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2.
Psychiatr Danub ; 32(Suppl 3): 320-336, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33030447

RESUMO

The war in Bosnia and Herzegovina (1992-1995) was an extremely hard traumatic event with different losses, separations of people, injuries, hard physical and psychical suffering of everyone. Children were especially in difficult conditions. One of the most remarkable things about children, as anyone who works with them soon finds out, is their resilience. While children are vulnerable to psychic damage and, if the damage is deep enough, to delays in emotional and even physical growth, they also have an astonishing capacity to bounce back. This is one of the most rewarding things about treating traumatized children. For many children, it takes very little, perhaps only some words of understanding, to help them tap into their own ability to heal. Taking care of child war psycho-trauma was a difficult task for me, as the war-time head of Department of psychiatry, without enough knowledge in child psycho-trauma and as person with a high responsibility, to organize together with other psychological caretakers of children, especially refugee children. This presentation will be some kind of my remembrance of period of 20-25 years ago when we, I think did good work of what we could and what we knew.


Assuntos
Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Guerra/psicologia , Adolescente , Adulto , Idoso , Bósnia e Herzegóvina , Criança , Família/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Refugiados/psicologia , Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos/reabilitação , Adulto Jovem
3.
Psychiatr Danub ; 32(Suppl 3): 386-395, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33030459

RESUMO

The use of violence and aggression on civilians during the war has become one of the most prominent military events of the 20th and 21st centuries, resulting in an increasing number of refugees and displaced persons in the midst of regional and tribal conflicts. We are witnessing a daily increase in the number of migrants when people are fleeing from their homes because of human rights violations, persecution, poverty, and conflict. When found in "host" countries, they often encounter bad conditions, with uncertainty and instability. Many come to Europe in search of economic and personal opportunities for progress, where they face different types of process of acculturation. 'Place loss', acute and chronic trauma, family disorders, and family reunification issues became more and more important issues. Refugees, asylum seekers and irregular migrants have a higher risk for certain mental health disorders, including posttraumatic stress, depression and psychosis. In addition to being exposed to various risk factors for mental disorders, migrants often face barriers to access to adequate health care to address these issues. Some of the biggest challenges for migrant populations within "host" countries include: lack of knowledge of health care rights and health systems; poor knowledge of the language; different belief systems and cultural expectations of health care; and the general lack of trust in experts and in government. The rates of depressive and anxiety disorders usually increase over time, and poor mental health is associated with poor socioeconomic conditions - particularly with social isolation and unemployment. Acculturative stress often implies a high discrepancy in the acculturation between parents and their children. This dislocation of families in new conditions has been caused by the different degrees of acceptance of "new culture" by children and parents, which causes serious difficulties, especially in bilingual terms.


Assuntos
Aculturação , Saúde Mental/estatística & dados numéricos , Refugiados , Migrantes , Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Europa (Continente) , Humanos , Refugiados/psicologia , Refugiados/estatística & dados numéricos , Migrantes/psicologia , Migrantes/estatística & dados numéricos
4.
Z Kinder Jugendpsychiatr Psychother ; 48(5): 369-379, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32880227

RESUMO

Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial Abstract. Unaccompanied minor refugees (UMR) are a group particularly vulnerable to mental illness. They pose a great challenge not only for child and youth psychiatric and psychotherapeutic care, but also for youth-welfare institutions. The study examines the effectiveness of Stabilization Training for Adolescent Refugees with Trauma Induced Disorders in inpatient youth-welfare facilities. Methods: We conducted a randomized controlled trial with pre-post design in a naturalistic setting, randomly assigning 9 housing groups for UMRs to the intervention or waiting control condition. The mental stress of 46 UMRs was assessed by both self-report and educational staff-report. Two educational staff members conducted the Stabilization Training for Adolescent Refugees with Trauma Induced Disorders as an intervention in each of the respective residential groups. Results: Participation in training led to a reduction in subjective general psychological stress. At the end of the training, psychological stress in self-judgment was significantly lower in the intervention group than in the waiting control condition. The effectiveness of the training is apparently not reflected by educational staff assessments. Conclusions: Stabilization training is a suitable instrument for the preclinical care of UMR and thus an essential basis for further psychotherapy.


Assuntos
Psicoterapia , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Adolescente , Humanos , Resultado do Tratamento
6.
Artigo em Alemão | MEDLINE | ID: mdl-32964252

RESUMO

PURPOSE: In the area of the Asylum Seeker Benefits Act (AsylbLG), there are two options for granting benefits that have practical relevance to health care (depending on the period of previous residence): minimum provision and benefits in special cases, analogous to the Social Code Book XII (SGB XII). METHOD: This secondary data analysis examines the performance of benefits in the case of illness among benefit recipients according to the AsylbLG at the Research Data Centre of the Federal and State Statistical Offices. The examined group of individuals have not yet been granted refugee status or asylum entitlement. RESULTS: As of 31 December 2018, 423,201 persons in Germany were receiving benefits according to the AsylbLG. A good third of these were women. The average age was 24 years, and more than half came from Asia. More than one-third of all benefit recipients were in outpatient (33.5%) or inpatient treatment (1.3%). Among the federal states, benefits for assistance in the case of illness as well as the health-related per capita gross expenditure varied considerably. The provision of illness benefits in reception facilities was relatively low. With the health card, the use of inpatient treatment was higher. The standard health-related provision of assistance in special cases (§2 AsylbLG analogous to SGB XII) reached a higher share of people entitled to benefits at the end of the year (42.7%) than the minimum provision according to §3 AsylbLG (29.0%). Nevertheless, it caused comparatively less gross expenditure. CONCLUSION: It is recommended to apply §2 AsylbLG for a prestay period of three months or longer in order to be able to grant assistance analogous to Chapters 5 to 9 SGB XII earlier. Nationwide introduction of an electronic health insurance card for asylum seekers would improve access.


Assuntos
Refugiados , Adulto , Assistência à Saúde , Feminino , Alemanha , Acesso aos Serviços de Saúde , Humanos , Adulto Jovem
7.
Soc Work Public Health ; 35(7): 579-589, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32970540

RESUMO

The objective of this study; is to find out the sensitivity, the concern that are created by the Covid-19 pandemic on the Syrian refugees, who live in Kilis province of Turkey and have different life standards and status and to find out their possibilities and attitudes of prevention from and combating the pandemic. The data of the study were collected between 12-16 April 2020 by applying a questionnaire on 414 refugees. According to the study results, it has been discovered that the refugees have concerns about Covid-19 and their insensitivity levels are low. It has been seen that there is a group who are not aware of the seriousness of the pandemic, who do not have enough information about the pandemic and cannot reach personal protective equipment (such as masks, gloves). In general, in the fight against pandemic; the levels of refugees' following the rules and their finding the decisions taken and implemented proper, can be defined as close to each other and good.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Refugiados , Adolescente , Adulto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Síria/etnologia , Turquia/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-32962038

RESUMO

Background: Infections are a leading cause of refugee morbidity. Recent data on the rate of airway infections and factors influencing their spread in refugee reception centers is scarce. Methods: A retrospective, cross-sectional study of de-identified medical records with a focus on respiratory infections in underage refugees was conducted at two large German refugee reception centers. Results: In total, medical data from n = 10,431 refugees over an observational period of n = 819 days was analyzed. Among pediatric patients (n = 4289), 55.3% presented at least once to the on-site medical ward with an acute respiratory infection or signs thereof. In 38.4% of pediatric consultations, acute airway infections or signs thereof were present. Airway infections spiked during colder months and were significantly more prevalent amongst preschool and resettled children. Their frequency displayed a positive correlation with the number of refugees housed at the reception centers. Conclusions: We show that respiratory infections are a leading cause for morbidity in young refugees and that their rate is influenced age, season, status, and residential density. This illustrates the need to protect refugee children from contracting airway infections which may also reduce the spread of coronavirus disease 2019 (COVID-19) during the current pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Refugiados/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Migrantes/estatística & dados numéricos , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Humanos , Pneumonia Viral/epidemiologia , Habitação Popular , Características de Residência , Estudos Retrospectivos
9.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32994177

RESUMO

BACKGROUND: New guidelines support using interferon-γ release assays (IGRAs) in children ≥2 years for diagnosis of latent tuberculosis infection (LTBI). However, lack of experience in young children and concern that IGRAs are less sensitive than tuberculin skin tests (TSTs) limit their use. Our aim was to identify active tuberculosis (TB) cases among high risk children <5 years and tested for LTBI with an IGRA. METHODS: . Retrospective review of domestic TB screening data from California's Refugee Health Electronic Information System for children <5 years old who resettled in California between October, 2013 and December, 2016. Children were crossmatched with the California TB registry to identify cases of TB disease between October 2013 and December 2018. RESULTS: A total of 3371 children <5 years were identified; the majority were born in countries with high TB incidence (>150 cases per 100 000). Half received IGRAs (n = 1878; 56%), a quarter received TSTs (n = 811; 24%); 1.4% of children were IGRA-positive (n = 26) and 13% were TST-positive (n = 106). Twenty-two IGRA results were indeterminate (1.2%). Sixteen children had both tests; 9 were discrepant (positive TST with negative IGRA). No cases of TB disease were identified during 10 797 person-years of follow-up. CONCLUSIONS: IGRA positivity was less than TST positivity in high risk children <5 years old. Despite fewer LTBI diagnoses in the IGRA-tested population, no cases of TB disease among children who tested negative were identified, suggesting IGRA is valuable tool for identifying LTBI in this population.


Assuntos
Testes de Liberação de Interferon-gama/estatística & dados numéricos , Tuberculose Latente/diagnóstico , Refugiados/estatística & dados numéricos , Teste Tuberculínico/estatística & dados numéricos , California/epidemiologia , Pré-Escolar , Feminino , Humanos , Tuberculose Latente/epidemiologia , Masculino , Estudos Retrospectivos
10.
PLoS Med ; 17(9): e1003283, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32877401

RESUMO

BACKGROUND: Since 2011, the protracted Syrian war has had tragic consequences on the lives of the Syrian people, threatening their stability, health, and well-being. The most vulnerable are children, who face interruption of schooling and child labor. This study explored the relationship between social capital and the physical health and emotional well-being of Syrian refugee working children in rural areas of Lebanon. METHODS AND FINDINGS: In this cross-sectional study, we surveyed 4,090 Syrian refugee children working in the Bekaa Valley of Lebanon in 2017. Children (8-18 years) gave direct testimony on their living and social environment in face-to-face interviews. Logistic regressions assessed the association of social capital and social cohesion with the health and emotional well-being of Syrian refugee working children; specifically, poor self-rated health, reporting a health problem, engaging in risky health behavior, feeling lonely, feeling optimistic, and being satisfied with life. Of the 4,090 working children in the study, 11% reported poor health, 16% reported having a health problem, and 13% were engaged in risky behaviors. The majority (67.5%) reported feeling lonely, while around 53% were optimistic and 59% were satisfied with life. The study findings suggest that positive social capital constructs were associated with better health. Lower levels of social cohesion (e.g., not spending time with friends) were significantly associated with poor self-rated health, reporting a physical health problem, and feeling more lonely ([adjusted odds ratio (AOR), 2.4; CI 1.76-3.36, p < 0.001], [AOR, 1.9; CI 1.44-2.55, p < 0.001], and [AOR, 0.5; CI 0.38-0.76, p < 0.001], respectively). Higher levels of social support (e.g., having good social relations), family social capital (e.g., discussing personal issues with parents), and neighborhood attachment (e.g., having a close friend) were all significantly associated with being more optimistic ([AOR, 1.5; CI 1.2-1.75, p < 0.001], [AOR, 1.3; CI 1.11-1.52, p < 0.001], and [AOR, 1.9; CI 1.58-2.29, p < 0.001], respectively) and more satisfied with life ([AOR, 1.3; CI 1.01-1.54, p = 0.04], [AOR, 1.2; CI 1.01-1.4, p = 0.04], and [AOR, 1.3; CI 1.08-1.6, p = 0.006], respectively). The main limitations of this study were its cross-sectional design, as well as other design issues (using self-reported health measures, using a questionnaire that was not subject to a validation study, and giving equal weighting to all the components of the health and emotional well-being indicators). CONCLUSIONS: This study highlights the association between social capital, social cohesion, and refugee working children's physical and emotional health. In spite of the poor living and working conditions that Syrian refugee children experience, having a close-knit network of family and friends was associated with better health. Interventions that consider social capital dimensions might contribute to improving the health of Syrian refugee children in informal tented settlements (ITSs).


Assuntos
Qualidade de Vida/psicologia , Refugiados/psicologia , Adolescente , Criança , Trabalho Infantil , Estudos Transversais , Emoções , Feminino , Humanos , Líbano/etnologia , Masculino , Razão de Chances , Capital Social , Meio Social , Apoio Social , Síria
11.
PLoS Med ; 17(9): e1003218, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32903257

RESUMO

BACKGROUND: A decade of Boko Haram insurgency brought conflict, mass displacement, and the destruction of basic infrastructure to Northeast Nigeria. Over 2 million internally displaced persons (IDPs) suffering from lack of basic hygienic conditions, malnutrition, and disease live in camps or are hosted by communities in the region, where the conflict has contributed to a massive destruction of health facilities. Infectious diseases like tuberculosis (TB) and HIV are especially difficult to address under such conditions, and IDPs are vulnerable to both. Although international investment supports some health interventions among IDPs, locally sourced solutions are lacking. METHODS AND FINDINGS: We evaluated the impact of an active case finding (ACF) intervention for TB and testing for HIV in IDP communities and provided linkages to treatment in 3 states in Northeast Nigeria: Adamawa, Gombe, and Yobe. The ACF was a component of a multistakeholder collaboration between government, civil society, and IDP community partners, which also included mapping of IDP populations and health services, supporting existing health facilities, developing a sample transport network, and organizing community outreach to support ACF. Between July 1, 2017, and June 30, 2018, ACF was conducted in 26 IDP camps and 963 host communities in 12 local government areas (LGAs) with another 12 LGAs serving as a control population. Outreach efforts resulted in 283,556 screening encounters. We screened 13,316 children and 270,239 adults including 150,303 (55.6%) adult women and 119,936 (44.4%) men. We tested 17,134 people for TB and 58,976 for HIV. We detected 1,423 people with TB and 874 people living with HIV. We linked 1,419 people to anti-TB treatment and 874 people with HIV to antiretroviral treatment sites. We evaluated additional TB cases notified and conducted comparative interrupted time series (ITS) analyses to assess the impact of ACF on TB case notifications. Through our efforts, bacteriologically confirmed TB notifications increased by 847 (45.1%) during the intervention period, with IDPs accounting for 46% of these notifications. The ITS analyses detected significant positive postintervention trend differences in TB notification rates between the intervention and control areas in all forms TB (incidence rate ratio [IRR] = 1.136 [1.072, 1.204]; p ≤ 0.001) and bacteriologically positive TB (IRR = 1.141 [1.058, 1.229]; p = 0.001). The TB prevalence (502 cases per 100,000 screening encounters) was 10 times the national notification rates and 2.3 times the estimated national incidence. Rates of HIV infection (1.8%) were higher than HIV prevalence estimates in the 3 states. Our study was limited by the nonrandom selection of LGAs. Furthermore, we did not use sensitive screening tools like chest X-ray and likely missed people with TB. CONCLUSIONS: In this study, we observed a burden of TB in IDP populations of Northeast Nigeria many times higher than national rates and HIV rates higher than state level estimates. The impact of the intervention showed that ACF can greatly increase TB case notifications. Engaging IDP communities, local governments, and civil society organizations is essential to ensuring the success of interventions targeting TB and HIV, and such approaches can provide sustained solutions to these and other health crises among vulnerable populations.


Assuntos
Intervenção Médica Precoce/métodos , Infecções por HIV/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Criança , Relações Comunidade-Instituição , Feminino , Instalações de Saúde , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Refugiados , Adulto Jovem
12.
PLoS Med ; 17(9): e1003337, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32956381

RESUMO

BACKGROUND: Globally, the number of refugees and asylum seekers has reached record highs. Past research in refugee mental health has reported wide variation in mental illness prevalence data, partially attributable to methodological limitations. This systematic review aims to summarise the current body of evidence for the prevalence of mental illness in global refugee populations and overcome methodological limitations of individual studies. METHODS AND FINDINGS: A comprehensive search of electronic databases was undertaken from 1 January 2003 to 4 February 2020 (MEDLINE, MEDLINE In-Process, EBM Reviews, Embase, PsycINFO, CINAHL, PILOTS, Web of Science). Quantitative studies were included if diagnosis of mental illness involved a clinical interview and use of a validated assessment measure and reported at least 50 participants. Study quality was assessed using a descriptive approach based on a template according to study design (modified Newcastle-Ottawa Scale). Random-effects models, based on inverse variance weights, were conducted. Subgroup analyses were performed for sex, sample size, displacement duration, visa status, country of origin, current residence, type of interview (interpreter-assisted or native language), and diagnostic measure. The systematic review was registered with PROSPERO (CRD) 42016046349. The search yielded a result of 21,842 records. Twenty-six studies, which included one randomised controlled trial and 25 observational studies, provided results for 5,143 adult refugees and asylum seekers. Studies were undertaken across 15 countries: Australia (652 refugees), Austria (150), China (65), Germany (1,104), Italy (297), Lebanon (646), Nepal (574), Norway (64), South Korea (200), Sweden (86), Switzerland (164), Turkey (238), Uganda (77), United Kingdom (420), and the United States of America (406). The prevalence of posttraumatic stress disorder (PTSD) was 31.46% (95% CI 24.43-38.5), the prevalence of depression was 31.5% (95% CI 22.64-40.38), the prevalence of anxiety disorders was 11% (95% CI 6.75-15.43), and the prevalence of psychosis was 1.51% (95% CI 0.63-2.40). A limitation of the study is that substantial heterogeneity was present in the prevalence estimates of PTSD, depression, and anxiety, and limited covariates were reported in the included studies. CONCLUSIONS: This comprehensive review generates current prevalence estimates for not only PTSD but also depression, anxiety, and psychosis. Refugees and asylum seekers have high and persistent rates of PTSD and depression, and the results of this review highlight the need for ongoing, long-term mental health care beyond the initial period of resettlement.


Assuntos
Transtornos Mentais/epidemiologia , Refugiados/psicologia , Ansiedade/epidemiologia , Transtornos de Ansiedade , Depressão/epidemiologia , Transtorno Depressivo , Feminino , Humanos , Masculino , Saúde Mental/tendências , Prevalência , Transtornos de Estresse Pós-Traumáticos/epidemiologia
13.
Cochrane Database Syst Rev ; 9: CD013458, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32885850

RESUMO

BACKGROUND: Migrants who have been forced to leave their home, such as refugees, asylum seekers, and internally displaced persons (IDP), are likely to experience stressors which may lead to mental health problems. The efficacy of interventions for mental health promotion, prevention, and treatment may differ in this population. OBJECTIVES: With this overview of systematic reviews, we will map the characteristics and methodological quality of existing systematic reviews and registered systematic review protocols on the promotion of mental health and prevention and treatment of common mental disorders among refugees, asylum seekers, and IDPs. The findings from this overview will be used to prioritise and inform future Cochrane reviews on the mental health of involuntary migrants. METHODS: We searched Ovid MEDLINE (1945 onwards), Ovid Embase (1974 onwards), Ovid PsycINFO, ProQuest PTSDpubs, Web of Science Core Collection, Cochrane Database of Systematic Reviews, NIHR Journals Library, CRD databases (archived), DoPHER, Epistemonikos, Health Evidence, 3ie International Initiative for Impact Evaluation, and PROSPERO, to identify systematic reviews of mental health interventions for involuntary migrants. We did not apply any restrictions on date, language, or publication status to the searches. We included systematic reviews or protocols for systematic reviews of interventions aimed at refugees, asylum seekers, and internally displaced persons. Interventions must have been aimed at mental health promotion (for example, classroom-based well-being interventions for children), prevention of mental health problems (for example, trauma-focussed Cognitive Behavioural Therapy to prevent post-traumatic stress disorder), or treatment of common mental disorders and symptoms (for example, narrative exposure therapy to treat symptoms of trauma). After screening abstracts and full-text manuscripts in duplicate, we extracted data on the characteristics of the reviews, the interventions examined in reviews, and the number of primary studies included in each review. Methodological quality of the included systematic reviews was assessed using AMSTAR 2. MAIN RESULTS: The overview includes 23 systematic reviews and 15 registered systematic review protocols. Of the 23 published systematic reviews, meta-analyses were conducted in eight reviews. It was more common for the search strategy or inclusion criteria of the reviews to state that studies involving refugees were eligible for inclusion (23/23), than for asylum seekers (14/23) or IDPs (7/23) to be explicitly mentioned. In most reviews, study eligiblity was either not restricted by participant age (9/23), or restricted to adults (10/23). Reviews commonly reported on studies of diagnosis or symptoms of post-traumatic stress disorder or trauma (11/23) and were less likely to report on depression or anxiety (6/23). In 15 reviews the intervention of interest was focused on/ specific to psychological therapy. Across all 23 reviews, the interventions most commonly identified from primary studies were general Cognitive Behavioural Therapy, Narrative Exposure Therapy, and a range of different integrative and interpersonal therapies. Even though many reviews included studies of participants without a diagnosis of a mental health problem, they often assessed mental health treatments and did not usually distinguish between promotion, prevention, and treatment in the review aims. Together the 23 systematic reviews included 336 references, of which 175 were unique primary studies. Limitations to the methodological quality of reviews most commonly related to reporting of selection criteria (21/23), absence of a protocol (19/23), reporting of study design (20/23), search strategy (22/23), and funding sources of primary studies (19/23). AUTHORS' CONCLUSIONS: Gaps exist in the evidence on mental health interventions for refugees, asylum seekers, and internally displaced persons. Most reviews do not specify that internally displaced persons are included in the selection criteria, even though they make up the majority of involuntary migrants worldwide. Reviews specific to mental health promotion and prevention of common mental disorders are missing, and there is more evidence available for adults or mixed populations than for children. The literature is focused on post-traumatic stress disorder and trauma-related symptoms, with less attention for depression and anxiety disorders. Better quality systematic reviews and better report of review design and methods would help those who may use these reviews to inform implementation of mental health interventions.


Assuntos
Promoção da Saúde , Transtornos Mentais/terapia , Saúde Mental , Refugiados/psicologia , Revisões Sistemáticas como Assunto , Humanos , Transtornos Mentais/prevenção & controle , Metanálise como Assunto , Refugiados/classificação , Transtornos de Estresse Pós-Traumáticos/terapia
14.
Health Rep ; 31(8): 3-12, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32816413

RESUMO

BACKGROUND: Few studies of the healthy immigrant effect (HIE) have examined the mental health outcomes of Canadian-born individuals on a national scale compared with immigrants by admission category. This study fills this gap by examining the self-reported mental health (SRMH) of immigrants by admission category and other immigration dimensions (e.g., source world region and duration since landing) and making comparisons with Canadian-born respondents to a population-based survey. DATA AND METHODS: Based on four cycles (2011 to 2014) of the Canadian Community Health Survey (CCHS) linked to the Longitudinal Immigration Database (IMDB), odds ratios of high (i.e., excellent or very good) SRMH among Canadian-born respondents and IMDB-linked immigrants are compared using logistic regression. Among the IMDB immigrant population, high SRMH was also examined according to the above-mentioned immigration dimensions. Adjusted results were hierarchically controlled for age, sex, social and economic factors, and sense of belonging. RESULTS: Age-sex adjusted results show that immigrants, especially refugees, are less likely than the Canadian-born population to report high mental health levels, but these differences disappeared after full adjustment. The odds of immigrants having high SRMH differed more by source world region and duration since landing. For example, fully adjusted results show support for the HIE, with recent immigrants (interviewed within 10 years of landing) more likely to report high SRMH than either the Canadian-born population or established immigrants. Greater odds of high SRMH among recent immigrants also holds across admission classes and for selected world regions. DISCUSSION: This study provides new evidence on differences in mental health between Canadian-born individuals and immigrants by various characteristics. Results support a deterioration of the HIE in SRMH and identify factors significantly associated with SRMH. This study can also serve as a baseline for further studies on the impact of COVID-19 on immigrants' mental health by immigrant category.


Assuntos
Emigrantes e Imigrantes/psicologia , Nível de Saúde , Saúde Mental , Refugiados/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Criança , Infecções por Coronavirus/psicologia , Bases de Dados Factuais , Emigração e Imigração , Grupos Étnicos , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia Viral/psicologia , Autorrelato , Adulto Jovem
15.
Int J Equity Health ; 19(1): 141, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819364

RESUMO

An estimated 2 million foreign-born migrants of working age (15-64) were living in South Africa (SA) in 2017. Structural and practical xenophobia has driven asylum-seekers, refugees, and undocumented migrants in SA to abject poverty and misery. The Coronavirus Disease 2019 (COVID-19) containment measures adopted by the SA government through the lockdown of the nation have tremendously deepened the unequal treatment of asylum-seekers and refugees in SA. This can be seen through the South African government's lack of consideration of this marginalized population in economic, poverty, and hunger alleviation schemes. Leaving this category of our society out of the national response safety nets may lead to negative coping strategies causing mental health issues and secondary health concerns. An effective response to the socioeconomic challenges imposed by the COVID-19 pandemic should consider the economic and health impact of the pandemic on asylum-seekers, refugees, and undocumented migrants.


Assuntos
Infecções por Coronavirus/epidemiologia , Disparidades nos Níveis de Saúde , Pneumonia Viral/epidemiologia , Refugiados/estatística & dados numéricos , Imigrantes Indocumentados/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adolescente , Adulto , Infecções por Coronavirus/prevenção & controle , Governo , Humanos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Fatores Socioeconômicos , África do Sul/epidemiologia , Adulto Jovem
17.
Glob Public Health ; 15(10): 1578-1581, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816647

RESUMO

The COVID-19 pandemic is now a global crisis and the Rohingya refugees in Bangladesh are in the most vulnerable situation. Lack of access to services that are considered critical and life-saving such as food, drinkable water, and shelter, together with limited access to health services are turning an already serious crisis into a major human disaster. Meanwhile, there are concerns that Rohingya refugees are already in too poor health to ward off the COVID-19. Access to the abovementioned facilities and trustworthy information about COVID-19 are amongst their dire needs to combat this pandemic. The humanitarian organisations in collaboration with the Government of Bangladesh should urgently scale up their efforts to provide proper isolation centres, protective equipment, and trained health care representatives to avoid a potential catastrophe. Finally, immediate education intervention is desperately needed to protect the Rohingya refugees from this deadly COVID-19 pandemic.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Pneumonia Viral/epidemiologia , Refugiados , Bangladesh/epidemiologia , Betacoronavirus , Feminino , Humanos , Masculino , Pandemias , Fatores de Risco , Violência/estatística & dados numéricos
18.
PLoS One ; 15(8): e0237776, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822404

RESUMO

While medical advocacy is mandated as a core professional commitment in a growing number of ethical codes and medical training programs, medical advocacy and social justice engagement are regularly subordinated to traditional clinical responsibilities. This study aims to provide insight into factors that motivate clinician engagement and perseverance with medical advocacy, so as to inform attempts by policymakers, leaders and educators to promote advocacy practices in medicine. Furthermore, this study aims to provide an analysis of the role of medical advocates in systems where patients' rights are perceived to be infringed and consider how we might best support and protect these medical advocates as a profession, by exploring the experiences and perspectives of Australian clinicians defending the health of detained asylum seekers. In this qualitative study thirty-two medical and health professionals advocating on asylum seeker health in immigration detention were interviewed. Transcripts were coded both inductively and deductively from interview question domains and thematically analysed. Findings suggested that respondents' motivations for advocacy stemmed from deeply intertwined professional and personal ethics. Overall, advocacy responses originated from the union of three integral stimuli: personal ethics, proximity and readiness. We conclude that each of these three integral factors must be addressed in any attempt to foster advocacy within the medical profession. In light of current global trends of increasingly protectionist immigration practices, promoting effective physician advocacy may become essential in ensuring patients' universal right to health.


Assuntos
Acesso aos Serviços de Saúde , Defesa do Paciente , Refugiados , Austrália , Feminino , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Masculino , Defesa do Paciente/ética , Defesa do Paciente/legislação & jurisprudência , Assistência Centrada no Paciente/ética , Assistência Centrada no Paciente/legislação & jurisprudência , Refugiados/legislação & jurisprudência
19.
Public Health ; 186: 101-106, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32795768

RESUMO

OBJECTIVES: This study investigated the magnitude of catastrophic health expenditure (CHE) among ex-Gazan households in Jerash camp in Jordan. STUDY DESIGN: This retrospective survey used a systematic sample. METHODS: A systematic sample was used wherein every fifth house in Jerash camp was invited to participate in the study. The camp represents the largest community of ex-Gazan refugees in Jerash camp. Of the 1038 households who were invited, 976 households agreed to participate (response rate = 94%) and filled the pilot-structured questionnaire with information related to their socio-economic characteristics, health status, and their healthcare and total household expenditures. van Doorslaer's method was used to calculate the frequency of CHE, wherein the expenditure on health care was considered catastrophic if it exceeded 10% of a household's total expenditure. RESULTS: Of the sample, 41.8% suffered from CHE. Moreover, we calculated the frequency of CHE using 15%, 20%, 30%, and 40% as threshold values, and the total rates were 14.7, 6.3, 1, and 0.3%, respectively. In addition, the statistical analysis of the results showed higher frequencies of CHE in households with larger number of dependents, those headed by widowed women, and those with history of hospitalizations. CONCLUSIONS: The study shows that the rate of CHE in Jerash camp is very high and mainly due to the cost of hospitalization. Special attention should be paid for the residents of that area.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Campos de Refugiados/estatística & dados numéricos , Adulto , Características da Família , Feminino , Serviços de Saúde , Nível de Saúde , Hospitalização , Humanos , Jordânia , Masculino , Pessoa de Meia-Idade , Oriente Médio , Campos de Refugiados/economia , Refugiados , Estudos Retrospectivos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
20.
PLoS One ; 15(8): e0236996, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32750066

RESUMO

Using novel registry data on persons receiving asylum welfare benefits in Germany for the period from 2010 to 2016, and quasi-experimental variation induced by German allocation policies, we identify the role that the size and composition of local co-national networks of asylum seekers play for formal labor market access within the same group. While the individual employment probability is not linked to network size, it increases with the number of employed local co-national asylum seekers and decreases with the number of non-employed network members, thereby underlining the central importance of network quality. JEL Classification: F22, J61, R23.


Assuntos
Emprego/estatística & dados numéricos , Refugiados , Adulto , Idoso , Emprego/tendências , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Adulto Jovem
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