International Journal of Environmental Research and Public Health

Editorial

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8 pages, 261 KiB

Open AccessEditorial

Health of Refugees and Migrants—Where Do We Stand and What Directions Should We Take?

by Osnat Keidar, David S. Srivastava, Emmanouil Pikoulis and Aristomenis K. Exadaktylos

Int. J. Environ. Res. Public Health 2019, 16(8), 1319; https://doi.org/10.3390/ijerph16081319 - 12 Apr 2019

Cited by 6 | Viewed by 3396

Abstract

International migration, particularly to Europe, has increased in the last few decades, making research on aspects of this phenomenon, including numbers, challenges, and successes, particularly vital [...] Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

Research

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9 pages, 1428 KiB

Open AccessArticle

For What Illnesses Do Asylum Seekers and Undocumented Migrant Workers in Israel Seek Healthcare? An Analysis of Medical Visits at a Large Urgent Care Clinic for the Uninsured in Tel Aviv

by Elizabeth B. Moran, Mark A. Katz, Orel-Ben Ari, Nadav Davidovitch and Oren Zwang

Int. J. Environ. Res. Public Health 2019, 16(2), 252; https://doi.org/10.3390/ijerph16020252 - 16 Jan 2019

Cited by 11 | Viewed by 3700

Abstract

In 2017, there were nearly 80,000 asylum seekers and undocumented migrant workers in Israel, most of whom did not have health insurance. We evaluated trends in medical visits of asylum seekers and undocumented migrant workers who presented to Terem Refugee Clinic (TRC), a [...] Read more.

In 2017, there were nearly 80,000 asylum seekers and undocumented migrant workers in Israel, most of whom did not have health insurance. We evaluated trends in medical visits of asylum seekers and undocumented migrant workers who presented to Terem Refugee Clinic (TRC), a large clinic in Tel Aviv available only to uninsured residents of Israel. Data were collected from electronic medical records at TRC from 2013–2017. Diagnoses were grouped into categories using ICD-10-equivalent diagnosis codes. We used a chi-squared test for trends to test the significance of trends 2013 to 2017. There were 99,569 medical visits from 2013 to 2017 at TRC. Visits were lowest in 2013 (11,112), and relatively stable from 2014–2017 (range: 19,712–23,172). Most visits were among adults aged 18–35 (41.2%) and children <2 years old (23.7%). Only 3% of visits were from patients aged >50. The percentage of infectious disease diagnoses decreased over the study period, from 9.4% of all diagnoses in adults in 2014 to 5.2% in 2017, and from 32.0% of all diagnoses in children in 2013 to 19.4% in 2017. The annual percentage of respiratory diagnoses in children and adults 18–35 years of age, musculoskeletal in all adults, and digestive in adults except women ≥35 years old increased. Over time, asylum seekers and undocumented migrant workers visited TRC with fewer infectious diseases diagnoses overall but more respiratory diseases, including acute respiratory infections and more musculoskeletal diseases. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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17 pages, 320 KiB

Open AccessArticle

by Eva Morawa and Yesim Erim

Int. J. Environ. Res. Public Health 2018, 15(11), 2545; https://doi.org/10.3390/ijerph15112545 - 13 Nov 2018

Cited by 13 | Viewed by 3303

Abstract

Background: Health-related lifestyle behaviors such as smoking, alcohol consumption, physical inactivity and obesity are major cardiovascular risk factors. Previous studies have mostly demonstrated a favorable association between religiosity and these cardiovascular risk factors; however, no studies have investigated this relationship in Polish [...] Read more.

Background: Health-related lifestyle behaviors such as smoking, alcohol consumption, physical inactivity and obesity are major cardiovascular risk factors. Previous studies have mostly demonstrated a favorable association between religiosity and these cardiovascular risk factors; however, no studies have investigated this relationship in Polish immigrants. The aim of this cross-sectional study was to examine the association between health-related lifestyle behaviors and religiosity in Polish immigrants in Germany. Methods: The smoking patterns, frequency of alcohol consumption, physical activity, and presence of overweight/obesity were assessed in 257 first-generation immigrants of Polish origin living in Germany. Religiosity was measured with the Centrality of Religiosity Scale (CRS, Huber, 2003) consisting of 15 items that categorized the respondents into intrinsically, extrinsically, and not/marginally religious. Results: After adjusting for various sociodemographic, migration, and health-related characteristics, intrinsic religiosity was significantly associated with a lower risk of being a smoker (odds ratios (OR) = 0.34, confidence intervals (CI) = 0.15–0.76) and was also associated with a lower risk of alcohol consumption (OR = 0.33, CI = 0.15–0.71), but a higher risk of being overweight/obese (OR = 2.53, CI = 1.15–5.56) in comparison with extrinsic/marginal religiosity. No significant relationship was found between religiosity and physical activity. Conclusions: In Polish immigrants, intrinsic religiosity acts as a protective factor against some cardiovascular risk factors (smoking and alcohol consumption). Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

9 pages, 263 KiB

Open AccessArticle

Perspectives on the Measles, Mumps and Rubella Vaccination among Somali Mothers in Stockholm

by Asha Jama, Mona Ali, Ann Lindstrand, Robb Butler and Asli Kulane

Int. J. Environ. Res. Public Health 2018, 15(11), 2428; https://doi.org/10.3390/ijerph15112428 - 1 Nov 2018

Cited by 33 | Viewed by 7816

Abstract

Background: Vaccination hesitancy and skepticism among parents hinders progress in achieving full vaccination coverage. Swedish measles, mumps and rubella (MMR) vaccine coverage is high however some areas with low vaccination coverage risk outbreaks. This study aimed to explore factors influencing the decision [...] Read more.

Background: Vaccination hesitancy and skepticism among parents hinders progress in achieving full vaccination coverage. Swedish measles, mumps and rubella (MMR) vaccine coverage is high however some areas with low vaccination coverage risk outbreaks. This study aimed to explore factors influencing the decision of Somali parents living in the Rinkeby and Tensta districts of Stockholm, Sweden, on whether or not to vaccinate their children with the measles, mumps and rubella (MMR) vaccine. Method: Participants were 13 mothers of at least one child aged 18 months to 5 years, who were recruited using snowball sampling. In-depth interviews were conducted in Somali and Swedish languages and the data generated was analysed using qualitative content analysis. Both written and verbal informed consent were obtained from participants. Results: Seven of the mothers had not vaccinated their youngest child at the time of the study and decided to postpone the vaccination until their child became older (delayers). The other six mothers had vaccinated their child for MMR at the appointed time (timely vaccinators). The analysis of the data revealed two main themes: (1) barriers to vaccinate on time, included issues surrounding fear of the child not speaking and unpleasant encounters with nurses and (2) facilitating factors to vaccinate on time, included heeding vaccinating parents’ advice, trust in nurses and trust in God. The mothers who had vaccinated their children had a positive impact in influencing other mothers to also vaccinate. Conclusions: Fear, based on the perceived risk that vaccination will lead to autism, among Somali mothers in Tensta and Rinkeby is evident and influenced by the opinions of friends and relatives. Child Healthcare Center nurses are important in the decision-making process regarding acceptance of MMR vaccination. There is a need to address mothers’ concerns regarding vaccine safety while improving the approach of nurses as they address these concerns. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

18 pages, 325 KiB

Open AccessArticle

Exploring Risk Factors Affecting the Mental Health of Refugee Women Living with HIV

by Agata Vitale and Judy Ryde

Int. J. Environ. Res. Public Health 2018, 15(10), 2326; https://doi.org/10.3390/ijerph15102326 - 22 Oct 2018

Cited by 12 | Viewed by 7144

Abstract

Little is known about how the intersection of being a forced migrant and living with HIV can contribute to the development or exacerbation of pre-existing mental conditions. This study is set in this context and it aims to explore specific risk factors affecting [...] Read more.

Little is known about how the intersection of being a forced migrant and living with HIV can contribute to the development or exacerbation of pre-existing mental conditions. This study is set in this context and it aims to explore specific risk factors affecting the mental health of refugee women living with HIV. A total of eight refugee women living with HIV took part in the study; they were individually interviewed, and their transcripts were thematically analyzed. The overall findings indicated that participants’ mental health was impaired by multiple stressors associated with their conditions, such as racial discrimination, HIV-related stigma, including from health professionals, loneliness, and resettlement adversities. These all represent threats to public health, as they discourage individuals from engaging with adequate health/mental health services. Despite their situation, participants had not received psychological interventions and their healthcare was reduced to managing the physical symptoms of HIV. Participants indicated their need to take part in group interventions that could promote their mental health and social recovery. These findings are relevant to raising awareness about the specific risk factors affecting refugee women living with HIV and to provide evidence for public health interventions based on this specific population’s need. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

14 pages, 770 KiB

Open AccessArticle

Fruit and Vegetable Consumption among Immigrants in Portugal: A Nationwide Cross-Sectional Study

by Liliane Costa, Sónia Dias and Maria Do Rosário O. Martins

Int. J. Environ. Res. Public Health 2018, 15(10), 2299; https://doi.org/10.3390/ijerph15102299 - 19 Oct 2018

Cited by 6 | Viewed by 4662

Abstract

This study aims to compare adequate fruit and vegetable (F&V) intake between immigrants and natives in Portugal, and to analyse factors associated with consumption of F&V among immigrants. Data from a population based cross-sectional study (2014) was used. The final sample comprised 17,410 [...] Read more.

This study aims to compare adequate fruit and vegetable (F&V) intake between immigrants and natives in Portugal, and to analyse factors associated with consumption of F&V among immigrants. Data from a population based cross-sectional study (2014) was used. The final sample comprised 17,410 participants (≥20 years old), of whom 7.4% were immigrants. Chi-squared tests and logistic regression models were conducted to investigate the association between adequate F&V intake, sociodemographic, anthropometric, and lifestyle characteristics. Adequate F&V intake was more prevalent among immigrants (21.1% (95% CI: 19.0–23.4)) than natives (18.5% (95% CI: 17.9–19.1)), (p = 0.000). Association between migrant status and adequate F&V intake was only evident for men: immigrants were less likely to achieve an adequate F&V intake (OR = 0.67, 95% CI = 0.66–0.68) when compared to Portuguese. Among immigrants, being female, older, with a higher education, and living in a low urbanisation area increased the odds of having F&V consumption closer to the recommendations. Adjusting for other factors, length of residence appears as a risk factor (15 or more years vs. 0–9 years: OR = 0.52, 95% CI = 0.50–0.53), (p = 0.000) for adequate F&V intake. Policies aiming to promote adequate F&V consumption should consider both populations groups, and gender-based strategies should address proper sociodemographic, anthropometric, and lifestyle determinants. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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9 pages, 1370 KiB

Open AccessArticle

Healthcare Utilization in a Large Cohort of Asylum Seekers Entering Western Europe in 2015

by Martin Wetzke, Christine Happle, Annabelle Vakilzadeh, Diana Ernst, Georgios Sogkas, Reinhold E. Schmidt, Georg M. N. Behrens, Christian Dopfer and Alexandra Jablonka

Int. J. Environ. Res. Public Health 2018, 15(10), 2163; https://doi.org/10.3390/ijerph15102163 - 1 Oct 2018

Cited by 23 | Viewed by 3981

Abstract

During the current period of immigration to Western Europe, national healthcare systems are confronted with high numbers of asylum seekers with largely unknown health status. To improve care taking strategies, we assessed healthcare utilization in a large, representative cohort of newly arriving migrants [...] Read more.

During the current period of immigration to Western Europe, national healthcare systems are confronted with high numbers of asylum seekers with largely unknown health status. To improve care taking strategies, we assessed healthcare utilization in a large, representative cohort of newly arriving migrants consisting of n = 1533 residents of a reception center in Northern Germany in 2015. Most asylum seekers were young, male adults, and the majority came from the Eastern Mediterranean region. Overall, we observed a frequency of 0.03 visits to the onsite primary healthcare ward per asylum seeker and day of camp residence (IQR 0.0–0.07, median duration of residence 38.0 days, IQR 30.0–54.25). Female asylum seekers showed higher healthcare utilization rates than their male counterparts, and healthcare utilization was particularly low in asylum seekers in their second decade of life. Furthermore, a significant correlation between time after camp entrance and healthcare utilization behavior occurred: During the first week of camp residence, 37.1 visits/100 asylum seekers were observed, opposed to only 9.5 visits/100 asylum seekers during the sixth week of camp residence. This first data on healthcare utilization in a large, representative asylum seeker cohort entering Western Europe during the current crisis shows that primary care is most needed in the first period directly after arrival. Our dataset may help to raise awareness for refugee and migrant healthcare needs and to adapt care taking strategies accordingly. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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11 pages, 674 KiB

Open AccessArticle

Emergency Department Discharge Outcome and Psychiatric Consultation in North African Patients

by Osnat Keidar, Sabrina N. Jegerlehner, Stephan Ziegenhorn, Adam D. Brown, Martin Müller, Aristomenis K. Exadaktylos and David S. Srivastava

Int. J. Environ. Res. Public Health 2018, 15(9), 2033; https://doi.org/10.3390/ijerph15092033 - 17 Sep 2018

Cited by 3 | Viewed by 3882

Abstract

Studies in Europe have found that immigrants, compared to the local population, are more likely to seek out medical care in Emergency Departments (EDs). In addition, studies show that immigrants utilize medical services provided by EDs for less acute issues. Despite these observed [...] Read more.

Studies in Europe have found that immigrants, compared to the local population, are more likely to seek out medical care in Emergency Departments (EDs). In addition, studies show that immigrants utilize medical services provided by EDs for less acute issues. Despite these observed differences, little is known about the characteristics of ED use by North African (NA) immigrants. The main objective of this study was to examine whether there were differences in ED discharge outcomes and psychiatric referrals between NA immigrants and Swiss nationals. A retrospective analysis was conducted using patient records from NA and Swiss adults who were admitted to the ED of the University Hospital in Bern (Switzerland) from 2013–2016. Measures included demographic information as well as data on types of admission. Outcome variables included discharge type and psychiatric referral. A total of 77,619 patients generated 116,859 consultations to the ED, of which 1.1 per cent (n = 1338) were consultations by NA patients. Compared to Swiss national patients, NA patients were younger, with a median age of 38.0 (IQR 28–51 years vs. 52.0 (IQR 32–52) for Swiss and predominantly male (74.4% vs. 55.6% in the Swiss). NA patient admission type was more likely to be “walk-in” or legal admission (7.5% vs 0.8 in Swiss,). Logistic regressions indicated that NA patients had 1.2 times higher odds (95% CI 1.07–1.40, p < 0.003) of receiving ambulatory care. An effect modification by age group and sex was observed for the primary outcome “seen by a psychiatrist”, especially for men in the 16–25 years age group, whereby male NA patients had 3.45 times higher odds (95% CI: 2.22–5.38) of having being seen by a psychiatrist. In conclusion differences were observed between NA and Swiss national patients in ED consultations referrals and outcomes, in which NA had more ambulatory discharges and NA males, especially young, were more likely to have been seen by psychiatrist. Future studies would benefit from identifying those factors underlying these differences in ED utilization. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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13 pages, 787 KiB

Open AccessArticle

by Christian Dopfer, Annabelle Vakilzadeh, Christine Happle, Evelyn Kleinert, Frank Müller, Diana Ernst, Reinhold E. Schmidt, Georg M. N. Behrens, Sonja Merkesdal, Martin Wetzke and Alexandra Jablonka

Int. J. Environ. Res. Public Health 2018, 15(9), 1934; https://doi.org/10.3390/ijerph15091934 - 5 Sep 2018

Cited by 25 | Viewed by 6059

Abstract

Background: Immigration into Europe has reached an all-time high. Provision of coordinated healthcare, especially to refugee women that are at increased risk for adverse pregnancy outcomes, is a challenge for receiving health care systems. Methods: We assessed pregnancy rates and associated primary healthcare [...] Read more.

Background: Immigration into Europe has reached an all-time high. Provision of coordinated healthcare, especially to refugee women that are at increased risk for adverse pregnancy outcomes, is a challenge for receiving health care systems. Methods: We assessed pregnancy rates and associated primary healthcare needs in three refugee cohorts in Northern Germany during the current crisis. Results: Out of n = 2911 refugees, 18.0% were women of reproductive age, and 9.1% of these were pregnant. Pregnancy was associated with a significant, 3.7-fold increase in primary health care utilization. Language barrier and cultural customs impeded healthcare to some refugee pregnant women. The most common complaints were demand for pregnancy checkup without specific symptoms (48.6%), followed by abdominal pain or urinary tract infections (in 11.4% of cases each). In 4.2% of pregnancies, severe complications such as syphilis or suicide attempts occurred. Discussion: We present data on pregnancy rates and pregnancy associated medical need in three current refugee cohorts upon arrival in Germany. Healthcare providers should be particularly aware of the requirements of pregnant migrants and should adapt primary caretaking strategies accordingly. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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13 pages, 1999 KiB

Open AccessArticle

Increased Urgent Care Center Visits by Southeast European Migrants: A Retrospective, Controlled Trial from Switzerland

by Jolanta Klukowska-Röetzler, Maria Eracleous, Martin Müller, David S. Srivastava, Gert Krummrey, Osnat Keidar and Aristomenis K. Exadaktylos

Int. J. Environ. Res. Public Health 2018, 15(9), 1857; https://doi.org/10.3390/ijerph15091857 - 28 Aug 2018

Cited by 7 | Viewed by 4912

Abstract

We investigated whether immigrants from Southeast Europe (SE) and Swiss patients have different reasons for visiting the emergency department (ED). Our retrospective data analysis for the years 2013–2017 describes the pattern of ED consultations for immigrants from SE living in Switzerland (Canton Bern), [...] Read more.

We investigated whether immigrants from Southeast Europe (SE) and Swiss patients have different reasons for visiting the emergency department (ED). Our retrospective data analysis for the years 2013–2017 describes the pattern of ED consultations for immigrants from SE living in Switzerland (Canton Bern), in comparison with Swiss nationals, with a focus on type of referral and reason for admission. A total of 153,320 Swiss citizens and 12,852 immigrants from SE were included in the study. The mean age was 51.30 (SD = 21.13) years for the Swiss patients and 39.70 (SD = 15.87) years for the SE patients. For some countries of origin (Albania, Bosnia and Herzegovina, and Turkey), there were highly statistically significant differences in sex distribution, with a predominance of males. SE immigrants had a greater proportion of patients in the lower triage level (level 3: SE: 67.3% vs. Swiss: 56.0%) and a greater proportion of patients in the high triage level than the Swiss population (level 1: SE: 3.4% vs. Swiss: 8.8%). SE patients of working age (16–65 years) were six times more often admitted by ambulance than older (≥65 years) SE patients, whereas this ratio was similar in the Swiss population. In both groups, the fast track service was primarily used for patients of working age (<65) and more than three times more often in the SE than the Swiss group (SE: 39.1%, Swiss: 12.6%). We identified some indications for access to primary care in emergency departments for immigrants and highlighted the need for attention to the role of organizational characteristics of primary health care in Switzerland. We highlighted the need for professional support to improve the quality of healthcare for immigrants. In the future, we will need more primary care services and general practitioners with a migrant background. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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8 pages, 292 KiB

Open AccessArticle

by Subin Park, Soo Jung Rim and Jin Yong Jun

Int. J. Environ. Res. Public Health 2018, 15(8), 1694; https://doi.org/10.3390/ijerph15081694 - 9 Aug 2018

Cited by 15 | Viewed by 3953

Abstract

This study investigated the factors associated with suicidal ideation among 174 North Korean refugees (aged 13–27 years) residing in South Korea. Specifically, we compared sociodemographic, familial, social, and psychological characteristics between participants with and without suicidal ideation. Twenty-nine refugees (16.7%) had exhibited suicidal [...] Read more.

This study investigated the factors associated with suicidal ideation among 174 North Korean refugees (aged 13–27 years) residing in South Korea. Specifically, we compared sociodemographic, familial, social, and psychological characteristics between participants with and without suicidal ideation. Twenty-nine refugees (16.7%) had exhibited suicidal ideation in the past 12 months. These refugees had significantly lower levels of familial cohesion (U = 1459.0; p < 0.001), self-esteem (U = 1032.0; p < 0.001), and resilience (U = 1190.0; p < 0.001), as well as higher levels of expressional suppression (U = 1202.5; p < 0.001) and post-traumatic stress disorder symptoms (U = 1303.0; p = 0.001), (with Cohen’s d > 0.5), compared to those without suicidal ideation. A multiple logistic regression analysis showed that the level of emotional suppression and familial cohesion were significantly associated with suicidal ideation, after controlling for the other variables. Familial and individual interventions, particularly those focused on encouraging emotional expression and familial cohesion, will be useful for North Korean refugee youth, who have a high risk of suicide. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

10 pages, 767 KiB

Open AccessArticle

Obesity Inequalities According to Place of Birth: The Role of Education

by Elena Rodriguez-Alvarez, Nerea Lanborena and Luisa N. Borrell

Int. J. Environ. Res. Public Health 2018, 15(8), 1620; https://doi.org/10.3390/ijerph15081620 - 31 Jul 2018

Cited by 4 | Viewed by 5100

Abstract

This study examined obesity inequalities according to place of birth and educational attainment in men and in women in Spain. A cross-sectional study was conducted using data from the Spanish National Health Survey 2011–2012 and from the European Health Survey in Spain 2014. [...] Read more.

This study examined obesity inequalities according to place of birth and educational attainment in men and in women in Spain. A cross-sectional study was conducted using data from the Spanish National Health Survey 2011–2012 and from the European Health Survey in Spain 2014. We used data for 27,720 adults aged 18–64 years of whom 2431 were immigrants. We used log-binomial regression to quantify the association of place of birth with obesity before and after adjusting for the selected characteristics in women and in men. We found a greater probability of obesity in immigrant women (PR: 1.42; 95% CI: 1.22–1.64) and a lower probability of obesity in immigrant men (PR: 0.73; 95% CI: 0.59–0.89) relative to natives after adjustment. Significant heterogeneity was observed for the association of place of birth and obesity according to education in men (p-interactions = 0.002): Men with lower educational levels (PR: 0.47; 95% CI: 0.26–0.83) have a protective effect against obesity compared with their native counterparts. This study suggests that place of birth may affect obesity in women and in men. However, this effect may be compounded with education differently for women and men. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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9 pages, 286 KiB

Open AccessArticle

Upon Rejection: Psychiatric Emergencies of Failed Asylum Seekers

by Georgios Schoretsanitis, Dinesh Bhugra, Sarah Eisenhardt, Meret E. Ricklin, David S. Srivastava, Aristomenis Exadaktylos and Sebastian Walther

Int. J. Environ. Res. Public Health 2018, 15(7), 1498; https://doi.org/10.3390/ijerph15071498 - 16 Jul 2018

Cited by 12 | Viewed by 4208

Abstract

Background: The status of a refugee or asylum seeker is only recognised after legal processes. The uncertainty of these procedures or the rejection itself may severely impact mental well-being. Methods: We surveyed the patterns of psychiatric services used by patients whose applications for [...] Read more.

Background: The status of a refugee or asylum seeker is only recognised after legal processes. The uncertainty of these procedures or the rejection itself may severely impact mental well-being. Methods: We surveyed the patterns of psychiatric services used by patients whose applications for asylum had been rejected. In a retrospective investigation of admissions to the University Emergency Department in Bern, Switzerland between 1 March 2012 and 28 February 2017, we studied patients receiving a psychiatric consultation after their applications had been rejected. The primary endpoint was based on the comparison of these individuals with controls who were asylum seekers with pending asylum applications using the Mann-Whitney U test and the chi-square test (χ²) with a significance level of 0.05. Results: Thirty-eight cases were identified. There were more men than women and the mean age was 30.08 ± 9.62 years. Patients predominantly presented as walk-in patients (n = 16, 42.1%), most frequently due to suicidal ideation (n = 16, 42.1%). Stress-related disorders were the most common diagnosis (n = 29, 76.3%) and patients were mainly referred to inpatient treatment (n = 28, 73.7%). Patients with rejected applications were less likely to be living in reception centres than patients with a pending application (χ² = 17.98, p < 0.001). Conclusion: The profile of asylum seekers whose applications had been rejected reflects individuals with high-stress levels, potentially aggravated by the negative asylum decision. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

7 pages, 256 KiB

Open AccessArticle

Verbal and Non-Verbal Aggression in a Swiss University Emergency Room: A Descriptive Study

by Dominic Kaeser, Rebekka Guerra, Osnat Keidar, Urs Lanz, Michael Moses, Christian Kobel, Aristomenis K. Exadaktylos and Meret E. Ricklin

Int. J. Environ. Res. Public Health 2018, 15(7), 1423; https://doi.org/10.3390/ijerph15071423 - 6 Jul 2018

Cited by 17 | Viewed by 4712

Abstract

Workplace violence (WPV) by patients and visitors is a hazard in many emergency departments (ED), with serious consequences for both staff and patients. Patients with a migratory background seem to be prone to being involved in WPV. We therefore reviewed all reports of [...] Read more.

Workplace violence (WPV) by patients and visitors is a hazard in many emergency departments (ED), with serious consequences for both staff and patients. Patients with a migratory background seem to be prone to being involved in WPV. We therefore reviewed all reports of ED staff who experienced WPV over a 4-year period (2013–2016). We analyzed data on the reasons for the incident, the time of day, the manner of violence, the consequences, and the migratory background of the aggressor. In total, 83 cases of WPV were reported over a four-year period. The average age of the violent person was 33.1 years; in 35 cases (42.0%), aggressors were younger than 30 years old, 53 (63.8%) were male, 49 (59%) were of Swiss nationality, and 35–40% had a migratory background. The odds ratio of people originating from a low- to middle-income country versus those originating from a high-income country was 1.8. Furthermore, 45.8% of the patients arrived by ambulance (n = 38) and 19 patients (22.9%) were self-presenting. Most cases (92.8%) involved verbal aggression, but in more than half of the cases, physical assault (56.6%) was also reported. In addition, 43 (51.8%) of the events occurred during the night. Results also showed that 42 (50.6%) of patients who were involved in WPV were under the influence of alcohol and 29 (34.9%) suffered from psychiatric disorders. Security personnel and police were involved in 53 (63.9%) and 47 (56.6%) cases, respectively. Twenty patients (24.1%) were sedated and 16 (19.3%) were restrained. In 18 cases (21.7%), the psychiatrist ordered compulsory hospitalization in a psychiatric institution. Taken together, WPV is a relatively common event in our ED and persons with a migratory background are involved more often relative to their frequency of ED visits. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

10 pages, 627 KiB

Open AccessArticle

Psychiatric Emergencies of Asylum Seekers; Descriptive Analysis and Comparison with Immigrants of Warranted Residence

by Georgios Schoretsanitis, Sarah Eisenhardt, Meret E. Ricklin, David S. Srivastava, Sebastian Walther and Aristomenis Exadaktylos

Int. J. Environ. Res. Public Health 2018, 15(7), 1300; https://doi.org/10.3390/ijerph15071300 - 21 Jun 2018

Cited by 8 | Viewed by 4125

Abstract

Background: The aim of our study was to assess utilization patterns of psychiatric services by asylum seekers. Methods: We included 119 adults who presented themselves at the University Emergency Department between 1 March 2012 and 1 January 2017 for psychiatric consultation. Descriptive data [...] Read more.

Background: The aim of our study was to assess utilization patterns of psychiatric services by asylum seekers. Methods: We included 119 adults who presented themselves at the University Emergency Department between 1 March 2012 and 1 January 2017 for psychiatric consultation. Descriptive data were compared with a control group of non-Swiss individuals with warranted residence permits using Mann-Whitney-U and chi square (χ²) tests. Results: Patients were mainly single, male, residing in reception centers, and presented themselves most frequently due to suicidal ideation. Almost 60% of the patients were assigned to inpatient treatments, with 28 involuntary cases. Compared to the control group, asylum seekers were younger and more often men (p < 0.001 for both). Further, they less often had family in Switzerland (χ² = 9.91, p = 0.007). The proportion of patients coming in as walk-ins was significantly higher in the control group than in asylum seekers (χ² = 37.0, p < 0.001). Asylum seekers were more frequently referred due to suicidal ideation and aggressive behavior than participants in the control group (χ² = 80.07, p < 0.001). Diagnoses for asylum seekers infrequently included mood, as they often reported stress-related disorders (χ² = 19.6, p = 0.021) and they were infrequently released home (χ² = 9.19, p = 0.027). Conclusion: Asylum seekers more frequently demonstrated severe symptoms such as suicidal ideation and aggressive behavior and they were mainly treated as inpatients, potentially due to minimal social resources. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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8 pages, 634 KiB

Open AccessArticle

Tuberculosis Specific Interferon-Gamma Production in a Current Refugee Cohort in Western Europe

by Alexandra Jablonka, Christian Dopfer, Christine Happle, Georgios Sogkas, Diana Ernst, Faranaz Atschekzei, Stefanie Hirsch, Annabelle Schäll, Adan Jirmo, Philipp Solbach, Reinhold Ernst Schmidt, Georg M. N. Behrens and Martin Wetzke

Int. J. Environ. Res. Public Health 2018, 15(6), 1263; https://doi.org/10.3390/ijerph15061263 - 14 Jun 2018

Cited by 6 | Viewed by 4274

Abstract

Background: In 2015, a high number of refugees with largely unknown health statuses immigrated to Western Europe. To improve caretaking strategies, we assessed the prevalence of latent tuberculosis infection (LTBI) in a refugee cohort. Methods: Interferon-Gamma release assays (IGRA, Quantiferon) were performed in [...] Read more.

Background: In 2015, a high number of refugees with largely unknown health statuses immigrated to Western Europe. To improve caretaking strategies, we assessed the prevalence of latent tuberculosis infection (LTBI) in a refugee cohort. Methods: Interferon-Gamma release assays (IGRA, Quantiferon) were performed in n = 232 inhabitants of four German refugee centers in the summer of 2015. Results: Most refugees were young, male adults. Overall, IGRA testing was positive in 17.9% (95% CI = 13.2–23.5%) of subjects. Positivity rates increased with age (0% <18 years versus 46.2% >50 years). Age was the only factor significantly associated with a positive IGRA in multiple regression analysis including gender, C reactive protein, hemoglobin, leukocyte, and thrombocyte count and lymphocyte, monocyte, neutrophil, basophil, and eosinophil fraction. For one year change in age, the odds are expected to be 1.06 times larger, holding all other variables constant (p = 0.015). Conclusion: Observed LTBI frequencies are lower than previously reported in similar refugee cohorts. However, as elderly people are at higher risk for developing active tuberculosis, the observed high rate of LTBI in senior refugees emphasizes the need for new policies on the detection and treatment regimens in this group. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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14 pages, 672 KiB

Open AccessArticle

Immunization Offer Targeting Migrants: Policies and Practices in Italy

by Teresa Dalla Zuanna, Martina Del Manso, Cristina Giambi, Flavia Riccardo, Antonino Bella, Maria Grazia Caporali, Maria Grazia Dente, Silvia Declich and The Italian Survey CARE Working Group

Int. J. Environ. Res. Public Health 2018, 15(5), 968; https://doi.org/10.3390/ijerph15050968 - 12 May 2018

Cited by 10 | Viewed by 4414

Abstract

The unprecedented flow of migrants over the last three years places Italy in front of new issues regarding medical care from the rescue phase up to the integration into the national health services, including preventive actions. We used online questionnaires to investigate the [...] Read more.

The unprecedented flow of migrants over the last three years places Italy in front of new issues regarding medical care from the rescue phase up to the integration into the national health services, including preventive actions. We used online questionnaires to investigate the Italian national and regional policies for immunization offer targeting asylum seekers, refugees, irregular migrants and unaccompanied minors. Another questionnaire was used to assess how these policies are translated into practice in migrant reception centres and community health services. Questionnaires were filled out at the national level, in 14 out of 21 Regions/Autonomous Provinces, and in 36 community health services and 28 migrant reception centres. Almost all responders stated that all vaccinations included in the National Immunization Plan are offered to migrant children and adolescents. The situation concerning adults is fragmented, with most of the Regions and local centres offering more vaccines than the national offer—which include polio, tetanus and measles–mumps-rubella. Data on immunized immigrants is archived at the regional/local level with different methods and not available at the national level. Further efforts to ensure consistency in vaccine provision and adequate mechanisms of exchanging data are needed to guarantee a complete vaccination offer and avoid unnecessary health actions, including unnecessary re-vaccination. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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11 pages, 624 KiB

Open AccessArticle

Impact of the Introduction of the Electronic Health Insurance Card on the Use of Medical Services by Asylum Seekers in Germany

by Kevin Claassen and Pia Jäger

Int. J. Environ. Res. Public Health 2018, 15(5), 856; https://doi.org/10.3390/ijerph15050856 - 25 Apr 2018

Cited by 19 | Viewed by 5603

Abstract

Objectives: Asylum seekers in Germany represent a highly vulnerable group from a health perspective. Furthermore, their access to healthcare is restricted. While the introduction of the Electronic Health Insurance Card (EHIC) for asylum seekers instead of healthcare-vouchers is discussed controversially using politico-economic reasons, [...] Read more.

Objectives: Asylum seekers in Germany represent a highly vulnerable group from a health perspective. Furthermore, their access to healthcare is restricted. While the introduction of the Electronic Health Insurance Card (EHIC) for asylum seekers instead of healthcare-vouchers is discussed controversially using politico-economic reasons, there is hardly any empirical evidence regarding its actual impact on the use of medical services. The aim of the study is to examine this impact on the use of medical services by asylum seekers as measured by their consultation rate of ambulant physicians (CR). Study Design: For this purpose, a standardized survey was conducted with 260 asylum seekers in different municipalities, some of which have introduced the EHIC for asylum seekers, while others have not. Methods: The period prevalence was compared between the groups “with EHIC” and “without EHIC” using a two-sided t-test. Multivariate analysis was done using a linear OLS regression model. Results: Asylum seekers in possession of the EHIC are significantly more likely to seek ambulant medical care than those receiving healthcare-vouchers. Conclusions: The results of this study suggest that having to ask for healthcare-vouchers at the social security office could be a relevant barrier for asylum seekers. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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10 pages, 1653 KiB

Open AccessArticle

Trauma and Depression among North Korean Refugees: The Mediating Effect of Negative Cognition

by Subin Park, Yeeun Lee and Jin Yong Jun

Int. J. Environ. Res. Public Health 2018, 15(4), 591; https://doi.org/10.3390/ijerph15040591 - 25 Mar 2018

Cited by 19 | Viewed by 6694

Abstract

North Korean refugees experience adaptation difficulties, along with a wide range of psychological problems. Accordingly, this study examined the associations between early traumatic experiences, negative automatic thoughts, and depression among young North Korean refugees living in South Korea. Specifically, we examined how different [...] Read more.

North Korean refugees experience adaptation difficulties, along with a wide range of psychological problems. Accordingly, this study examined the associations between early traumatic experiences, negative automatic thoughts, and depression among young North Korean refugees living in South Korea. Specifically, we examined how different factors of negative automatic thoughts would mediate the relationship between early trauma and depressive symptoms. A total of 109 North Korean refugees aged 13–29 years were recruited from two alternative schools. Our path analysis indicated that early trauma was positively linked with thoughts of personal failure, physical threat, and hostility, but not with thoughts of social threat. The link with depressive symptoms was only significant for thoughts of personal failure. After removing all non-significant pathways, the model revealed that early traumatic experiences were positively associated with depressive symptoms (ß = 0.61, 95% CI = 0.48–0.73) via thoughts of personal failure (ß = 0.17, 95% CI = 0.08–0.28), as well as directly (ß = 0.44, 95% CI = 0.27–0.59). Interventions that target negative cognitions of personal failure may be helpful for North Korean refugees at risk of depression. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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12 pages, 536 KiB

Open AccessArticle

Preparedness of Health Care Professionals for Delivering Sexual and Reproductive Health Care to Refugee and Migrant Women: A Mixed Methods Study

by Zelalem B. Mengesha, Janette Perz, Tinashe Dune and Jane Ussher

Int. J. Environ. Res. Public Health 2018, 15(1), 174; https://doi.org/10.3390/ijerph15010174 - 22 Jan 2018

Cited by 32 | Viewed by 10677

Abstract

Past research suggests that factors related to health care professionals’ (HCPs) knowledge, training and competency can contribute to the underutilisation of sexual and reproductive health (SRH) care by refugee and migrant women. The aim of this study was to examine the perceived preparedness [...] Read more.

Past research suggests that factors related to health care professionals’ (HCPs) knowledge, training and competency can contribute to the underutilisation of sexual and reproductive health (SRH) care by refugee and migrant women. The aim of this study was to examine the perceived preparedness of HCPs in relation to their knowledge, confidence and training needs when it comes to consulting refugee and migrant women seeking SRH care in Australia. A sequential mixed methods design, comprising an online survey with 79 HCPs (45.6% nurses, 30.3% general practitioners (GPs), 16.5% health promotion officers, and 7.6% allied health professionals) and semi-structured interviews with 21 HCPs, was utilised. HCPs recognised refugee and migrant women’s SRH as a complex issue that requires unique skills for the delivery of optimal care. However, they reported a lack of training (59.4% of nurses, 50% of GPs, and 38.6% of health promotion officers) and knowledge (27.8% of nurses, 20.8% of GPs, and 30.8% of health promotion officers) in addressing refugee and migrant women’s SRH. The majority of participants (88.9% of nurses, 75% of GPs, and 76% of health promotion officers) demonstrated willingness to engage with further training in refugee and migrant women’s SRH. The implications of the findings are argued regarding the need to train HCPs in culturally sensitive care and include the SRH of refugee and migrant women in university and professional development curricula in meeting the needs of this growing and vulnerable group of women. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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41 pages, 5010 KiB

Open AccessReview

Effectiveness of Screening and Treatment Approaches for Schistosomiasis and Strongyloidiasis in Newly-Arrived Migrants from Endemic Countries in the EU/EEA: A Systematic Review

by Eric N. Agbata, Rachael L. Morton, Zeno Bisoffi, Emmanuel Bottieau, Christina Greenaway, Beverley-A. Biggs, Nadia Montero, Anh Tran, Nick Rowbotham, Ingrid Arevalo-Rodriguez, Daniel T. Myran, Teymur Noori, Pablo Alonso-Coello, Kevin Pottie and Ana Requena-Méndez

Int. J. Environ. Res. Public Health 2019, 16(1), 11; https://doi.org/10.3390/ijerph16010011 - 20 Dec 2018

Cited by 54 | Viewed by 9353

Abstract

We aimed to evaluate the evidence on screening and treatment for two parasitic infections—schistosomiasis and strongyloidiasis—among migrants from endemic countries arriving in the European Union and European Economic Area (EU/EEA). We conducted a systematic search of multiple databases to identify systematic reviews and [...] Read more.

We aimed to evaluate the evidence on screening and treatment for two parasitic infections—schistosomiasis and strongyloidiasis—among migrants from endemic countries arriving in the European Union and European Economic Area (EU/EEA). We conducted a systematic search of multiple databases to identify systematic reviews and meta-analyses published between 1 January 1993 and 30 May 2016 presenting evidence on diagnostic and treatment efficacy and cost-effectiveness. We conducted additional systematic search for individual studies published between 2010 and 2017. We assessed the methodological quality of reviews and studies using the AMSTAR, Newcastle–Ottawa Scale and QUADAS-II tools. Study synthesis and assessment of the certainty of the evidence was performed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We included 28 systematic reviews and individual studies in this review. The GRADE certainty of evidence was low for the effectiveness of screening techniques and moderate to high for treatment efficacy. Antibody-detecting serological tests are the most effective screening tests for detection of both schistosomiasis and strongyloidiasis in low-endemicity settings, because they have higher sensitivity than conventional parasitological methods. Short courses of praziquantel and ivermectin were safe and highly effective and cost-effective in treating schistosomiasis and strongyloidiasis, respectively. Economic modelling suggests presumptive single-dose treatment of strongyloidiasis with ivermectin for all migrants is likely cost-effective, but feasibility of this strategy has yet to be demonstrated in clinical studies. The evidence supports screening and treatment for schistosomiasis and strongyloidiasis in migrants from endemic countries, to reduce morbidity and mortality. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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21 pages, 724 KiB

Open AccessReview

Accessibility and Acceptability of Infectious Disease Interventions Among Migrants in the EU/EEA: A CERQual Systematic Review

by Matt Driedger, Alain Mayhew, Vivian Welch, Eric Agbata, Doug Gruner, Christina Greenaway, Teymur Noori, Monica Sandu, Thierry Sangou, Christine Mathew, Harneel Kaur, Manish Pareek and Kevin Pottie

Int. J. Environ. Res. Public Health 2018, 15(11), 2329; https://doi.org/10.3390/ijerph15112329 - 23 Oct 2018

Cited by 17 | Viewed by 5936

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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13 pages, 839 KiB

Open AccessReview

Interventions to Improve Vaccination Uptake and Cost Effectiveness of Vaccination Strategies in Newly Arrived Migrants in the EU/EEA: A Systematic Review

by Charles Hui, Jessica Dunn, Rachael Morton, Lukas P. Staub, Anh Tran, Sally Hargreaves, Christina Greenaway, Beverly Ann Biggs, Robin Christensen and Kevin Pottie

Int. J. Environ. Res. Public Health 2018, 15(10), 2065; https://doi.org/10.3390/ijerph15102065 - 20 Sep 2018

Cited by 34 | Viewed by 7576

Abstract

Newly arrived migrants to the EU/EEA (arrival within the past five years), as well as other migrant groups in the region, might be under-immunised and lack documentation of previous vaccinations, putting them at increased risk of vaccine-preventable diseases circulating in Europe. We therefore [...] Read more.

Newly arrived migrants to the EU/EEA (arrival within the past five years), as well as other migrant groups in the region, might be under-immunised and lack documentation of previous vaccinations, putting them at increased risk of vaccine-preventable diseases circulating in Europe. We therefore performed a systematic review conforming to PRISMA guidelines (PROSPERO CRD42016045798) to explore: (i) interventions that improve vaccine uptake among migrants; and (ii) cost-effectiveness of vaccination strategies among this population. We searched MEDLINE, Embase, CINAHL, and Cochrane Database of Systematic Reviews (CDSR) between 1 January 2006 to 18 June 2018. We included three primary intervention studies performed in the EU/EEA or high-income countries and one cost effectiveness study relevant to vaccinations in migrants. Intervention studies showed small but promising impact only on vaccine uptake with social mobilization/community outreach, planned vaccination programs and education campaigns. Targeting migrants for catch-up vaccination is cost effective for presumptive vaccination for diphtheria, tetanus, and polio, and there was no evidence of benefit of carrying out pre-vaccination serological testing. The cost-effectiveness is sensitive to the seroprevalence and adherence to vaccinations of the migrant. We conclude that scarce but direct EU/EEA data suggest social mobilization, vaccine programs, and education campaigns are promising strategies for migrants, but more research is needed. Research should also study cost effectiveness of strategies. Vaccination of migrants should continue to be a public heath priority in EU/EEA. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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24 pages, 961 KiB

Open AccessReview

The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review

by Christina Greenaway, Iuliia Makarenko, Claire Nour Abou Chakra, Balqis Alabdulkarim, Robin Christensen, Adam Palayew, Anh Tran, Lukas Staub, Manish Pareek, Joerg J. Meerpohl, Teymur Noori, Irene Veldhuijzen, Kevin Pottie, Francesco Castelli and Rachael L. Morton

Int. J. Environ. Res. Public Health 2018, 15(9), 2013; https://doi.org/10.3390/ijerph15092013 - 14 Sep 2018

Cited by 26 | Viewed by 8126

Abstract

Chronic hepatitis C (HCV) is a public health priority in the European Union/European Economic Area (EU/EEA) and is a leading cause of chronic liver disease and liver cancer. Migrants account for a disproportionate number of HCV cases in the EU/EEA (mean 14% of [...] Read more.

Chronic hepatitis C (HCV) is a public health priority in the European Union/European Economic Area (EU/EEA) and is a leading cause of chronic liver disease and liver cancer. Migrants account for a disproportionate number of HCV cases in the EU/EEA (mean 14% of cases and >50% of cases in some countries). We conducted two systematic reviews (SR) to estimate the effectiveness and cost-effectiveness of HCV screening for migrants living in the EU/EEA. We found that screening tests for HCV are highly sensitive and specific. Clinical trials report direct acting antiviral (DAA) therapies are well-tolerated in a wide range of populations and cure almost all cases (>95%) and lead to an 85% lower risk of developing hepatocellular carcinoma and an 80% lower risk of all-cause mortality. At 2015 costs, DAA based regimens were only moderately cost-effective and as a result less than 30% of people with HCV had been screened and less 5% of all HCV cases had been treated in the EU/EEA in 2015. Migrants face additional barriers in linkage to care and treatment due to several patient, practitioner, and health system barriers. Although decreasing HCV costs have made treatment more accessible in the EU/EEA, HCV elimination will only be possible in the region if health systems include and treat migrants for HCV. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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17 pages, 350 KiB

Open AccessReview

Prevalence of Sexual Violence in Migrants, Applicants for International Protection, and Refugees in Europe: A Critical Interpretive Synthesis of the Evidence

by Lotte De Schrijver, Tom Vander Beken, Barbara Krahé and Ines Keygnaert

Int. J. Environ. Res. Public Health 2018, 15(9), 1979; https://doi.org/10.3390/ijerph15091979 - 11 Sep 2018

Cited by 50 | Viewed by 8346

Abstract

(1) Background: Sexual violence (SV) is a major public health problem, with negative socio-economic, physical, mental, sexual, and reproductive health consequences. Migrants, applicants for international protection, and refugees (MARs) are vulnerable to SV. Since many European countries are seeing high migratory pressure, [...] Read more.

(1) Background: Sexual violence (SV) is a major public health problem, with negative socio-economic, physical, mental, sexual, and reproductive health consequences. Migrants, applicants for international protection, and refugees (MARs) are vulnerable to SV. Since many European countries are seeing high migratory pressure, the development of prevention strategies and care paths focusing on victimised MARs is highly needed. To this end, this study reviews evidence on the prevalence of SV among MAR groups in Europe and the challenges encountered in research on this topic. (2) Methods: A critical interpretive synthesis of 25 peer-reviewed academic studies and 22 relevant grey literature documents was conducted based on a socio-ecological model. (3) Results: Evidence shows that SV is highly frequent in MARs in Europe, yet comparison with other groups is still difficult. Methodologically and ethically sound representative studies comparing between populations are still lacking. Challenges in researching SV in MARs are located at the intrapersonal, interpersonal, community, societal, and policy levels. (4) Conclusions: Future research should start with a clear definition of the concerned population and acts of SV to generate comparable data. Participatory qualitative research approaches could be applied to better grasp the complexity of interplaying determinants of SV in MARs. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

19 pages, 953 KiB

Open AccessReview

The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review

by Daniel T Myran, Rachael Morton, Beverly-Ann Biggs, Irene Veldhuijzen, Francesco Castelli, Anh Tran, Lukas P Staub, Eric Agbata, Prinon Rahman, Manish Pareek, Teymur Noori and Kevin Pottie

Int. J. Environ. Res. Public Health 2018, 15(9), 1898; https://doi.org/10.3390/ijerph15091898 - 1 Sep 2018

Cited by 27 | Viewed by 8430

Abstract

Migrants from hepatitis B virus (HBV) endemic countries to the European Union/European Economic Area (EU/EEA) comprise 5.1% of the total EU/EEA population but account for 25% of total chronic Hepatitis B (CHB) infection. Migrants from high HBV prevalence regions are at the highest [...] Read more.

Migrants from hepatitis B virus (HBV) endemic countries to the European Union/European Economic Area (EU/EEA) comprise 5.1% of the total EU/EEA population but account for 25% of total chronic Hepatitis B (CHB) infection. Migrants from high HBV prevalence regions are at the highest risk for CHB morbidity. These migrants are at risk of late detection of CHB complications; mortality and onwards transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of CHB screening and vaccination programs among migrants to the EU/EEA. We found no RCTs or direct evidence evaluating the effectiveness of CHB screening on morbidity and mortality of migrants. We therefore used a systematic evidence chain approach to identify studies relevant to screening and prevention programs; testing, treatment, and vaccination. We identified four systematic reviews and five additional studies and guidelines that reported on screening and vaccination effectiveness. Studies reported that vaccination programs were highly effective at reducing the prevalence of CHB in children (RR 0.07 95% CI 0.04 to 0.13) following vaccination. Two meta-analyses of therapy for chronic HBV infection found improvement in clinical outcomes and intermediate markers of disease. We identified nine studies examining the cost-effectiveness of screening for CHB: a strategy of screening and treating CHB compared to no screening. The median acceptance of HB screening was 87.4% (range 32.3–100%). Multiple studies highlighted barriers to and the absence of effective strategies to ensure linkage of treatment and care for migrants with CHB. In conclusion, screening of high-risk children and adults and vaccination of susceptible children, combined with treatment of CHB infection in migrants, are promising and cost-effective interventions, but linkage to treatment requires more attention. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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18 pages, 2315 KiB

Open AccessReview

Impact of the Refugee Crisis on the Greek Healthcare System: A Long Road to Ithaca

by Ourania S. Kotsiou, Panagiotis Kotsios, David S. Srivastava, Vaios Kotsios, Konstantinos I. Gourgoulianis and Aristomenis K. Exadaktylos

Int. J. Environ. Res. Public Health 2018, 15(8), 1790; https://doi.org/10.3390/ijerph15081790 - 20 Aug 2018

Cited by 40 | Viewed by 12993

Abstract

Greece is the country of “Xenios Zeus”, the Ancient Greek god of foreigners and hospitality; however, it is also the main point of entry to Europe. Since the beginning of 2014, 1,112,332 refugees crossed the borders of Greece. Overall, 33,677 children and adolescent [...] Read more.

Greece is the country of “Xenios Zeus”, the Ancient Greek god of foreigners and hospitality; however, it is also the main point of entry to Europe. Since the beginning of 2014, 1,112,332 refugees crossed the borders of Greece. Overall, 33,677 children and adolescent refugees sought asylum in Greece from 2013 to 2017, while 57,042 refugees are currently being hosted. The rapid entry of refugees into Greece raised the critical issue of health policy. The Greek National Health Service (NHS) faces many challenges. Adequate economic and human support is essential if this situation is to be managed successfully. However, Greece still bears the burden of the economic downturn since 2009. In fact, the crisis led to shortages in crucial equipment, and unmet health needs for both locals and refugees. The NHS deals with traumatic experiences, as well as cultural and linguistic differences. Overcrowded reception centers and hotspots are highly demanding and are associated with severe disease burden. This highlights the importance of guidelines for medical screening, healthcare provision, and a well-managed transition to definitive medical facilities. Furthermore, non-governmental organizations make an essential contribution by ensuring appropriate support to refugee minors, especially when they experience poor access to the NHS. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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23 pages, 1708 KiB

Open AccessReview

The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review

by Kevin Pottie, Tamara Lotfi, Lama Kilzar, Pamela Howeiss, Nesrine Rizk, Elie A. Akl, Sonia Dias, Beverly-Ann Biggs, Robin Christensen, Prinon Rahman, Olivia Magwood, Anh Tran, Nick Rowbotham, Anastasia Pharris, Teymur Noori, Manish Pareek and Rachael Morton

Int. J. Environ. Res. Public Health 2018, 15(8), 1700; https://doi.org/10.3390/ijerph15081700 - 9 Aug 2018

Cited by 28 | Viewed by 7449

Abstract

Migrants, defined as individuals who move from their country of origin to another, account for 40% of newly-diagnosed cases of human immunodeficiency virus (HIV) in the European Union/European Economic Area (EU/EEA). Populations at high risk for HIV include migrants, from countries or living [...] Read more.

Migrants, defined as individuals who move from their country of origin to another, account for 40% of newly-diagnosed cases of human immunodeficiency virus (HIV) in the European Union/European Economic Area (EU/EEA). Populations at high risk for HIV include migrants, from countries or living in neighbourhoods where HIV is prevalent, and those participating in high risk behaviour. These migrants are at risk of low CD4 counts at diagnosis, increased morbidity, mortality, and onward transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of HIV testing strategies in migrant populations and to estimate their effect on testing uptake, mortality, and resource requirements. Following a systematic overview, we included four systematic reviews on the effectiveness of strategies in non-migrant populations and inferred their effect on migrant populations, as well as eight individual studies on cost-effectiveness/resource requirements. We assessed the certainty of our results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The systematic reviews reported that HIV tests are highly accurate (rapid test >90% sensitivity, Western blot and ELISA >99% sensitivity). A meta-analysis showed that rapid testing approaches improve the access and uptake of testing (risk ratio = 2.95, 95% CI: 1.69 to 5.16), and were associated with a lower incidence of HIV in the middle-aged women subgroup among marginalised populations at a high risk of HIV exposure and HIV related stigma. Economic evidence on rapid counselling and testing identified strategic advantages with rapid tests. In conclusion, community-based rapid testing programmes may have the potential to improve uptake of HIV testing among migrant populations across a range of EU/EEA settings. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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12 pages, 410 KiB

Open AccessReview

A Systematic Review of Sexual and Reproductive Health Knowledge, Experiences and Access to Services among Refugee, Migrant and Displaced Girls and Young Women in Africa

by Olena Ivanova, Masna Rai and Elizabeth Kemigisha

Int. J. Environ. Res. Public Health 2018, 15(8), 1583; https://doi.org/10.3390/ijerph15081583 - 26 Jul 2018

Cited by 113 | Viewed by 18646

Abstract

Adolescent girls and young women are an overlooked group within conflict- or disaster-affected populations, and their sexual and reproductive health (SRH) needs are often neglected. Existing evidence shows that forced migration and human mobility make girls and women more vulnerable to poor SRH [...] Read more.

Adolescent girls and young women are an overlooked group within conflict- or disaster-affected populations, and their sexual and reproductive health (SRH) needs are often neglected. Existing evidence shows that forced migration and human mobility make girls and women more vulnerable to poor SRH outcomes such as high risk sexual behaviors, lack of contraception use, STIs and HIV/AIDS. We performed a systematic literature review to explore knowledge, experiences and access to SRH services in this population group across the African continent. Two databases (PubMed and Web of Science) were searched and from 896 identified publications, 15 peer-reviewed articles published in English met the inclusion criteria for this review. These consisted of eight applied qualitative, five quantitative and two mixed-method study designs. The quality of the studies was evaluated by the mixed-methods appraisal tool (MMAT) using scores in percentages (0–100%). Available evidence indicates that knowledge of young women and girls regarding contraceptive methods, STIs and HIV/AIDS are limited. This population group often experiences gender-based and sexual violence and abuse. The access and availability of SRH services are often limited due to distances, costs and stigma. This review demonstrates that there is still a dearth of peer-reviewed literature on SRH related aspects among refugee, migrant and displaced girls and young women in Africa. The data disaggregation by sex and age should be emphasized for future research in this field. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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22 pages, 488 KiB

Open AccessReview

Sexual Health Help-Seeking Behavior among Migrants from Sub-Saharan Africa and South East Asia living in High Income Countries: A Systematic Review

by Donna Angelina Rade, Gemma Crawford, Roanna Lobo, Corie Gray and Graham Brown

Int. J. Environ. Res. Public Health 2018, 15(7), 1311; https://doi.org/10.3390/ijerph15071311 - 22 Jun 2018

Cited by 45 | Viewed by 8806

Abstract

The number of migrants has increased globally. This phenomenon has contributed to increasing health problems amongst migrants in high-income countries, including vulnerability for HIV acquisition and other sexual health issues. Adaptation processes in destination countries can present difficulties for migrants to seek help [...] Read more.

The number of migrants has increased globally. This phenomenon has contributed to increasing health problems amongst migrants in high-income countries, including vulnerability for HIV acquisition and other sexual health issues. Adaptation processes in destination countries can present difficulties for migrants to seek help from and gain access to health services. This study examined migrants’ from sub-Saharan Africa (SSA) and South East Asia (SEA) sexual health help-seeking behavior in high-income countries with universal health coverage. The systematic review followed PRISMA guidelines and was registered with PROSPERO. Several databases were searched from 2000 to 2017. Of 2824 studies, 15 met the inclusion criteria. These consisted of 12 qualitative and three quantitative studies conducted in Australia, Spain, the United Kingdom, Belgium, Scotland, Ireland, and Sweden. Migrants experienced a range of difficulties accessing health services, specifically those related to sexual health, in high-income countries. Few studies described sources of sexual health help-seeking or facilitators to help-seeking. Barriers to access were numerous, including: stigma, direct and indirect costs, difficulty navigating health systems in destination countries and lack of cultural competency within health services. More culturally secure health services, increased health service literacy and policy support to mitigate costs, will improve health service access for migrants from SSA and SEA. Addressing the structural drivers for stigma and discrimination remains an ongoing and critical challenge. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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16 pages, 1975 KiB

Open AccessReview

Key Dimensions for the Prevention and Control of Communicable Diseases in Institutional Settings: A Scoping Review to Guide the Development of a Tool to Strengthen Preparedness at Migrant Holding Centres in the EU/EEA

by Flavia Riccardo, Jonathan E. Suk, Laura Espinosa, Antonino Bella, Cristina Giambi, Martina Del Manso, Christian Napoli, Maria Grazia Dente, Gloria Nacca and Silvia Declich

Int. J. Environ. Res. Public Health 2018, 15(6), 1120; https://doi.org/10.3390/ijerph15061120 - 30 May 2018

Cited by 10 | Viewed by 7924

Abstract

Migrant centres, as other institutions hosting closed or semi-open communities, may face specific challenges in preventing and controlling communicable disease transmission, particularly during times of large sudden influx. However, there is dearth of evidence on how to prioritise investments in aspects such as [...] Read more.

Migrant centres, as other institutions hosting closed or semi-open communities, may face specific challenges in preventing and controlling communicable disease transmission, particularly during times of large sudden influx. However, there is dearth of evidence on how to prioritise investments in aspects such as human resources, medicines and vaccines, sanitation and disinfection, and physical infrastructures to prevent/control communicable disease outbreaks. We analysed frequent drivers of communicable disease transmission/issues for outbreak management in institutions hosting closed or semi-open communities, including migrant centres, and reviewed existing assessment tools to guide the development of a European Centre for Disease Prevention and Control (ECDC) checklist tool to strengthen preparedness against communicable disease outbreaks in migrant centres. Among articles/reports focusing specifically on migrant centres, outbreaks through multiple types of disease transmission were described as possible/occurred. Human resources and physical infrastructure were the dimensions most frequently identified as crucial for preventing and mitigating outbreaks. This review also recognised a lack of common agreed standards to guide and assess preparedness activities in migrant centres, thereby underscoring the need for a capacity-oriented ECDC preparedness checklist tool. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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322 KiB

Open AccessReview

Infant Feeding Beliefs, Attitudes, Knowledge and Practices of Chinese Immigrant Mothers: An Integrative Review of the Literature

by Ana Cristina Lindsay, Qun Le and Mary L. Greaney

Int. J. Environ. Res. Public Health 2018, 15(1), 21; https://doi.org/10.3390/ijerph15010021 - 23 Dec 2017

Cited by 22 | Viewed by 7503

Abstract

Chinese are a fast-growing immigrant population group in several parts of the world (e.g., Australia, Canada, Europe, Southeast Asia, United States). Research evidence suggests that compared to non-Hispanic whites, individuals of Asian-origin including Chinese are at higher risk of developing cardiovascular disease and [...] Read more.

Chinese are a fast-growing immigrant population group in several parts of the world (e.g., Australia, Canada, Europe, Southeast Asia, United States). Research evidence suggests that compared to non-Hispanic whites, individuals of Asian-origin including Chinese are at higher risk of developing cardiovascular disease and type 2 diabetes at a lower body mass index (BMI). These risks may be possibly due to genetic differences in body composition and metabolic responses. Despite the increasing numbers of Chinese children growing up in immigrant families and the increasing prevalence of obesity among Chinese, little research has been focused on children of Chinese immigrant families. This integrative review synthesizes the evidence on infant feeding beliefs, attitudes, knowledge and practices of Chinese immigrant mothers; highlights limitations of available research; and offers suggestions for future research. Using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we searched four electronic academic/research databases (CINAHL, Medline, PsycINFO, and PubMed) to identify peer-reviewed, full-text papers published in English between January 2000 and September 2017. Only studies with mothers 18+ years old of normally developing infants were included. Of the 797 citations identified, 15 full-text papers were retrieved and 11 studies (8 cross-sectional studies, 3 qualitative studies) met the inclusion criteria and were included in this review. Reviewed studies revealed high initiation rates of breastfeeding, but sharp declines in breastfeeding rates by six months of age. In addition, reviewed studies revealed that the concomitantly use of breast milk and formula, and the early introduction of solid foods were common. Finally, reviewed studies identified several familial and socio-cultural influences on infant feeding beliefs and practices that may increase risk of overweight and obesity during infancy and early childhood among Chinese children of immigrant families. Nonetheless, as only 11 studies were identified and because the majority of studies (n = 8) were conducted in Australia, additional research including longitudinal studies, and studies conducted in countries with large Chinese immigrant population are needed to further identify and understand influences on Chinese immigrant mothers’ beliefs, attitudes, and practices related to infant feeding that may increase risk of child overweight and obesity. This information is needed to develop interventions tailored to the beliefs and needs of this fast-growing immigrant group and aimed at promoting healthy infant feeding practices to prevent childhood overweight and obesity. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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4 pages, 258 KiB

Open AccessCommentary

Linkage to Care Is Important and Necessary When Identifying Infections in Migrants

by Manish Pareek, Teymur Noori, Sally Hargreaves and Maria Van den Muijsenbergh

Int. J. Environ. Res. Public Health 2018, 15(7), 1550; https://doi.org/10.3390/ijerph15071550 - 22 Jul 2018

Cited by 11 | Viewed by 5314

Abstract

Migration is an important driver of population dynamics in Europe. Although migrants are generally healthy, subgroups of migrants are at increased risk of a range of infectious diseases. Early identification of infections is important as it prevents morbidity and mortality. However, identifying infections [...] Read more.

Migration is an important driver of population dynamics in Europe. Although migrants are generally healthy, subgroups of migrants are at increased risk of a range of infectious diseases. Early identification of infections is important as it prevents morbidity and mortality. However, identifying infections needs to be supported by appropriate systems to link individuals to specialist care where they can receive further diagnostic tests and clinical management. In this commentary we will discuss the importance of linkage to care and how to minimise attrition in clinical pathways. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

14 pages, 548 KiB

Open AccessFeature PaperConcept Paper

A Brief Introduction to the Multidimensional Intercultural Training Acculturation Model (MITA) for Middle Eastern Adolescent Refugees

by Atefeh Fathi, Usama El-Awad, Tilman Reinelt and Franz Petermann

Int. J. Environ. Res. Public Health 2018, 15(7), 1516; https://doi.org/10.3390/ijerph15071516 - 18 Jul 2018

Cited by 9 | Viewed by 5773

Abstract

The large number of adolescent refugees around the world constitutes a great challenge for societies. However, current models of acculturation have been developed for migrants, but not specifically for adolescent refugees. Crucial factors to describe adolescent refugee acculturation, such as intentions to return [...] Read more.

The large number of adolescent refugees around the world constitutes a great challenge for societies. However, current models of acculturation have been developed for migrants, but not specifically for adolescent refugees. Crucial factors to describe adolescent refugee acculturation, such as intentions to return to their homeland, especially with respect to adolescent refugees with temporary residency and experiences of potentially traumatic events, are missing. Hence, the Multidimensional Intercultural Training Acculturation (MITA) model is introduced. The model proposes that two major concerns for adolescent refugees, which are socio-cultural adjustment and mental health, are predicted by intercultural and social–emotional competence, intentions to return to their homeland, and experiences of traumatic events. Moreover, the effects of three modes of acculturation are also proposed in the model. It is expected that these variables mediate the effects of intercultural competence, social–emotional competence, intentions to return to the homeland, and experiences of traumatic events on socio-cultural adjustment as well as mental health. Finally, it is also expected that in-group social support and out-group social support moderate the direct connection between the experiences of traumatic events and mental health. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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6 pages, 599 KiB

Open AccessCommentary

Time to Rethink Refugee and Migrant Health in Europe: Moving from Emergency Response to Integrated and Individualized Health Care Provision for Migrants and Refugees

by Karl Puchner, Evika Karamagioli, Anastasia Pikouli, Costas Tsiamis, Athanasios Kalogeropoulos, Eleni Kakalou, Elena Pavlidou and Emmanouil Pikoulis

Int. J. Environ. Res. Public Health 2018, 15(6), 1100; https://doi.org/10.3390/ijerph15061100 - 28 May 2018

Cited by 38 | Viewed by 7848

Abstract

In the last three years, the European Union (EU) is being confronted with the most significant influx of migrants and refugees since World War II. Although the dimensions of this influx—taking the global scale into account—might be regarded as modest, the institutional response [...] Read more.

In the last three years, the European Union (EU) is being confronted with the most significant influx of migrants and refugees since World War II. Although the dimensions of this influx—taking the global scale into account—might be regarded as modest, the institutional response to that phenomenon so far has been suboptimal, including the health sector. While inherent challenges of refugee and migrant (R&M) health are well established, it seems that the EU health response oversees, to a large extend, these aspects. A whole range of emergency-driven health measures have been implemented throughout Europe, yet they are failing to address adequately the changing health needs and specific vulnerabilities of the target population. With the gradual containment of the migratory and refugee waves, three years after the outbreak of the so-called ‘refugee crisis’, we are, more than ever, in need of a sustainable and comprehensive health approach that is aimed at the integration of all of migrants and refugees—that is, both the new and old population groups that are already residing in Europe—in the respective national health systems. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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14 pages, 21995 KiB

Open AccessCommentary

The Emergency Medical System in Greece: Opening Aeolus’ Bag of Winds

by Ourania S. Kotsiou, David S. Srivastava, Panagiotis Kotsios, Aristomenis K. Exadaktylos and Konstantinos I. Gourgoulianis

Int. J. Environ. Res. Public Health 2018, 15(4), 745; https://doi.org/10.3390/ijerph15040745 - 13 Apr 2018

Cited by 26 | Viewed by 7758

Abstract

An Emergency Medical Service (EMS) system must encompass a spectrum of care, with dedicated pre-hospital and in-hospital medical facilities. It has to be organised in such a way as to include all necessary services—such as triage accurate initial assessment, prompt resuscitation, efficient management [...] Read more.

An Emergency Medical Service (EMS) system must encompass a spectrum of care, with dedicated pre-hospital and in-hospital medical facilities. It has to be organised in such a way as to include all necessary services—such as triage accurate initial assessment, prompt resuscitation, efficient management of emergency cases, and transport to definitive care. The global economic downturn has had a direct effect on the health sector and poses additional threats to the healthcare system. Greece is one of the hardest-hit countries. This manuscript aims to present the structure of the Greek EMS system and the impact of the current economic recession on it. Nowadays, primary care suffers major shortages in crucial equipment, unmet health needs, and ineffective central coordination. Patients are also facing economic limitations that lead to difficulties in using healthcare services. The multi-factorial problem of in-hospital EMS overcrowding is also evident and has been linked with potentially poorer clinical outcomes. Furthermore, the ongoing refugee crisis challenges the national EMS. Adoption of a triage scale, expansion of the primary care network, and an effective primary–hospital continuum of care are urgently needed in Greece to provide comprehensive, culturally competent, and high-quality health care. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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6 pages, 281 KiB

Open AccessCommentary

Strengthening Emergency Care Systems to Mitigate Public Health Challenges Arising from Influxes of Individuals with Different Socio-Cultural Backgrounds to a Level One Emergency Center in South East Europe

by Michèle Twomey, Ana Šijački, Gert Krummrey, Tyson Welzel, Aristomenis K. Exadaktylos and Marko Ercegovac

Int. J. Environ. Res. Public Health 2018, 15(3), 501; https://doi.org/10.3390/ijerph15030501 - 12 Mar 2018

Cited by 1 | Viewed by 3460

Abstract

Emergency center visits are mostly unscheduled, undifferentiated, and unpredictable. A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers. This is particularly pertinent as the influx of people seeking [...] Read more.

Emergency center visits are mostly unscheduled, undifferentiated, and unpredictable. A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers. This is particularly pertinent as the influx of people seeking asylum or in transit mostly present with emergency care needs or first seek help at an emergency center. Triage not only reduces the risk of missing or losing a patient that may be deteriorating in the waiting room but also enables a time-critical response in the emergency care service provision. As part of a joint emergency care system strengthening and patient safety initiative, the Serbian Ministry of Health in collaboration with the Centre of Excellence in Emergency Medicine (CEEM) introduced a standardized triage process at the Clinical Centre of Serbia (CCS). This paper describes four crucial stages that were considered for the integration of a standardized triage process into acute care pathways. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

258 KiB

Open AccessCommentary

Trauma and Pain in Family-Orientated Societies

by Jan Ilhan Kizilhan

Int. J. Environ. Res. Public Health 2018, 15(1), 44; https://doi.org/10.3390/ijerph15010044 - 28 Dec 2017

Cited by 11 | Viewed by 4739

Abstract

People from family-oriented societies in particular, in addition to having a post-traumatic stress disorder (PTSD) suffer from chronic pain and physical complaints. Such people have a different understanding of physical illness and pain and, compared to patients from western societies, have different ideas [...] Read more.

People from family-oriented societies in particular, in addition to having a post-traumatic stress disorder (PTSD) suffer from chronic pain and physical complaints. Such people have a different understanding of physical illness and pain and, compared to patients from western societies, have different ideas on healing, even when confronted with the therapist. Hitherto, these factors have not been sufficiently taken into account in modern, multi-module therapy approaches. Trauma can be perceived via pain and physical complaints, whereby the pain is not restricted to one part of the body but is seen as covering the body as a whole. Therefore, in the treatment and above all in the patient-therapist relationship, it is necessary to understand what importance is attached to the perceived pain in relation to the trauma. The afflicted body expresses the trauma in the shape of its further-reaching consequences such as the patient’s social, collective, economic and cultural sensitivity. Therefore, for the effective treatment of trauma and chronic pain, it is necessary to use a multi-modal, interdisciplinary, and culture-sensitive approach when treating patients from traditional cultural backgrounds. Full article

(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)

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