La relación entre migración y derecho a la salud desde la perspectiva bioética. Una revisión sistemática de literatura / La relació entre migració i dret a la salut des de la perspectiva bioètica. Una revisió sistemàtica delaliteratura / The relationship between migration and the right to health from a bioethical perspective. A systematic literature review

Uno de los principales debates en bioética gira en torno al acceso a la salud de personas migrantes, sin embargo, es difícil encontrar estudios o artículos que consignen las aportaciones concretas que la bioética ha hecho en esta materia. Por esta razón, esta revisión sistemática tiene como objetivo principal identificar los aportes que la bioética ha realizado a la relación entre migración y el derecho humano de acceso a la salud desde el año 2006. Con base en la metodología PRISMA, se realizó una búsqueda de artículos en los repositorios cerrados de Scielo, PubMed, Elsevier, Redalyc y Dialnet, procurando que estos fueran de revistas indexadas. Se excluyeron aquellos que fueron publicados antes del año 2006. En total, se eligieron 13 artículos que fueron sometidos a una lectura detallada para reportar sus resultados y conclusiones. Los hallazgos fueron agrupados en seis categorías y se identificó como principal aportación de esta disciplina la formulación de principios bioéticos que guían la labor médica y científica y que son nociones básicas para elaborar políticas públicas de acceso a la salud. Se considera que los resultados recabados son relevantes para autoridades, profesionales de la salud, científicos y migrantes, así como para la elaboración de nuevos proyectos que retomen el objetivo de esta investigación con otro enfoque.(AU)

Undels principals debats en bioètica gira entorn de l'accés a la salut de les persones migrants, però és difícil trobar estudis o articles que recullin les contribucions concretes que la bioètica ha fet en aquesta matèria. Per aquesta raó, aquesta revisió sistemàtica té com a objectiu principal identificar les aportacions que la bioètica ha fet a la relació entre migració i el dret humà d'accés a la salut des de l'any 2006. Basant-se en la metodologia PRISMA, es va dur a terme una cerca d'articles als repositoris tancats de Scielo, PubMed, Elsevier, Redalyc i Dialnet, procurant que aquests fossin de revistes indexades. Es van excloure aquells que van ser publicats abans de l'any 2006. En total, es van seleccionar 13 articles que van ser sotmesos a una lecturadetallada per informar els seus resultats i conclusions. Les troballes es van agrupar en sis categories i es va identificar com a principal aportació d'aquesta disciplina la formulació de principis bioètics que guien la tasca mèdica i científica i que sónnocions bàsiques per elaborar polítiques públiques d'accés a la salut. Es considera que els resultats recopilats són rellevants per a les autoritats, professionals de la salut, científics i migrants, així com per a l'elaboració de nous projectes que reprenen l'objectiu d'aquesta investigació amb una altra perspectiva.(AU)

One of the main debates in bioethics revolves around access to health care for migrants; however, it is difficult to find studies or articles that record the concrete contributions that bioethics has made in this area. For this reason, the main objective of this systematic review is to identify the contributions that bioethics has made to the relationshipbetween migration and the human right of access to health since 2006. Based on the PRISMA methodology, a search for articles was carried out in the closed repositories of Scielo, PubMed, Elsevier, Redalyc and Dialnet, ensuring that these were from indexedjournals. Articles published before 2006 were excluded. In total, 13 articles were selected and subjected to a detailed reading in order to report their results and conclusions. The findings were grouped into six categories and the main contribution of this discipline was identified as the formulation of bioethical principles that guide medical and scientific work and are basic notions for developing public policies on access to health. The results obtained are considered relevant for authorities, health professionals, scientists and migrants, as well as for the development of new projects that take up the objective of this research with a different approach.(AU)

El doble desafío de la adolescencia migrante / El doble repte de l'adolescència emigrant / The double challenge of migrant adolescence

Las adolescencias migrantes se encuentran ante el doble desafíode elaboración de cuestiones propias de su desarrollo junto a las relacionadas con el proceso migratorio parti-cular o de su entorno adulto. En el presente artículo se reflexiona sobre la conceptualización de la adolescenciamigrante, los procesos migratorios y los duelos asociados a partir de relatos en primera persona, superandoel adultocentrismo y etnocentrismo para la buena praxis profesional.(AU)

Adolescent migrants are faced with the double challenge ofdealing with issues of their own development together with those related to the particular migratory process orto their adult environment. This article reflects on the conceptualization of migrant adolescence, the migratoryprocesses and the associated mourning based on first-person accounts, overcoming adultcentrism and ethno-centrism for good professional praxis.(AU)

Les adolescències emigrants es troben davant del doble desa-fiament d’elaboració de qüestions pròpies del seu desenvolupament juntament amb les relacionades amb elprocés migratori particular o del seu entorn adult. En aquest article, es reflexiona sobre la conceptualització del'adolescència emigrant, els processos migratoris i els dols associats a partir de relats en primera persona, supe-rant l’adultcentrisme i l'etnocentrisme per a la bona praxi professional.(AU)

El proceso de duelo en la familia que emigra: del «Síndrome de Ulises» a la patología / El procés de dol en la família que emigra: de la “síndrome d'Ulisses” a la patologia / The grieving process in the migrant family: from the "Ulysses Syndrome" to pathology

En este artículo des-cribiremos la migración como un proceso en el cual aparecen profundas pérdidas. La reacción ante la pérdidaconstituye un proceso de duelo, que empieza antes de partir con la ambivalencia y termina con la reintroyec-ción del objeto cuando aparece la integración de la familia en la sociedad de acogida. Dependiendo de cómo serealiza la migración podrá elaborarse el duelo (migración normal), generará dificultades como el Síndrome delInmigrante con Estrés Crónico y Múltiple (Ulysses Sindrome) o fracasará la elaboración, apareciendo entoncessituaciones de riesgo por las que la familia puede desorganizarse y enfermar.(AU)

In this article, we willdescribe migration as a process in which profound losses occur. The reaction to the loss constitutes a mourningprocess, which begins before the migration with ambivalence and ends with the reintroduction of the objectwhen the integration of the family into the host society takes place. Depending on how the migration is carriedout, the mourning can be elaborated (normal migration), it will generate difficulties such as the Chronic andMultiple Stress Migrant Syndrome (Ulysses Syndrome) or the elaboration will fail, thus creating risk situations inwhich the family can become disorganised and become ill.(AU)

En aquest article descriuremla migració com un procés en el qual apareixen profundes pèrdues. La reacció davant la pèrdua constitueix unprocés de dol, que comença abans de marxar amb l'ambivalència i acaba amb la reintrojecció de l'objecte quanapareix la integració de la família en la societat d'acollida. Depenent de com es realitza la migració es pot ela-borar el dol (migració normal), generarà dificultats com la síndrome de l'immigrant amb estrès crònic i múltiple(Ulysses Sindrome) o fracassarà l'elaboració, amb l’aparició llavors de situacions de risc per les quals la famíliapot desorganitzar-se i emmalaltir.(AU)

Intercultural competence in healthcare / Interkulturális kompetenciák az egészségügyi ellátásban

International migration is a current and growing phenomenon, which has become an increasingly critical issue in Europe since 2013 and this has posed new challenges to the healthcare systems of the European Union (EU). The need for 'culturally competent' healthcare systems that can adapt and respond to the needs of a changing population while taking into account cultural, religious, linguistic and gender diversity, has become more and more an agenda across Europe. Nowadays, it is widely accepted that inequalities in health conditions are mainly due to socio-economic factors, and disparities are particularly evident among certain ethnic and cultural minority groups. Additionally, minorities often face difficulties during their attempts in accessing healthcare, including linguistic and cultural barriers. These barriers are primarily manifested in communication and other interactions between the patient and the healthcare provider. Communication difficulties and misunderstandings may lead to frustration and prejudice among caregivers and also to a lack of cooperation from patients, and consequently, may contribute to poorer health outcomes. Therefore, in order to ensure the highest quality of care for migrants, ethnic or other minority populations in our increasingly diverse societies, it is of crucial importance to overcome the difficulties arising from linguistic, cultural and religious differences. To achieve these goals, an important step is the development of intercultural competences within the healthcare system. Our paper discusses the concept, content and opportunities for the development of intercultural competence in clinical and healthcare settings. Orv Hetil. 2020; 161(32): 1322-1330.

[Primary care of refugees and migrants. Lesson learnt from the EUR-HUMAN project]. / Menekültek, migránsok az alapellátásban. Mit tanulhattunk az EUR-HUMAN projekt eredményeibol?

In 2015, local wars, starvation and misery in some Middle Eastern, Asian and African countries forced millions of people to leave their homelands. Many of these people migrated toward Europe, reaching Hungary as well. The refugee crisis created significant challenges for all national healthcare systems across Europe. Limited attention has been given to the extent to which health service provision for refugees and migrants has become a task for primary health care (PHC), which has been unprepared as a profession and pressured by the enormous workload. Hungarian primary care was involved only to an extent in the refugees' health care, as most of the migrants entering Hungary wanted to move forward to other countries. The need for evidence-based patient-centred interventions to assess refugee healthcare needs, and for training programmes for rapid capacity-building for integrated PHC was addressed by the EUropean Refugees - HUman Movement and Advisory Network (EUR-HUMAN) project, which 7 European countries developed together. The overall aim of the EUR-HUMAN project is to enhance the knowledge and expertise of European member states who accept refugees and migrants in addressing their health needs, safeguarding them from risks, while at the same time to minimize cross-border health risks. This initiative focuses on addressing the early arrival period, transition and longer-term settlement of refugees in European host countries. A primary objective of this project is to identify, design and assess interventions to improve PHC delivery for refugees and migrants with a focus on vulnerable groups. The structure, the main focus and outputs of the project are described and summarized in this paper, providing relevant information and access to educational materials for Hungarian (primary care) physicians. The EUR-HUMAN project was operated in 2016 under the auspices of the European Commission and funded by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). Orv Hetil. 2018; 159(35): 1414-1422.

[Motivations for foreign employment and carrier change among Hungarian physiotherapists]. / Külföldi munkavállalás és pályaelhagyási indítékok a magyar gyógytornászok körében.

INTRODUCTION: An increasing motivation can be experienced among professional workers within the Hungarian healthcare system towards foreign employment or career change. AIM: The aim of the authors was to assess Hungarian physiotherapists' migration and career changing behaviour and to understand the underlying factors. METHOD: A national survey in Hungary from April to August, 2014 was performed. Only physiotherapists who practice in Hungary were included (n = 215). RESULTS: The results suggest that age (p<0.05) and the rate of financial appreciation experienced in the workplace (p<0.01) significantly affect the appearance of migratory thoughts. Those physiotherapists who do not feel themselves financially appreciated, are 55 times more likely to search for employment outside the country's borders [OR = 55.28 CI (95%) = 18.85 to 161.12]. The most common causes for that are unfavourable financial (p<0.01) and moral recognition (p<0.01). CONCLUSIONS: In order to prevent our already highly-qualified colleagues from leaving the country or from considering to leave the profession we should concentrate on increasing the financial and moral appreciation of the profession within the Hungarian healthcare system.

[Migration of an epicardial pacemaker into the abdominal cavity]. / Hasüregbe vándorolt epicardialis pacemaker.

Migration of a permanent pacemaker generator from their intramuscular pocket to the abdominal cavity is a less frequent, but potentially life-threatening complication. The authors present the case of a 69-year-old woman, who visited the emergency department of the clinic, with complains of non-specific abdominal symptoms. Her past medical history included a complete atrioventricular block diagnosed in 2009 during the mitral valve replacement and since then she had an epicardial permanent pacemaker; the pulse generator was placed into an intramuscular pouch created in the left subcostal region. Surprisingly, radiologic examinations showed that the generator migrated into the pouch of Douglas. Considering patient safety, first a new intracardiac pacemaker was implanted and then the migrated device was removed surgically. The patient was discharged on the seventh postoperative day.