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1.
PLoS One ; 19(7): e0306318, 2024.
Article in English | MEDLINE | ID: mdl-38995937

ABSTRACT

Afghan refugees child labourers face many challenges as they are labelled as refugees. In an attempt to explore these challenges, the present study was conducted in Tehran with a qualitative approach. The present qualitative research was conducted using a conventional content analysis approach with 25 Afghan child labourers in 2022 in Tehran. Child labourers were selected through purposive and snowball sampling and interviewed in a semi-in-depth interview. The data were analysed based on Granheim and Lundman's criteria, as well as those of Guba and Lincoln, to further enrich the findings. A total of 3 categories, 13 sub-categories, and 183 initial codes were extracted from the data analysis, including: "psychological challenges" (history of harassment and abuse, negative effects, high-risk behaviours, and family detachment); "health challenges" (physical problems, inappropriate accommodation, medical/therapeutic problems, and health threats); and "social challenges" (neglected childhood, dual identity, educational limitations, inadequate social support, social isolation, and social humiliation). At the individual level, it is possible to meet the child labourers' health needs and make them aware of the hazards of working in the streets through physical examination at certain intervals and holding training workshops on harassment prevention, anger control, prevention of high-risk behaviours, prevention of infectious diseases such as hepatitis, and strengthening self-confidence to improve health. Also, the Afghan child labourers' work could be intervened at the social and familial level by providing accommodation in more suitable neighbourhoods, providing health insurance for child labourers, creating the chances of studying in schools, preventing dropouts, and strengthening social relations in order to improve children's health.


Subject(s)
Qualitative Research , Refugees , Humans , Iran , Afghanistan , Male , Child , Female , Refugees/psychology , Child Labor , Adolescent , Social Support
2.
Front Public Health ; 12: 1413258, 2024.
Article in English | MEDLINE | ID: mdl-38989114

ABSTRACT

As a result of the United States withdrawal from Afghanistan in fall 2021, 1,260 Afghan evacuees arrived in Minnesota between October 2021 and February 2022. Several contextual factors including an overtaxed health system under duress from COVID-19 and uncertain benefit eligibility prompted a coordinated public health response to appropriately address the acute and pressing medical concerns of our new neighbors. This community case study describes the State of Minnesota's cross-sectoral response that created a welcoming environment, identified public health concerns, and addressed acute medical needs. Medical volunteers provided an initial health and safety check for Afghan families upon arrival. Volunteers also offered onsite culturally and linguistically appropriate mental health assessments, group therapy, women's clinics, vaccine clinics, medication refills, and ongoing walk-in primary care. Care coordinators facilitated primary care and specialty care referrals. The majority (96%) of eligible arrivals were screened as part of this response and the median time between arrival to Minnesota and initial health screening was 2 days. Half of all arrivals screened reported at least one health concern and 56% were referred to a specialty for further evaluation. Almost one in four adults (24%) reported mental health concerns. Existing partnerships across local sectors can be leveraged to provide comprehensive physical and mental health services to newcomers in an emergency response.


Subject(s)
COVID-19 , Humans , Minnesota , Afghanistan , COVID-19/epidemiology , Female , Refugees , Adult , Male , Primary Health Care
3.
BMC Pregnancy Childbirth ; 24(1): 479, 2024 Jul 16.
Article in English | MEDLINE | ID: mdl-39014313

ABSTRACT

BACKGROUND: The number of Afghan families in the US has grown over the past two decades, yet there is a paucity of research focused on their maternal healthcare experiences. Afghan families have one of the highest fertility rates in the world and typically have large families. As the US faces rising maternal mortality rates, it is crucial to understand factors that affect health outcomes for culturally distinct groups. We aimed to better understand Afghan women's maternal health experiences in South Texas as a step toward designing culturally sensitive care. METHODS: Using a qualitative descriptive design, twenty Afghan women who gave birth in the US within the past 2 years participated in audio-recorded interviews. The first and second authors conducted each interview using a semi-structured interview guide. The authors used an in vivo coding method and qualitative content analysis of the transcribed narrative data. RESULTS: We identified three broad categories with corresponding sub-categories: 1) Maternal Healthcare Experiences: pregnancy, birthing, and postpartum, 2) Communication: language barrier, relationship with husband, and health information seeking, 3) Access to Care: transportation and financing healthcare. The participants expressed perspectives of gratefulness and positive experiences, yet some described stories of poor birth outcomes that led to attitudes of mistrust and disappointment. Distinct cultural preferences were shared, providing invaluable insights for healthcare providers. CONCLUSIONS: The fact that the Afghan culture is strikingly different than the US mainstream culture can lead to stereotypical assumptions, poor communication, and poor health outcomes. The voices of Afghan women should guide healthcare providers in delivering patient-centered, culturally sensitive maternity care that promotes healthy families and communities.


Subject(s)
Health Services Accessibility , Qualitative Research , Refugees , Humans , Female , Afghanistan/ethnology , Refugees/psychology , Pregnancy , Adult , Maternal Health Services , Texas , Maternal Health/ethnology , United States , Young Adult , Communication Barriers
4.
PLoS One ; 19(7): e0298812, 2024.
Article in English | MEDLINE | ID: mdl-39018326

ABSTRACT

International concern for the human rights of Afghan women has spiked since the Taliban consolidated power in Afghanistan in fall 2021. Yet little is known about how to effectively advocate for women's human rights under this new context. We present findings from a random sample of all adult Afghan internet users' attitudes toward peace, security, gender, and human rights and find significant support for women's human rights as a national priority within Afghanistan, even when controlling for other priorities and even among many men and women aligned with the Taliban. Given that men now have much more political power in Afghan society to protect women's rights, we paid particular attention to men's attitudes toward women's human rights. Our evidence from an embedded survey experiment, building on earlier literature from other countries, demonstrates that fathers of eldest daughters are particularly likely to favor prioritizing women's rights when primed to think about the gender of their eldest children. Thus, the human rights and humanitarian community should spend more time and attention engaging with this demographic, and specifically creating marketing and advocacy strategies that encourage men to think about or act on behalf of their eldest daughters.


Subject(s)
Attitude , Human Rights , Humans , Female , Afghanistan , Male , Adult , Gender Equity , Women's Rights , Surveys and Questionnaires , Middle Aged , Young Adult , Adolescent
5.
Environ Monit Assess ; 196(8): 701, 2024 Jul 04.
Article in English | MEDLINE | ID: mdl-38965084

ABSTRACT

This study investigates the performance of CMIP6 models in reproducing historical temperature and precipitation data for Iran and neighboring countries (Afghanistan, Pakistan, Turkmenistan, Azerbaijan, Armenia, Turkey, and Iraq) from 1980 to 2014. Reanalysis data from the ECMWF database (ERA5) for temperature and precipitation were utilized as a reference for the period 1980-2014. Additionally, ten Atmosphere-Ocean General Circulation Models (AOGCMs) from CMIP6 were employed to simulate temperature and precipitation data for the study region based on the IPCC Sixth Assessment Report databases. The Kling-Gupta Efficiency (KGE) index was used to evaluate the accuracy of CMIP6 models in replicating daily temperature and precipitation. The results indicate that different CMIP6 models exhibit varying degrees of accuracy in simulating historical temperatures and precipitation, depending on the month and the country. For instance, the IPSL-CM6A-LR model demonstrated the best annual performance in estimating temperature in Azerbaijan (KGE = 0.5), while the HadGEM3-GC31-LL model showed the lowest annual performance in Pakistan (KGE = -1.4). Interestingly, the models were found to be more accurate in simulating temperatures during warm months compared to cold ones. Furthermore, the accuracy of different models in estimating annual precipitation varied significantly, ranging from -0.64 (MRI-EMS2-0 model in Afghanistan) to 0.05 (CMCC-ESM2 model in Armenia). Similar to temperature, the study found that models were generally more accurate in simulating precipitation during cold months compared to warm ones.


Subject(s)
Environmental Monitoring , Rain , Temperature , Iran , Environmental Monitoring/methods , Models, Theoretical , Pakistan , Turkey , Iraq , Azerbaijan , Afghanistan
6.
BMC Pediatr ; 24(1): 436, 2024 Jul 06.
Article in English | MEDLINE | ID: mdl-38971723

ABSTRACT

BACKGROUND: Child stunting is prevalent in low and middle-income countries (LMICs), but an information gap remains regarding its current prevalence, correlates, and the impact of vaccination against this condition in Afghanistan. This study aimed to determine the prevalence and correlates of moderate and severe stunting and the potential impact of basic and full vaccination among children under five in Afghanistan. METHODS: This is a secondary analysis of the 2022-23 Afghanistan Multiple Indicators Cluster Survey (MICS) including 32,989 children under 5. Descriptive statistics were employed to describe the distribution of independent variables and the prevalence of stunting across them. Chi-square analysis was used to examine the association between each independent variable with stunting. Multinomial logistic regression was used to examine the risk of stunting across different independent variables. RESULTS: A total of 32,989 children under 5 years old were included in this study. Of those 44.7% were stunted with 21.74% being severely stunted. Children aged 24-35 and 36-47 months faced the highest risk as compared to those aged 1-5 months. The prevalence was lower in female children and they were less likely to experience severe stunting. Stunting was more prevalent in rural areas, with children there 1.16 to 1.23 times more likely to be affected than urban counterparts. Lower wealth correlated with higher stunting. Younger maternal age at birth (≤ 18) correlated with increased stunting risks, particularly in severe cases. Parental education was inversely related to stunting; higher education levels in parents, especially fathers, were associated with lower stunting rates. Households with more than seven children showed a 25% and 44% higher risk of moderate and severe stunting, respectively, compared to families with 1-4 children. Improved sanitation, but not drinking water sources, was linked to reduced stunting in the adjusted model. Vaccination had a protective effect; in the adjusted analysis, basic and full vaccinations significantly lowered the risk of severe stunting by 46% and 41%, respectively. CONCLUSION: In this nationally representative study, the prevalence of stunting was substantial (44.7%) in Afghan children. Additionally, the findings emphasize the critical factors associated with child stunting and underscore the protective role of vaccination against this condition, which provides policymakers with directions for policy efforts and intervention strategies to reduce child stunting in Afghanistan.


Subject(s)
Growth Disorders , Vaccination , Humans , Afghanistan/epidemiology , Growth Disorders/epidemiology , Prevalence , Female , Infant , Child, Preschool , Male , Vaccination/statistics & numerical data , Risk Factors , Socioeconomic Factors
7.
J Health Care Poor Underserved ; 35(3S): 167-173, 2024.
Article in English | MEDLINE | ID: mdl-39069937

ABSTRACT

Limited English proficient patients are prone to adverse health care effects compared to English proficient patients, including decreased access to care, lower health literacy, and worse clinical outcomes. This report describes a multi-modal medical interpreter program at a safety-net health system designed for the emerging Afghan population in San Antonio, Texas.


Subject(s)
Safety-net Providers , Translating , Humans , Texas , Safety-net Providers/organization & administration , Afghanistan , Limited English Proficiency , Health Literacy
8.
Br J Gen Pract ; 74(suppl 1)2024 Jun 20.
Article in English | MEDLINE | ID: mdl-38902049

ABSTRACT

BACKGROUND: Following Kabul's fall in August 2021, there was influx of Afghan refugees in the UK. Southampton's Bridging Hotel provided temporary shelter to 22 families, totaling 116 individuals. The Living Well Partnership (LWP); assumed primary care provision for these vulnerable residents facing health inequalities. AIM: Enhancing refugee healthcare access and integration into the NHS system. Improving healthcare education, boosting confidence in appropriate healthcare use, and utilisation of electronic consultations effectively. METHOD: Working with the local authorities, primary care services were brought to the hotel. Regular 3-hour drop-in sessions with a health and wellbeing coach were established and attended by residents. Non-identifiable data was recorded in individual patient care records and summarised quantitatively.  Qualitative data was collected via a pre-established questionnaire during the sessions.   RESULTS: Identified issues included language barriers, mental health problems, infectious diseases, contraception, and healthcare access. Language barriers were addressed with interpreters. Fifty-nine patients accessed support services, with 13 benefiting from e-consultations, and nine requiring on-site medical consultations in a 3-month period. Mental health support and infectious disease referrals were facilitated. Access challenges were mitigated by transitioning to e-consultations or face-to-face appointments. Outcomes included improved patient independence, awareness of healthcare processes, familiarity with LWP services, and confidence in navigating the NHS. CONCLUSION: A multifaceted approach is vital for addressing language and access barriers for refugees. Providing educational resources through facilitated groups empowered refugees and improved healthcare access. This initiative highlights the importance of organised support for vulnerable populations during crises and can be applied more widely.


Subject(s)
Communication Barriers , Health Services Accessibility , Refugees , Humans , Afghanistan/ethnology , United Kingdom , Primary Health Care , Female , Male , Vulnerable Populations , Adult , State Medicine , Referral and Consultation
9.
Appl Ergon ; 119: 104323, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38824829

ABSTRACT

In 2015, the VIRTUS helmet was introduced to UK Armed Forces and will ultimately replace the Mark 7 combat helmet. The VIRTUS helmet has a reduced trimline compared to the Mark 7 helmet and can incorporate attachments such as a visor, mandible guard and nape protection. An anonymous questionnaire was provided to 200 UK Armed Forces personnel deployed to four locations on Operation TORAL in Afghanistan between September and October 2019. This is the first User feedback survey assessing the VIRTUS helmet in an operational environment. Users were measured to ascertain the fit of their helmet and asked to rate perceived helmet mass and comfort using a 5-point Likert scale. Users were also asked whether the VIRTUS helmet was better than previous helmets and about their use of the nape protection. The VIRTUS helmet was perceived to be an improvement over previously issued UK combat helmets in terms of both comfort and mass.


Subject(s)
Head Protective Devices , Military Personnel , Humans , United Kingdom , Military Personnel/psychology , Surveys and Questionnaires , Male , Adult , Equipment Design , Afghan Campaign 2001- , Female , Afghanistan , Young Adult , Consumer Behavior , Feedback
10.
Medicine (Baltimore) ; 103(25): e38542, 2024 Jun 21.
Article in English | MEDLINE | ID: mdl-38905413

ABSTRACT

RATIONALE: Fahr syndrome is a rare, degenerative neurological condition characterized by bilateral idiopathic calcification of the periventricular region, especially the basal ganglia. This condition is often misdiagnosed as other neurological or psychiatric disorders due to its rarity and overlapping symptoms. PATIENT CONCERNS: A 34-year-old man had been experiencing seizures and cognitive dysfunction for few years, which were further compounded by slurred speech and motor difficulties as acute conditions. DIAGNOSIS: After investigations, severe hypocalcemia, and hypoparathyroidism were detected and his brain computed tomography showed extensive bilateral calcifications in basal ganglia, thalamus, dentate nuclei, and some parts of subcortical white matter, suggestive of Fahr syndrome. Although, the patient was initially misdiagnosed due to a lack of information and the rarity of this disease. INTERVENTION: The patient was treated with intravenous calcium gluconate, vitamin D3, l-ornithine l-aspartate syrup, and levetiracetam, replacing carbamazepine. OUTCOME: His symptoms, including slurred speech, muscle pain, and stiffness improved, serum calcium normalized, and he was discharged with medications for memory deficit and depression. LESSONS: This case underscores the importance of raising awareness among physicians, especially in areas with limited medical resources, about the significance of prompt diagnosis and appropriate symptomatic treatment in enhancing patient prognosis and quality of life.


Subject(s)
Calcinosis , Cognitive Dysfunction , Seizures , Humans , Male , Adult , Seizures/etiology , Seizures/drug therapy , Cognitive Dysfunction/etiology , Cognitive Dysfunction/diagnosis , Calcinosis/complications , Calcinosis/diagnosis , Afghanistan , Basal Ganglia Diseases/diagnosis , Basal Ganglia Diseases/complications , Hypoparathyroidism/complications , Hypoparathyroidism/diagnosis , Hypoparathyroidism/drug therapy , Hypocalcemia/drug therapy , Tomography, X-Ray Computed , Neurodegenerative Diseases
11.
Afr J Reprod Health ; 28(5): 90-102, 2024 May 31.
Article in English | MEDLINE | ID: mdl-38920395

ABSTRACT

The research explores Afghan refugee women's challenges in accessing education, employment, and legal rights in Khyber Pakhtunkhwa, Pakistan. It seeks to inform policy changes to improve their socioeconomic circumstances and mitigate these hardships. The study employs qualitative methodologies, utilizing interviews, observation, and document analysis to capture rich, in-depth narratives from three Afghan refugee women. Each narrative provides unique insights into the women's struggles with education, employment, and securing legal rights. The research highlights challenges from forced migration, gender inequality, cultural norms, and socioeconomic marginalization, causing a holistic crisis for Afghan refugee women in Khyber Pakhtunkhwa, Pakistan. These issues hinder access to education, employment, financial vulnerabilities, and legal uncertainties. The study suggests a comprehensive, multi-pronged approach to policy changes, including education reform for refugee girls, gender-responsive recruitment practices, and legal reforms to secure refugees' rights. It emphasizes gender-responsive support services and involves Afghan refugee women in policy development processes, leveraging their experiences for more effective and inclusive policies.


La recherche explore les difficultés rencontrées par les femmes réfugiées afghanes pour accéder à l'éducation, à l'emploi et aux droits légaux à Khyber Pakhtunkhwa, au Pakistan. Il cherche à éclairer les changements politiques pour améliorer leur situation socio-économique et atténuer ces difficultés. L'étude utilise des méthodologies qualitatives, utilisant des entretiens, des observations et des analyses de documents pour recueillir des récits riches et approfondis de trois femmes réfugiées afghanes. Chaque récit fournit un aperçu unique des luttes des femmes en matière d'éducation, d'emploi et d'obtention de leurs droits légaux. La recherche met en évidence les défis liés à la migration forcée, à l'inégalité entre les sexes, aux normes culturelles et à la marginalisation socio-économique, provoquant une crise holistique pour les femmes réfugiées afghanes à Khyber Pakhtunkhwa, au Pakistan. Ces problèmes entravent l'accès à l'éducation, à l'emploi, souffrent de vulnérabilités financières et d'incertitudes juridiques. L'étude suggère une approche globale et multidimensionnelle des changements politiques, y compris une réforme de l'éducation pour les filles réfugiées, des pratiques de recrutement sensibles au genre et des réformes juridiques pour garantir les droits des réfugiés. Il met l'accent sur les services de soutien sensibles au genre et implique les femmes réfugiées afghanes dans les processus d'élaboration des politiques, en tirant parti de leurs expériences pour des politiques plus efficaces et inclusives.


Subject(s)
Qualitative Research , Refugees , Humans , Refugees/psychology , Female , Pakistan/ethnology , Afghanistan/ethnology , Adult , Socioeconomic Factors , Employment , Women's Rights , Culture , Emigration and Immigration/legislation & jurisprudence
15.
Prev Med ; 185: 108039, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38862030

ABSTRACT

This study examines the association between Afghan women's autonomy (WA) and experience of domestic violence (physical, sexual, and emotional) in the previous 12 months, and whether this association is moderated by education status. We used data from 19,098 married women aged 15-49, who completed the 2015 Afghanistan Demographic and Health Survey- the first and only national survey administered in the country. WA was measured across 5 domains (healthcare, visiting family, household purchases, spending, and contraceptive use). Adjusted odds ratios and 95% confidence intervals for the association between domestic violence in the past 12 months (any vs. none) and WA were estimated using multiple logistic regression and adjusted for covariates. Interaction terms between education status and WA were also assessed. We found that the experience of physical, emotional, and sexual violence was 45% 30%, and 7%, and at least 1 in 2 had no autonomy. After adjustment, compared to women without autonomy, WA in healthcare decisions, spending, visiting families, and household purchases significantly decreased the odds of physical violence. Similarly, WA in healthcare decisions and spending significantly decreased the odds of sexual violence. Lastly, WA in spending and not using contraception was associated with reduced odds of emotional violence. We also found a greater protective effect of WA in visiting family among women with any education across each domestic violence outcome. These findings provide insights into areas for intervention to address gender inequalities (Sustainable Development Goal 3) and mitigate adverse health outcomes for mothers and their children (Goal 5).


Subject(s)
Domestic Violence , Educational Status , Personal Autonomy , Humans , Female , Afghanistan , Adult , Domestic Violence/statistics & numerical data , Domestic Violence/psychology , Adolescent , Middle Aged , Health Surveys , Young Adult
16.
Child Care Health Dev ; 50(4): e13295, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38927007

ABSTRACT

INTRODUCTION: This study examines the health problems and healthcare needs of refugee and asylum-seeker children and aims to develop strategies for improvement. METHODS: Based on quantitative data from 448 refugee and asylum-seeker children and 222 non-refugee local children, this study was conducted at Düzce University, Department of Paediatrics, between 2010 and 2021. The refugee children originated from three countries: Iraq (n = 304), Syria (n = 101) and Afghanistan (n = 43). The data were analysed using the SPSS data analysis program. Ethical clearance was obtained from the Ethics Committee of Düzce Üniversity. RESULTS: The results suggest that refugee and asylum-seeker children have significantly higher rates of acute illness or infection, malnutrition (p < 0.001) and anaemia (p < 0.001) than local children as a result of living in overcrowded families (p = 0.017) and unhealthy conditions. Adolescent pregnancy (p = 0.049) emerges as an important social problem as a result of child marriage among refugee children, mostly in the form of consanguineous marriages (p < 0.001). The rate of having at least two adolescent pregnancies (under 18) was highest among Syrian refugee girls (p = 0.01). Although refugee and asylum-seeker children have higher rates of health insurance (between 74% and 95%), they have lower rates of insurance compared to local children. This research also compares the data from three nationalities, including Syria, Afghanistan and Iraq children; Iraqi and Afghan children under the international protection (IP) system with limited social support and rights had worse health conditions compared to other groups. Although Iraqi children had the highest rates of health insurance on admission (p < 0.001), they also had higher rates of chronic diseases (p = 0.001), infections (p = 0.004), allergic rhinitis (p = 0.001) and malnutrition (p < 0.001). The youngest age of admission (p = 0.006) and the shortest length of stay (p = 0.004) were for Afghan children who also had higher rates of upper respiratory infections (p = 0.021). CONCLUSIONS: This study highlights the urgent need for improved screening programmes and the importance of collaborative efforts to address the specific health needs of these populations. Addressing the health status of child refugees is a complex and multifaceted task that requires the active participation of healthcare professionals, policymakers and researchers, each of whom has a crucial role to play.


Subject(s)
Refugees , Humans , Refugees/statistics & numerical data , Female , Child , Male , Afghanistan/ethnology , Syria/ethnology , Adolescent , Child, Preschool , Iraq/ethnology , Infant , Child Health , Health Services Needs and Demand
17.
BMJ Open ; 14(6): e079615, 2024 Jun 05.
Article in English | MEDLINE | ID: mdl-38839389

ABSTRACT

OBJECTIVES: This study aimed to qualitatively explore (1) the experiences of female survivors of domestic abuse and mental health problems in Afghanistan; (2) how female survivors of violence and abuse, male members of the community and service providers perceive and respond to mental health and domestic violence in Afghanistan and (3) the provision of mental health services for female survivors of violence and abuse in Afghanistan, including the barriers and challenges faced around accessing mental health services. DESIGN: Qualitative interviews and framework thematic analysis. SETTING: Kabul, Bamyan and Nangarhar in Afghanistan. PARTICIPANTS: 60 female survivors of domestic abuse, 60 male community members and 30 service providers who work with female survivors of domestic abuse. RESULTS: Experiences of multiple and compounding traumatic experiences of violence, armed conflict, and complex and competing psychosocial concerns were common among the female survivor participants. All female survivor participants reported experiencing negative mental health outcomes in relation to their experiences of violence and abuse, which were further precipitated by widespread social stigma and gender norms. Support and service provision for female survivors was deemed by participants to be insufficient in comparison to the amount of people who need to access them. CONCLUSIONS: There are many risks and barriers women face to disclosing their experiences of violence and mental health problems which restrict women's access to psychological support. Culturally relevant services and trauma-informed interventions are necessary to respond to these issues. Service providers should be trained to effectively recognise and respond to survivors' mental health needs.


Subject(s)
Domestic Violence , Qualitative Research , Social Stigma , Survivors , Humans , Female , Afghanistan , Adult , Survivors/psychology , Domestic Violence/psychology , Male , Mental Health Services , Interviews as Topic , Young Adult , Middle Aged , Health Services Accessibility
18.
Front Endocrinol (Lausanne) ; 15: 1403684, 2024.
Article in English | MEDLINE | ID: mdl-38919493

ABSTRACT

Introduction: Currently, over two million war refugees live in Germany. Exposure to war and flight is associated with a high burden of diseases, not limited to mental disorders and infections. We aimed to analyze diabetes treatment and outcomes of pediatric refugees and migrants from Ukraine and Syria/Afghanistan with type 1 diabetes (T1D) in German-speaking countries. Materials and methods: We included patients with T1D documented between January 2013 and June 2023 in the German/Austrian/Luxembourgian/Swiss DPV registry, aged < 20 years, born in Ukraine [U], in Syria or Afghanistan [S/A], or without migration background [C]. Using logistic, linear, and negative binomial regression models, we compared diabetes technology use, BMI-SDS, HbA1c values, as well as severe hypoglycemia and DKA rates between groups in the first year of treatment in the host country. Results were adjusted for sex, age, diabetes duration, and time spent in the host country. Results: Among all patients with T1D aged < 20 years, 615 were born in Ukraine [U], 624 in Syria or Afghanistan [S/A], and 28,106 had no migration background [C]. Compared to the two other groups, patients from Syria or Afghanistan had a higher adjusted BMI-SDS (0.34 [95%-CI: 0.21-0.48] [S/A] vs. 0.13 [- 0.02-0.27] [U] and 0.20 [0.19-0.21] [C]; all p<0.001), a lower use of CGM or AID system (57.6% and 4.6%, respectively [S/A] vs. 83.7% and 7.8% [U], and 87.7% and 21.8% [C], all p<0.05) and a higher rate of severe hypoglycemia (15.3/100 PY [S/A] vs. 7.6/100 PY [C], and vs. 4.8/100 PY [U], all p<0.05). Compared to the two other groups, patients from Ukraine had a lower adjusted HbA1c (6.96% [95%-CI: 6.77-7.14] [U] vs. 7.49% [7.32-7.66] [S/A] and 7.37% [7.36-7.39] [C], all p<0.001). Discussion: In their first treatment year in the host country, young Syrian or Afghan refugees had higher BMI-SDS, lower use of diabetes technology, higher HbA1c, and a higher rate of severe hypoglycemia compared to young Ukrainian refugees. Diabetologists should be aware of the different cultural and socioeconomic backgrounds of refugees to adapt diabetes treatment and education to specific needs.


Subject(s)
Diabetes Mellitus, Type 1 , Refugees , Transients and Migrants , Humans , Syria/ethnology , Syria/epidemiology , Refugees/statistics & numerical data , Ukraine/epidemiology , Female , Male , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 1/epidemiology , Afghanistan/epidemiology , Child , Adolescent , Transients and Migrants/statistics & numerical data , Germany/epidemiology , Child, Preschool , Young Adult , Glycated Hemoglobin/analysis , Registries , Infant , Hypoglycemic Agents/therapeutic use
19.
Psychother Psychosom Med Psychol ; 74(6): 224-231, 2024 Jun.
Article in German | MEDLINE | ID: mdl-38865998

ABSTRACT

OBJECTIVE: Aim of the study was to report evidence on mental health needs and access to mental health and psychosocial support for Leipzig citizens of Afghan and Iraqi citizenship in the presence of mental stress and, above all, to identify barriers to access to care. METHODS: All adults in Leipzig with Iraqi or Afghan citizenship, who were not born in Germany were contacted. Various instruments (PHQ-9, GAD-7, SSS-8, PCL-5/LEC-5) to screen for symptoms of depression, anxiety, somatization disorder or PTSD and one item for self-reported emotional problems were used. Questions on health care utilization and barriers to care followed. RESULTS: 51.4% screened positive in at least one of the tests and self-reported emotional problems. 38.2% of those in need of treatment did not seek help. Frequent reasons for not seeking help were, that the people wanted to solve the problem on their own or that the problem did not bother them very much. A lack of trust and understanding regarding the healthcare system and fear of discrimination and stigmatisation were also perceived as additional barriers to care. DISCUSSION: The study revealed a high percentage of mental health needs. This could be due to the high number of traumatic events and post-migration stressors. A longer period of residence in Germany and easier access to the public health system through the health insurance card could have encouraged the health care utilization. The treatment gap was caused by barriers to care such as a lack of knowledge or trust of the German health care system and fear of stigmatisation and discrimination. CONCLUSION: More information about access to care structures and more low-threshold services need to be implemented. These should be organised on an interdisciplinary basis and focus on culturally and racially sensitive care. Mental health awareness should be strengthened and under no circumstances should the access to care be restricted any further.


Subject(s)
Health Services Accessibility , Mental Health Services , Stress, Psychological , Humans , Adult , Male , Female , Germany , Mental Health Services/statistics & numerical data , Middle Aged , Stress, Psychological/psychology , Stress, Psychological/therapy , Young Adult , Afghanistan , Iraq , Adolescent , Patient Acceptance of Health Care/psychology , Aged
20.
Article in English | MEDLINE | ID: mdl-38700838

ABSTRACT

Elements such as As, Cd, Cr and Pb are classified as contaminants of major concern for public health, due to their high degree of toxicity. Saffron is an important medicinal herbal spice used in variety of food items, pharmaceutical medicines, and cosmetics. Presence of heavy metals in saffron will increase the health risk to consumers. Also, authentication of geographical origin of saffron is an issue of utmost importance for global trading. The present study is focused on investigation of elemental contaminants in saffron and elemental composition of saffron from India (Jammu and Kashmir); Iran and Afghanistan are also explored for geographical discrimination, using Chemometrics. In total, 29 elements including Ag, Al, As, B, Ba, Be, Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, P, Pb, Sb, Se, Si, Sr, Ti, Tl, V and Zn were analyzed using ICP-OES. Toxic elemental contaminants including As, Cd, Pb were found below the maximum permissible limit. Using PCA, elements B, Ni, Ba, Fe, V, Si, Al, Ti, K, Na, Sr, and Zn were found as significant discriminators of geographical origin. Elemental composition of saffron may be utilized, to prevent cases of falsified geographical origin in trade.


Subject(s)
Crocus , Food Contamination , Crocus/chemistry , Food Contamination/analysis , Metals, Heavy/analysis , Chemometrics , India , Iran , Afghanistan , Geography
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