmed.1003076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 02/25/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Information regarding the prevalence of infectious diseases (IDs) in child and adolescent refugees in Europe is scarce. Here, we evaluate a standardized ID screening protocol in a cohort of unaccompanied refugee minors (URMs) in a municipal region of southwest Germany. METHODS AND FINDINGS From January 2016 to December 2017, we employed a structured questionnaire to screen a cohort of 890 URMs. Collecting sociodemographic information and medical history, we also performed a standardized diagnostics panel, including complete blood count, urine status, microbial stool testing, tuberculosis (TB) screening, and serologies for hepatitis B virus (HBV) and human immunodeficiency virus (HIV). The mean age was 16.2 years; 94.0% were male, and 93.6% originated from an African country. The most common health complaints were dental problems (66.0%). The single most frequent ID was scabies (14.2%). Of the 776 URMs originating from high-prevalence countries, 7.7% and 0.4% tested positive for HBV and HIV, respectively. Nineteen pathogens were detected in a total of 119 stool samples (16.0% positivity), with intestinal schistosomiasis being the most frequent pathogen (6.7%). Blood eosinophilia proved to be a nonspecific criterion for the detection of parasitic infections. Active pulmonary TB was identified in 1.7% of URMs screened. Of note, clinical warning symptoms (fever, cough >2 weeks, and weight loss) were insensitive parameters for the identification of patients with active TB. Study limitations include the possibility of an incomplete eosinophilia workup (as no parasite serologies or malaria diagnostics were performed), as well as the inherent selection bias in our cohort because refugee populations differ across Europe. CONCLUSIONS Our study found that standardized ID screening in a URM cohort was practicable and helped collection of relevant patient data in a thorough and time-effective manner. However, screening practices need to be ameliorated, especially in relation to testing for parasitic infections. Most importantly, we found that only a minority of infections were able to be detected clinically. This underscores the importance of active surveillance of IDs among refugees.
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Affiliation(s)
- Ales Janda
- Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Freiburg, Germany
| | - Kristin Eder
- Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Freiburg, Germany
| | - Roland Fressle
- Practice for Childhood and Adolescent Medicine, Freiburg, Germany
| | - Anne Geweniger
- Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Freiburg, Germany
| | - Natalie Diffloth
- Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Freiburg, Germany
| | - Maximilian Heeg
- Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Freiburg, Germany
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nadine Binder
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Institute of Digitalization in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Germany
| | | | - Jan Rohr
- Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Freiburg, Germany
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Henneke
- Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Freiburg, Germany
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Hufnagel
- Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Freiburg, Germany
| | - Roland Elling
- Department of Pediatrics and Adolescent Medicine, Medical Center—University of Freiburg, Freiburg, Germany
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta Ottenstein Programme, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
- * E-mail:
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24
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Agbata EN, Padilla PF, Agbata IN, Armas LH, Solà I, Pottie K, Alonso-Coello P. Migrant Healthcare Guidelines: A Systematic Quality Assessment. J Immigr Minor Health 2019; 21:401-413. [PMID: 29785690 DOI: 10.1007/s10903-018-0759-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Significant international and cross-border migration has led to a growing availability of migrant healthcare guidelines (MHGs), which we systematically reviewed for quality. PubMed, MEDLINE, CINHAL, PsychINFO and guideline developer/guideline databases were searched for MHGs published 2006-2016. Three independent reviewers assessed eligible MHGs using the Appraisal of Guidelines, Research and Evaluation II instrument (AGREE II). MHGs were identified as high quality if they had a score of ≥ 60% in at least three of the six domains, including "rigour of development", and overall quality was assessed on a seven-point Likert scale. We included 32 MHGs. Overall agreement between reviewers was very good. Mean scores for each AGREE II domain were as follows: 85 ± 19.0% for "scope and purpose"; 51 ± 30.5% for "stakeholder involvement"; 34 ± 31.9% for "rigour of development"; 86 ± 7.3% for "clarity of presentation"; 40 ± 23.6% for "applicability"; and 27 ± 38.5% for "editorial independence". Nine and six MHGs were deemed "recommended" or "recommended with modifications", respectively, and 17 were "not recommended". Our review of MHGs has highlighted critical deficiencies in rigour of development, applicability, editorial independence and stakeholder involvement that point to the need for improvements in future MHGs.
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Affiliation(s)
- Eric Nwachukwu Agbata
- Faculty of Health and Psychology, Master of Public Health (MPH) programme, University of Roehampton, London, UK. .,Methodology of Biomedical Research and Public Health, Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Paulina Fuentes Padilla
- Iberoamerican Cochrane Centre, Barcelona, Spain.,Faculty of Medicine and Dentistry, Universidad de Antofagasta, Antofagasta, Chile
| | - Ifeoma Nwando Agbata
- The Wicklow Mental Health Service, Newcastle Hospital, Greystones, Wicklow, Ireland
| | | | - Ivan Solà
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Kevin Pottie
- Centre for Global Health Institute of Population Health, University of Ottawa, Ottawa, ON, Canada.,C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Biomedical Research Institute, Sant Pau (IIB Sant Pau), Barcelona, Spain
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25
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The diagnosis and treatment of urogenital schistosomiasis in Italy in a retrospective cohort of immigrants from Sub-Saharan Africa. Infection 2019; 47:447-459. [PMID: 30666616 DOI: 10.1007/s15010-019-01270-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 01/09/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate ultrasound and praziquantel to, respectively, assess and reduce urogenital schistosomiasis (UGS)-associated morbidity in migrants from Sub-Saharan Africa (SSA). METHODS Migrants from SSA with UGS attending three Italian centres for tropical diseases during 2011-2016 were retrospectively enrolled. Data on clinical symptoms, routine laboratory, parasitological tests, and ultrasound reported as per the WHO-Niamey protocol were collected at baseline and at available follow-up visits after treatment with praziquantel 40 mg/kg/day for 3 days. RESULTS One hundred and seventy patients with UGS were enrolled and treated with praziquantel. Baseline ultrasonography showed urinary tract abnormalities in 115/169 patients (68%); the mean global Schistosoma haematobium score was 2.29 (SD 2.84, IQR 0-2), the mean urinary bladder intermediate score 1.75 (SD 1.73, IQR 0-2), and the mean upper urinary tract intermediate score 0.54 (SD 2.37, IQR 1-10). Abnormalities were more common among the 111 (65%) who were symptomatic (p < 0.02; OR 2.53; 95% CI 1.19-5.35). Symptoms started in 94/111 (85%) before arriving (median 63 months, IQR 12-119). At follow-up, we observed a significant reduction in the prevalence of UGS-related symptoms, blood, urine, and ultrasound abnormalities. CONCLUSIONS Our study results support the use of ultrasound and praziquantel for assessing and reducing UGS-associated morbidity in migrants. Health-seeking behaviour, diagnostic, and treatment delays contribute to the advanced pathology and qualified treatment success. To ensure earlier treatment, based on our findings, clinical experience, and available literature, we propose an algorithm for the diagnosis and clinical management of UGS. Multicentre studies are needed to improve the management of subjects with UGS in non-endemic countries.
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26
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Heenan RC, Volkman T, Stokes S, Tosif S, Graham H, Smith A, Tran D, Paxton G. 'I think we've had a health screen': New offshore screening, new refugee health guidelines, new Syrian and Iraqi cohorts: Recommendations, reality, results and review. J Paediatr Child Health 2019; 55:95-103. [PMID: 30094942 DOI: 10.1111/jpc.14142] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 11/30/2022]
Abstract
AIM To examine refugee health assessments in Syrian and Iraqi children in the context of changes to offshore immigration screening, updated Australian refugee health guidelines and the primary care refugee health model in Victoria. METHODS This is a retrospective audit of Syrian and Iraqi children aged 0-17 years attending a specialist immigrant health service from January 2015 to September 2017. RESULTS We saw 128 children (7 months-16 years, 64.8% male). Prior to arrival, 58.9% of children had experienced trauma, and 67.9% had missed at least 1 year of school. Almost all children (93.3%) were linked with a regular general practitioner in Australia, and 23.6% children were linked with a refugee health nurse; offshore health records were infrequently available. Of school-aged children, 25% were not enrolled in school 3 months after arrival. Only 2 of 113 (1.8%) children had completed a recommended refugee health assessment, and 55.1% had commenced appropriate catch-up vaccination in primary care. After screening completion, the most prevalent conditions were low vitamin D (63.6%); growth/nutrition (24.2%), neurological/metabolic (16.4%), learning/behaviour (15.6%) and mental health (12.5%) concerns; latent tuberculosis infection (11.8%); and developmental delay (10.2%). Sixteen children required surgery after arrival, and six children had life-threatening medical conditions on arrival - only one had an offshore critical alert; care for the other five children resulted in 133 unanticipated hospital admission days. CONCLUSIONS There are substantial challenges with the current primary care screening model in Victoria. Disability, developmental and mental health concerns were prominent in this cohort, and many children had delays in education access, compounding prior disadvantage.
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Affiliation(s)
- Rachel C Heenan
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Thomas Volkman
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Simon Stokes
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Shidan Tosif
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Hamish Graham
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Andrea Smith
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David Tran
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Northern Hospital, Melbourne, Victoria, Australia
| | - Georgia Paxton
- Immigrant Health Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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27
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Chandra M, Duri A, Smith M. Prevalence of chronic disease risk factors in 35- to 44-year-old humanitarian arrivals to New South Wales (NSW), Australia. Aust J Prim Health 2019; 25:19-23. [DOI: 10.1071/py18042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 09/08/2018] [Indexed: 11/23/2022]
Abstract
The aim of this study is to compare the prevalence of chronic disease risk factors in humanitarian arrivals to Sydney, New South Wales (NSW) with the Australian Indigenous and non-Indigenous populations aged 35–44 years. Data on risk factors collected from 237 refugees presenting to the NSW Refugee Health Service (RHS) from January 2015 to August 2016 were retrospectively analysed and compared with data from the Australian Health Surveys, 2011–13 for the Indigenous and non-Indigenous Australian populations. This study found significantly higher levels of triglycerides (z=3; 95% CI, 0.16–0.26); hypertension (z=3.2; 95% CI, 0.17–0.29); and smoking (z=3.5; 95% CI, 0.27–0.33) in refugees compared with the general Australian population. The Indigenous population had significantly higher levels of triglycerides (z=4; 95% CI, 0.16–0.26); body mass indexes (BMIs) (z=3.3; 95% CI 0.58–0.72); and smoking (z=5.4; 95 CI 0.27–0.33) compared with refugees. Based on the study findings, screening for chronic disease risk factors from age 35 years may be warranted in all humanitarian arrivals to Australia, along with dietary and lifestyle advice.
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28
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Driedger M, Mayhew A, Welch V, Agbata E, Gruner D, Greenaway C, Noori T, Sandu M, Sangou T, Mathew C, Kaur H, Pareek M, Pottie K. Accessibility and Acceptability of Infectious Disease Interventions Among Migrants in the EU/EEA: A CERQual Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2329. [PMID: 30360472 PMCID: PMC6267477 DOI: 10.3390/ijerph15112329] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 01/11/2023]
Abstract
In the EU/EEA, subgroups of international migrants have an increased prevalence of certain infectious diseases. The objective of this study was to examine migrants' acceptability, value placed on outcomes, and accessibility of infectious disease interventions. We conducted a systematic review of qualitative reviews adhering to the PRISMA reporting guidelines. We searched MEDLINE, EMBASE, CINAHL, DARE, and CDSR, and assessed review quality using AMSTAR. We conducted a framework analysis based on the Health Beliefs Model, which was used to organize our preliminary findings with respect to the beliefs that underlie preventive health behavior, including knowledge of risk factors, perceived susceptibility, severity and barriers, and cues to action. We assessed confidence in findings using an adapted GRADE CERQual tool. We included 11 qualitative systematic reviews from 2111 articles. In these studies, migrants report several facilitators to public health interventions. Acceptability depended on migrants' relationship with healthcare practitioners, knowledge of the disease, and degree of disease-related stigma. Facilitators to public health interventions relevant for migrant populations may provide clues for implementation. Trust, cultural sensitivity, and communication skills also have implications for linkage to care and public health practitioner education. Recommendations from practitioners continue to play a key role in the acceptance of infectious disease interventions.
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Affiliation(s)
- Matt Driedger
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 6M1, Canada.
| | - Alain Mayhew
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 6M1, Canada.
| | - Vivian Welch
- Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
| | - Eric Agbata
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universität Autònoma de Barcelona, 08193 Barcelona, Spain.
| | - Doug Gruner
- Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
| | - Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, 16973 Stockholm, Sweden.
| | - Monica Sandu
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 6M1, Canada.
| | - Thierry Sangou
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 6M1, Canada.
| | - Christine Mathew
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 6M1, Canada.
| | - Harneel Kaur
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 6M1, Canada.
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK.
| | - Kevin Pottie
- Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
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29
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Affiliation(s)
- Robin B McFee
- Debusk College of Osteopathic Medicine, Lincoln Memorial University.
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30
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Pottie K, Mayhew AD, Morton RL, Greenaway C, Akl EA, Rahman P, Zenner D, Pareek M, Tugwell P, Welch V, Meerpohl J, Alonso-Coello P, Hui C, Biggs BA, Requena-Méndez A, Agbata E, Noori T, Schünemann HJ. Prevention and assessment of infectious diseases among children and adult migrants arriving to the European Union/European Economic Association: a protocol for a suite of systematic reviews for public health and health systems. BMJ Open 2017; 7:e014608. [PMID: 28893741 PMCID: PMC5595200 DOI: 10.1136/bmjopen-2016-014608] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The European Centre for Disease Prevention and Control is developing evidence-based guidance for voluntary screening, treatment and vaccine prevention of infectious diseases for newly arriving migrants to the European Union/European Economic Area. The objective of this systematic review protocol is to guide the identification, appraisal and synthesis of the best available evidence on prevention and assessment of the following priority infectious diseases: tuberculosis, HIV, hepatitis B, hepatitis C, measles, mumps, rubella, diphtheria, tetanus, pertussis, poliomyelitis (polio), Haemophilus influenza disease, strongyloidiasis and schistosomiasis. METHODS AND ANALYSIS The search strategy will identify evidence from existing systematic reviews and then update the effectiveness and cost-effectiveness evidence using prospective trials, economic evaluations and/or recently published systematic reviews. Interdisciplinary teams have designed logic models to help define study inclusion and exclusion criteria, guiding the search strategy and identifying relevant outcomes. We will assess the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. ETHICS AND DISSEMINATION There are no ethical or safety issues. We anticipate disseminating the findings through open-access publications, conference abstracts and presentations. We plan to publish technical syntheses as GRADEpro evidence summaries and the systematic reviews as part of a special edition open-access publication on refugee health. We are following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols reporting guideline. This protocol is registered in PROSPERO: CRD42016045798.
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Affiliation(s)
- Kevin Pottie
- Departments of Family Medicine, and Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Alain D Mayhew
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Rachael L Morton
- The University of Sydney, NHMRC Clinical Trials Centre, Sydney, Australia
| | | | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Prinon Rahman
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Dominik Zenner
- Department of Public Health, Respiratory Diseases, Centre for Infectious Disease Surveillance and Control (CIDSC), London, UK
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation Leicester, University of Leicester, Leicester, UK
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Vivian Welch
- Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Joerg Meerpohl
- Cochrane Germany, MedicalCenter-University of Freiburg, Freiburg, Germany
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Inserm/Université Paris Descartes, Paris, France
| | - Pablo Alonso-Coello
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Iberoamerican Cochrane Centre, CIBERESP-IIB Sant Pau, Barcelona, Spain
| | - Charles Hui
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Beverley-Ann Biggs
- Department of Medicine, University of Melbourne, and Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Ana Requena-Méndez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB),Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Eric Agbata
- Departmentof Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, UniversitatAutònoma de Barcelona, Barcelona, Spain
- Faculty of Health Science, University of Roehampton, London, UK
| | - Teymur Noori
- Surveillanceand Response Unit, Scientific Assessment Section, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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