Full Text Available Abstract Background Medical care for asylum seekers is a complex and critical issue worldwide. It is influenced by social, political, and economic pressures, as well as premigration conditions, the process of migration, and postmigration conditions in the host country. Increasing needs and healthcare costs have led public health authorities to put nurse practitioners in charge of the management of a gatekeeping system for asylum seekers. The quality of this system has never been evaluated. We assessed the competencies of nurses and physicians in identifying the medical needs of asylum seekers and providing them with appropriate treatment that reflects good clinical practice. Methods This cross-sectional descriptive study evaluated the appropriateness of care provided to asylum seekers by trained nurse practitioners in nursing healthcare centers and by physicians in private practices, an academic medical outpatient clinic, and the emergency unit of the university hospital in Lausanne, Switzerland. From 1687 asylum seeking patients who had consulted each setting between June and December 2003, 450 were randomly selected to participate. A panel of experts reviewed their medical records and assessed the appropriateness of medical care received according to three parameters: 1 use of appropriate procedures to identify medical needs (medical history, clinical examination, complementary investigations, and referral, 2 provision of access to treatment meeting medical needs, and 3 absence of unnecessary medical procedures. Results In the nurse practitioner group, the procedures used to identify medical needs were less often appropriate (79% of reports vs. 92.4% of reports; p Conclusion Although the nursing gatekeeping system provides appropriate treatment to asylum seekers, it might be improved with further training in recording medical history and performing targeted clinical examination.
The physician's professional life involves reading and analysis of scientific journals, regardless of the specialization field. The hospital and academic areas lead to the scientific-literary activity development. The aim of this editorial is to make some reflections about the way a physician reaches intellectual development, through the creation of a culture of writing and reading scientific publications.
Church asylum, or sanctuary, is a practice to support, counsel and give shelter to refugees who are threatened with deportation to inhumane living conditions, torture or even death. This practice can be located at the interface of benevolence and politics.
Full Text Available Church asylum, or sanctuary, is a practice to support, counsel and give shelter to refugees who are threatened with deportation to inhumane living conditions, torture or even death. This practice can be located at the interface of benevolence and politics.
Portnoy, David B; Han, Paul K J; Ferrer, Rebecca A; Klein, William M P; Clauser, Steven B
Medical interventions are often characterized by substantial scientific uncertainty regarding their benefits and harms. Physicians must communicate to their patients as part of the process of shared decision making, yet they may not always communicate scientific uncertainty for several reasons. One suggested by past research is individual differences in physicians' tolerance of uncertainty. Relatedly, an unexplored explanation is physicians' beliefs about their patients' tolerance of uncertainty. To test this possibility, we surveyed a sample of primary care physicians (N = 1500) and examined the association between their attitudes about communicating and managing scientific uncertainty and their perceptions of negative reactions to uncertainty by their patients. Physician perceptions were measured by their propensity towards pessimistic appraisals of risk information and avoidance of decision making when risk information is ambiguous--of uncertain reliability, credibility or adequacy, known as 'ambiguity aversion'. Confirming past studies, physician demographics (e.g. medical specialty) predicted attitudes toward communicating scientific uncertainty. Additionally, physicians' beliefs about their patients' ambiguity aversion significantly predicted these preferences. Physicians who thought that more of their patients would have negative reactions to ambiguous information were more likely to think that they should decide what is best for their patients (β = 0.065, P = 0.013), and to withhold an intervention that had uncertainty associated with it (β = 0.170, P communicating scientific uncertainty about medical tests and treatments, physicians' perceptions of their patients' ambiguity aversion may be related to their attitudes towards communicating uncertainty. © 2011 John Wiley & Sons Ltd.
Steger, Bernhard; Colvin, Hans Peter; Rieder, Josef
Controllable lifestyle has become an important factor influencing career decision-making among physicians. In academic medicine, doctors are required to combine both patient care and research in their daily routine. Insufficient release of clinicians for research during contracted work hours may lead to increased weekly working hours in academic medical centers and deter medical graduates from academia. We tested for an association between numbers of scientific publications and an increased hourly workload among physicians. This was a cross-sectional online survey among all salaried physicians working in the university hospitals of Innsbruck and Salzburg, Austria. The main outcome measures were the self-reported total number of scientific papers published in peer-reviewed medical journals over the past two years and self-reported working hours. Of 590 returned surveys, 393 were fully completed and included in the study. The sample was stratified into three groups according to scientific output in the past two years: Group A, >/= 6 publications; Group B, 1-5 publications; Group C, no publications. Men were more likely than women to have a scientific publication: in Group A there was a male predominance of 75%, whereas in Group C only 48% were men (P = 0.0034). A total of 59% (n = 232) of all participants had not published a scientific article in the past two years (Group C) and worked a mean of 58.3 +/- 12 h/week. Physicians in Group B (n = 113) had published 2.4 +/- 1.4 papers and worked 62.8 +/- 12.9 h/week; those in Group A (n = 48) had published 11.5 +/- 6.6 papers and worked 73 +/- 13.1 h/week (P hours, reflecting the fact that research was mainly performed during overtime. Research activity among clinicians in academic medical centers is associated with significantly increased overtime hours. Measures need to be taken to allow medical graduates an academic career at reasonable impairment of personal lifestyle.
Cameron, Carrie; Deming, Stephanie P; Notzon, Beth; Cantor, Scott B; Broglio, Kristine R; Pagel, Walter
Research articles are the coin of the realm for anyone working in academia, and success or failure to publish determines a biomedical researcher's career path. At the same time, the dramatic increase in foreign faculty and trainees in U.S. academia, as well as in international scientific collaboration, adds another dimension to this developmental vacuum: limited English-language skills. Paradoxically, few programs exist to develop and support the skills needed to accomplish the vital task of writing English-language research articles, which does not come naturally to most. To better prepare all trainees for research careers, editors in the Department of Scientific Publications at The University of Texas M. D. Anderson Cancer Center created an in-depth training program that would target the writing skills gap effectively. Instruction focused on structure, rhetorical organization, and the conventions of biomedical publishing. More than 300 trainees have participated in 22 workshops. Results of a survey of 46 participants at 6 months to 2.5 years after workshop completion indicated that participants from all language backgrounds believed the course to have improved their writing (97.8% strongly agreed or agreed), made it easier to begin a manuscript (80.4%), and helped them to get published (56.8%), with nonnative speakers of English reporting somewhat greater perceived benefit than native English speakers. On the basis of these results, the authors conclude that researchers of varied linguistic backgrounds appreciate the need for, and benefit from, instruction in the conventions of scientific writing.
Full Text Available Abstract Background The government-led "evidence-based guidelines for cataract treatment" labelled pirenoxine and glutathione eye drops, which have been regarded as the standard care for cataracts in Japan, as lacking evidence of effectiveness, causing great upset among ophthalmologists and professional ophthalmology societies. This study investigated the reasons why such "scientific evidence of treatment effectiveness" is not easily accepted by physicians, and thus, why they do not change their clinical practices to reflect such evidence. Methods We conducted a qualitative study based on grounded theory to explore physicians' awareness of "scientific evidence" and evidence-supported treatment in relation to pirenoxine and glutathione eye drops, and to identify current barriers to the implementation of evidence-based policies in clinical practice. Interviews were conducted with 35 ophthalmologists and 3 general practitioners on their prescribing behaviours, perceptions of eye drop effectiveness, attitudes toward the eye drop guideline recommendations, and their perceptions of "scientific evidence." Results Although few physicians believed that eye drops are remarkably effective, the majority of participants reported that they prescribed eye drops to patients who asked for them, and that such patients accounted for a considerable proportion of those with cataracts. Physicians seldom attempted to explain to patients the limitations of effectiveness or to encourage them to stop taking the eye drops. Physicians also acknowledged the benefits of prescribing such drugs, which ultimately outweighed any uncertainty of their effectiveness. These benefits included economic incentives and a desire to be appreciated by patients. Changes in clinical practice were considered to bring little benefit to physicians or patients. Government approval, rarity of side effects, and low cost of the drops also encouraged prescription. Conclusion Physicians occasionally
McKenzie, Katherine C; Thomas, Arielle
According to the United Nations High Commissioner on Refugees, over 65 million people were displaced from their homes due to conflict and persecution in 2015. Many physicians express an interest in human rights and a desire to assist this group of refugees and asylum seekers. Physicians are able to use their unique skills by performing medical forensic evaluations of individuals seeking asylum. Some asylum seekers have psychological or physical scars or functional abnormalities relating to injuries or ill-treatment they experience due to persecution. Documenting these findings can significantly improve the likelihood that they will be granted asylum. This manuscript outlines the historical and legal background of asylum. Each of the individuals presented in this paper experienced persecution in different forms. One person was tortured due to his political opinion and one was assaulted because he was gay. One woman sought asylum due to domestic violence, another woman because she had been subjected to female genital mutilation/cutting (FGM/C) and the last suffered severe psychological trauma related to a forced marriage. Five typical clinical cases of medical forensic evaluations are outlined, each with different forms of persecution and physical or psychological findings. Physicians have an interest in using their expertise to help this underserved population. They report that working with asylum seekers is rewarding, intellectually stimulating and a novel way to use their training and skills. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Asylum seekers often find themselves in a situation where the structure and content of daily occupations have been disrupted and they might have limited access to paid work and education. Studies have shown that asylum seekers experience occupational deprivation and a change in daily occupations...... which might even influence their identity. Such deprivation can eventually lead to dissatisfaction with everyday life and to occupational dysfunction, i.e. a decline in ADL ability. Asylum seekers are a group who are more likely to suffer from health problems than the background population. Especially...... torture survivors suffer from ill health. Pain and psychological symptoms are among the most frequent health issues for both asylum seekers and torture survivors and may cause occupation-related problems. The overarching aim of this thesis was to investigate how staying in an asylum centre influenced...
The statement of the Federal Association of Physicians of Public Health Services provides recommendations concerning tuberculosis screening of refugees and asylum seekers on arrival specific to different groups of persons (adults, children, pregnant women, unaccompanied minors), taking into account the legal background and the current recommendations of the Robert Koch Institute as well as of the German Society for Pediatric Infectiology. In addition, recommendations are given to ensure treatment success in refugees and asylum seekers with tuberculosis, to carry out contact investigations and for preventive treatment of latent tuberculosis infection among refugees and asylum seekers. © Georg Thieme Verlag KG Stuttgart · New York.
Burkle, Frederick M; Chan, Jimmy T S; Yeung, Richard D S
The treatment of hunger strikers is always contentious, chaotic and complex. The management is particularly difficult for health professionals as it raises unprecedented clinical, ethical, moral, humanitarian, and legal questions. There are never any easy answers. The current situation of prisoners from the Iraq and Afghanistan Wars currently at the Guantanamo Bay Detention Center in Cuba demands unprecedented transparency, accountability and multilevel coordination to ensure that the rights of the strikers are properly met. There are scant references available in the scientific literature on the emergency management of these tragedies. This historical perspective documents the complex issues faced by emergency physicians in Hong Kong surrounding refugee camp asylum seekers from Vietnam in 1994 and is offered as a useful adjunct in understanding the complex issues faced by emergency health providers and managers.
Fernández-Guerrero, Inés María; Martín-Sánchez, Francisco Javier; Burillo-Putze, Guillermo; Miró, Òscar
To analyze the research output of Spanish emergency physicians between 2005 and 2014 and to compare it to their output in the previous 10-year period (1995-2004) as well as to that of emergency physicians in other countries and Spanish physicians in other specialties. Original articles indexed in the Science Citation Index Expanded of the Web of Science were included. Documents from Spanish emergency physicians were identified by combining the word Spain and any other search term identifying an emergency service or unit in Spain. To identify articles from 7 other Spanish specialties (hematology, endocrinology, cardiology, pneumology, digestive medicine, pediatrics, surgery and orthopedic medicine or traumatology) and emergency physicians in 8 other countries (United States, United Kingdom, Ireland, Italy, France, Germany, Netherlands, Belgium) we used similar strategies. Information about production between 1995 and 2004 was extracted from a prior publication. Spanish emergency physicians signed 1254 articles (mean [SD], 125  articles/y) between 2005 and 2014. That level of productivity was greater than in the 1995-2004 period (mean, 26  articles/y), although the annual growth rate fell from 12.5% in the previous 10-year period to 5.2% in the most recent one. Emergency medicine was among the least productive Spanish specialties we studied, but our discipline's annual growth rate of 5.2% was the highest. Spanish emergency medicine occupies an intermediate position (ranking fifth) among the 9 countries studied, although the population-adjusted rank was higher (fourth). When output was adjusted for gross domestic product, Spain climbed higher in rank, to second position. The annual growth rate was the fourth highest among countries, after Germany (9.9%), the Netherlands (7.3%), and Italy (6.0%). The research output of Spanish emergency physicians continues to be quantitatively lower than that of other Spanish specialties and of emergency physicians in other
Bloch-Infanger, Constantine; Bättig, Veronika; Kremo, Jürg; Widmer, Andreas F; Egli, Adrian; Bingisser, Roland; Battegay, Manuel; Erb, Stefan
The increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland. At the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospitalizations. Hundred ninety five of 2'544 and 516 of 6'243 asylum seekers registered at the national asylum reception and procedure centre Basel were referred to the University Hospital Basel in 2004/05 and 2014/15, and originated mainly from Europe (62.3%, mainly Turkey) and Africa (49.1%, mainly Eritrea), respectively. Median age was similar in both study periods (26.9 and 26.2 years). Infectious diseases in asylum seekers increased from 22.6% to 36.6% (pmigration-associated neglected infections. Physicians should be aware of these new challenges.
Hallas, Peter; Hansen, Anne R; Staehr, Mia A
The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic group...... of asylum seekers to study if the incidence of mental disorders increased with length of stay....
The falsifiability of scientific knowledge is an acquired result of contemporary philosophy of science and yet there is not a universal consensus upon the idea of the unity of scientific method. Albeit there are differences in techniques of testing (methodics) hypotheses in the vast field of research, the author, following the critical rationalism of Karl Popper, favors the perspective of the unity of method in natural as well in social and philological sciences.
Junod Perron, Noelle; Hudelson, Patricia
Somatisation is particularly challenging in multicultural contexts where patients and physicians often differ in terms of their illness-related beliefs and practices and health care expectations. This paper reports on a exploratory study aimed at better understanding how asylum seeker and refugee patients from the former country of Yugoslavia who were identified by their physicians as somatising make sense of their suffering. We conducted semi-structured interviews with 26 asylum seeker and refugee patients from the former country of Yugoslavia who attended the general medicine outpatient clinic of a Swiss teaching Hospital and were identified as presenting with somatisation. Interviews explored patients' illness perspectives and health care expectations. Interviews were audio taped, transcribed verbatim and analyzed to identify key themes in patients' narratives. Patients attributed the onset of symptoms to past traumatic experiences and tended to attribute their persistence to current living conditions and uncertain legal status. Patients formulated their suffering in both medical and social/legal terms, and sought help from physicians for both types of problems. Awareness of how asylum seeker and refugee patients make sense of their suffering can help physicians to better understand patients' expectations of the clinical encounter, and the particular nature and constraints of the patient-provider relationship in the context of asylum.
Full Text Available Abstract Background Somatisation is particularly challenging in multicultural contexts where patients and physicians often differ in terms of their illness-related beliefs and practices and health care expectations. This paper reports on a exploratory study aimed at better understanding how asylum seeker and refugee patients from the former country of Yugoslavia who were identified by their physicians as somatising make sense of their suffering. Methods We conducted semi-structured interviews with 26 asylum seeker and refugee patients from the former country of Yugoslavia who attended the general medicine outpatient clinic of a Swiss teaching Hospital and were identified as presenting with somatisation. Interviews explored patients' illness perspectives and health care expectations. Interviews were audio taped, transcribed verbatim and analyzed to identify key themes in patients' narratives. Results Patients attributed the onset of symptoms to past traumatic experiences and tended to attribute their persistence to current living conditions and uncertain legal status. Patients formulated their suffering in both medical and social/legal terms, and sought help from physicians for both types of problems. Conclusion Awareness of how asylum seeker and refugee patients make sense of their suffering can help physicians to better understand patients' expectations of the clinical encounter, and the particular nature and constraints of the patient-provider relationship in the context of asylum.
Hallas, Peter; Hansen, Anne R; Staehr, Mia A
group of asylum seekers to study if the incidence of mental disorders increased with length of stay. METHODS: The study population was asylum seekers in Danish asylum centres run by the Danish Red Cross. General medical care was provided by Red Cross staff who could refer selected cases to medical....... RESULTS: We found that referrals for mental disorders increased with length of stay in asylum centres in a large, multiethnic population of asylum seekers. The association was found in all the categories of psychiatric illness studied and for a majority of the nationality groups studied. CONCLUSION...
In the dynamic context of occupational medicine an increasing number of occupational health problems requires a high-quality standard practice supported by decisions consistent both with ethics and legislation. This paper examines the relationship between legal requirements, ethical values and scientific evidence issues in occupational health practice. i) Legal requirements. Italian law states that practice must be evidence-based and comply with the code of ethics for occupational health professionals of the ICOH. ii) Ethical values. The code itself emphasizes that practice should be relevant, knowledge-based, sound and appropriate to occupational risks. Furthermore, the objectives and methods of health surveillance and biological monitoring must be clearly defined and indicator must be chosen according to their relevance and predictive value. Any dilemma arising from the practice should be dealt with according to the ethical principles of health benefit, independence and justice. iii) Scientific evidence. Both the law and the code of ethics require that practice be based on available evidence. Decisions made on the basis of a comprehensive process founded on scientific evidence should result in effective and high-quality outcomes that respect both the law and the rights of individuals and society.
The first medical superintendent of the Toronto Lunatic Asylum, physician Dr. William Rees, found his tenure from 1841 to 1845 marked by financial struggle, extensive administrative conflict, and physical injury. His personality along with these events have given rise to negative portrayals of Rees as an inept administrator. Less known are his social contributions beyond his asylum work. A more extensive assessment of Rees suggests the value of his biography as a study of Upper Canadian professional and class status. While Rees's occupational endeavours before 1841 enhanced his status, negative experiences at the asylum changed this pattern and caused an ongoing decline in his social status after 1845.
Raphael Joaquim Teles Cyrillo
Full Text Available Introduction: This paper studies the influence of a Scientific Initiation Programme (SIP on the professional profile of new doctors from a Brazilian university. Aim and methods: Evaluate fifty-two new doctors divided into two groups matched by sex, age and academic performance and differing only in participation in the SIP. Professional and socioeconomic data were collected, including schooling of parents; average income before, during and after the medical course; current professional situation; results of exams for civil servant recruitment; and titles and degrees obtained after graduation. Results: Significant differences were found only in civil servant recruitment exam results (p = 0.0098 and in income after graduation (p = 0.02, which were both higher in the non-SIP group. Only one doctor got a M.Sc. degree after graduation, but many of them in both groups obtained technical titles, and had papers presented at congresses or published. Conclusions: Apparently, taking part in a SIP led to lower income and worse civil servant recruitment exam results. However, this may only reflect a transient phase in a long-term process. New research currently under way will answer this remaining question, now that more time has elapsed since graduation. Resumo: Introdução: Este trabalho estuda a influência de um programa de iniciação científica (PIC no perfil profissional de médicos recém-formados numa universidade pública brasileira. Objectivos e métodos: Avaliamos cinquenta e dois novos médicos arrolados em dois grupos pareados por sexo, idade e coeficiente de rendimento académico, diferindo apenas na sua participação no PIC. Dados acerca da situação profissional e socioeconómica foram obtidos, incluindo a escolaridade dos pais; a renda familiar média antes, durante e depois da realização do curso médico; a situação profissional actual; as aprovações em concurso público e os títulos e graus obtidos após a gradua
Full Text Available Asylum authorities in the European Union need to establish better procedures to help address the specific vulnerabilities and protection needs of women and girls who have undergone or are at risk of female genital mutilation.
Full Text Available Asylum seekers face appalling treatment at the immigrationdetention centre in Bulgaria. Treated as undocumentedimmigrants, they are penalised and deported – in blatantviolation of Bulgarian law and Refugee Convention obligations.
Orton, Lois; Griffiths, Jane; Green, Maia; Waterman, Heather
A small body of evidence demonstrates the challenges faced by migrant communities living with HIV but has yet to consider in-depth the experience of asylum seekers whose residency status is undetermined...
Lyra Jakuleviciene; Laurynas Bieksa; Egle Samuchovaite
...) attitudes are also frequent in many societies. However, the LGBT asylum seekers are frequently left outside the refugee definition due to many refugee qualification and procedural problems in LGBT cases...
Full Text Available Background: Asylum interviews within the asylum procedure are associated with psychological stress for traumatized asylum seekers. This study investigates the impact of asylum interviews on the mental health in a sample of 40 traumatized asylum seekers. The comparison group consisted of refugees (N=10 that had not been invited to an asylum interview. Additionally, the moderating effects of trial-related variables such as perceived justice of the trial, stress of giving testimony, and stress of waiting for the asylum interview were examined. Method: Participants were assessed on average 10 days before (t1 and 16 days after (t2 the asylum interview. Chi-square tests for dichotomous and categorical variables were used to compare the descriptive statistics of the two groups. To investigate symptom changes from t1 to t2, paired t-tests were calculated. The magnitude of effects was measured by Cohen's effect size d within groups. Hierarchical regression analyses were conducted for demographic and trial variables predicting posttraumatic intrusions, avoidance, and hyperarousal. Results: Data showed a significant increase in posttraumatic intrusions and a significant decrease in posttraumatic avoidance and hyperarousal symptoms from t1 to t2. No significant symptom changes in the posttraumatic stress disorder subscales were found in the comparison group. The results of hierarchical regression analyses revealed perceived justice of the interview to predict the increase of intrusions and the number of experienced traumata and testimony stress to predict posttraumatic avoidance. Conclusions: The present findings underline the stressful impact of asylum interviews on traumatized refugees. They indicate that the asylum interview might decrease posttraumatic avoidance and trigger posttraumatic intrusions, thus highlight the importance of ensuring that the already vulnerable group of traumatized refugees needs to be treated with empathy during their asylum
Full Text Available Abstract Background A small body of evidence demonstrates the challenges faced by migrant communities living with HIV but has yet to consider in-depth the experience of asylum seekers whose residency status is undetermined. The overall aim of our study was to explore the experiences of those who are both living with HIV and seeking asylum. This paper focuses on the stressors precipitated by the HIV diagnosis and by going through the asylum system; as well as participants’ resilience in responding to these stressors and the consequences for their health and wellbeing. Methods We conducted an ethnographic study. Fieldwork took place in the UK between 2008–2009 and included: 350 hours of observation at voluntary services providing support to black and minority ethnic groups living with HIV; 29 interviews and four focus group discussions with those who were seeking asylum and living with HIV; and 15 interviews with their health and social care providers. Data were analysed using the constant comparative method. Results There were three main stressors that threatened participants’ resilience. First, migration caused them to leave behind many resources (including social support. Second, stigmatising attitudes led their HIV diagnosis to be a taboo subject furthering their isolation. Third, they found themselves trapped in the asylum system, unable to influence the outcome of their case and reliant on HIV treatment to stay alive. Participants were, however, very resourceful in dealing with these experiences. Resilience processes included: staying busy, drawing on personal faith, and the support received through HIV care providers and voluntary organisations. Even so, their isolated existence meant participants had limited access to social resources, and their treatment in the asylum system had a profound impact on perceived health and wellbeing. Conclusions Asylum seekers living with HIV in the UK show immense resilience. However, their isolation
Bloch-Infanger, Constantine; Bättig, Veronika; Kremo, Jürg; Widmer, Andreas F.; Egli, Adrian; Bingisser, Roland; Battegay, Manuel; Erb, Stefan
Objective The increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland. Methods At the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospitalizations. Results Hundred ninety five of 2’544 and 516 of 6’243 asylum seekers registered at the national asylum reception and procedure centre Basel were referred to the University Hospital Basel in 2004/05 and 2014/15, and originated mainly from Europe (62.3%, mainly Turkey) and Africa (49.1%, mainly Eritrea), respectively. Median age was similar in both study periods (26.9 and 26.2 years). Infectious diseases in asylum seekers increased from 22.6% to 36.6% (p<0.001) and were the main reasons for hospitalizations (33.3% of 45 and 55.6% of 81 hospitalized patients, p = 0.017) in 2004/05 compared to 2014/15. The leading infectious diseases in hospitalized patients were tuberculosis (n = 4) and bacterial skin infections (n = 2) in 2004/05; Malaria (n = 9), pneumonia (n = 6), Chickenpox (n = 5), other viral infections (n = 5) and bacterial skin infections (n = 5) in 2014/15. Infectious diseases like malaria, cutaneous diphtheria, louseborne-relapsing fever or scabies were only found in the second study period. Almost one third of the admitted asylum seekers required isolation precautions with median duration of 6–9.5 days in both study periods. Conclusions The changing demography of asylum seekers arriving in Switzerland in the current refugee crisis has led to a shift in disease patterns with an increase of infectious diseases and the re-emergence of migration-associated neglected infections. Physicians should be aware of these new challenges. PMID:28617860
Full Text Available The increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland.At the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospitalizations.Hundred ninety five of 2'544 and 516 of 6'243 asylum seekers registered at the national asylum reception and procedure centre Basel were referred to the University Hospital Basel in 2004/05 and 2014/15, and originated mainly from Europe (62.3%, mainly Turkey and Africa (49.1%, mainly Eritrea, respectively. Median age was similar in both study periods (26.9 and 26.2 years. Infectious diseases in asylum seekers increased from 22.6% to 36.6% (p<0.001 and were the main reasons for hospitalizations (33.3% of 45 and 55.6% of 81 hospitalized patients, p = 0.017 in 2004/05 compared to 2014/15. The leading infectious diseases in hospitalized patients were tuberculosis (n = 4 and bacterial skin infections (n = 2 in 2004/05; Malaria (n = 9, pneumonia (n = 6, Chickenpox (n = 5, other viral infections (n = 5 and bacterial skin infections (n = 5 in 2014/15. Infectious diseases like malaria, cutaneous diphtheria, louseborne-relapsing fever or scabies were only found in the second study period. Almost one third of the admitted asylum seekers required isolation precautions with median duration of 6-9.5 days in both study periods.The changing demography of asylum seekers arriving in Switzerland in the current refugee crisis has led to a shift in disease patterns with an increase of infectious diseases and the re-emergence of migration-associated neglected infections. Physicians should be aware of these new challenges.
Eklöf, Niina; Hupli, Maija; Leino-Kilpi, Helena
The aim of this article was to discuss factors related to the researcher, interpreter and asylum seekers when planning focus group interviews with asylum seekers. Focus group interview is one of the basic data collection methods in descriptive nursing and health research. It has been used in multicultural research, allowing an opportunity to participate without literacy and to have linguistic and cultural support from other participants. Asylum seekers form a specific, vulnerable group, and the growing number of asylum seekers increases the need for research related to them. A culturally, methodologically and ethically high-quality focus group interview is based on the researcher's special knowledge and skills, acknowledgement of asylum seekers as both individuals and part of cultural and communal groups, and careful planning of the interpreter's role during the interviews. © 2017 John Wiley & Sons Ltd.
Full Text Available Two recent successful claims for asylum suggest that the Republic of Korea may be prepared to serve in the future as an important country of asylum for those suffering persecution due to their sexual orientation.
Full Text Available The recognition rate for Ukrainian asylum seekers in Poland remains at an extremely low level, with the concept of ‘internal flight alternative’ serving as the legal basis for rejection of many asylum applications.
Goodwin-Gill, Guy S.
Examines national concepts, powers and practices of detention; contrasts these with the individual rights of refugees and asylum-seekers under international law. Holds that although not formally obliged to grant permanent asylum, states must treat refugees and asylum seekers according to certain standards and must seek to alleviate their plight.…
Devillé, W.; Lamkaddem, M.; Gerritsen, A.A.M.; Ploeg, H.M. van der
Asylum seekers have the same rights to health care than Dutch citizens. But in practice, while refugees are registered at a general practice, the health care for asylum seekers is regulated by the Community Health Services for Asylum seekers. The study examines differences in the respective health
Verkuyten, Maykel; Steenhuis, Aafke
The present study examined ethnically Dutch preadolescents' understanding and reasoning about asylum seeker peers and friendships. The description of an asylum seeker was compared with that of a Moroccan and a Dutch peer. The findings suggest that asylum seekers were described more negatively than peers from the other two groups. Additionally, we…
Morville, Anne-Le; Erlandsson, Lena-Karin
This article presents a study of three asylum-seeking men from Iran and Afghanistan. It aimed to explore how and if they experienced occupations as occupations in a Danish asylum centre and how their life experience shaped their choice and value of current occupations. In-depth narrative interviews...... explored the participants’ occupational history and its influence on their occupations in the asylum centre. A thematic analysis showed that the participants had been subjected to occupational disruption and deprivation by politically oppressive systems even before their flight. Their occupations...... in Denmark were to a certain extent influenced by their earlier occupations and the current occupational deprivation they all experienced was due to limited possibilities in the centre. Although they tried their best to fill their days and create structure, there was a loss of valued occupations...
Stæhr Mia A
Full Text Available Abstract Background The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic group of asylum seekers to study if the incidence of mental disorders increased with length of stay. Methods The study population was asylum seekers in Danish asylum centres run by the Danish Red Cross. General medical care was provided by Red Cross staff who could refer selected cases to medical specialists. If an asylum seeker needed more than three specialist consultations for mental illness or five consultations for physical illness the referrals had to be approved by The Danish Immigration Service. Between July 2001 – December 2002 the Red Cross prospectively registered health related data on all new applications (n = 4516 to the Immigration Service regarding referrals to medical specialists. We used these records to analyse the association between length of stay in the asylum centres and overall rate of referral for mental disorders. Data was analysed using weighted linear regression. Results We found that referrals for mental disorders increased with length of stay in asylum centres in a large, multiethnic population of asylum seekers. The association was found in all the categories of psychiatric illness studied and for a majority of the nationality groups studied. Conclusion Length of stay in asylum centres was associated with an increase in referrals for mental disorders in a large, multiethnic group of asylum seekers. The present study supports the view that prolonged length of stay in an asylum centre is a risk factor for mental health. The risk of psychiatric illness among asylum seekers should be addressed by political and humanitarian means, giving prevention of illness the highest priority.
María José Correa Gómez
Full Text Available In a period shaped by the development of anatomical pathology and by the entrance of the scientific gaze over the body of the insane, the mental asylum underscored the key importance of the space, real or simulate, as a therapeutic tool. Madhouses were influenced by a proposal that followed in terms of design, location and implementation, the principles of alienism, adjusted to the Chilean setting. This process contributed to develop a specific asylum space, with internal and external landscapes, which characterized local alienism and its promise to treat madness. This article studies the Chilean asylums -planned or built- from the Madhouse (1852 to the National Open Door (1928, in order to show the process of appropriation of an international therapeutic model from the peculiarities of the institutional landscape.
EU member states often use speedy (accelerated) asylum procedures to examine asylum claims that are deemed manifestly unfounded. Speedy asylum procedures should generally be considered to be in the interest of the asylum applicant and the state. Accelerated procedures have however been criticised
National Council of the Churches of Christ of the United States of America, New York, NY. Church World Service.
Haitian refugees who are seeking political asylum in the United States are finding themselves unwelcome. Although various reports attest to continuing persecution in Haiti under the repressive Duvalier regime, the U.S. Immigration and Naturalization Service claims that the Haitians seek only greater economic opportunity and are not genuine…
Full Text Available This article examines the changes towards more gender-sensitive interpretations of refugee status in international and national asylum laws and policies within the context of contemporary and historical global power relations. It also analyzes the changes in the language that can be found in the international UNHCR guidelines for the protection of women asylum seekers, U.S. national guidelines for assessing gender-related asylum claims, and recent U.S. court decisions assessing the gendered claims of women. Among the analyzed court cases, the focus is on the 2005 Mohammed case due to its problematic court decision and legal interpretations. Finding the Western countries’ instrumentalization of the international refugee protection system crucial for understanding the contemporary asylum system and women asylum seekers, the argument connects the historical conditions with the way in which the protection of women refugees from “cultural” gendered violence has been articulated in asylum politics in the U.S. The author’s overall findings are that international law, governmental organizations, and liberal women’s human rights NGOs have shaped the international and national legal protection of (women asylum seekers in such a way that it reproduces global inequalities in its representation of “Third World” women and their culture, uses women asylum seekers fleeing from violence for the purpose of exercising Western cultural superiority, and covers up the restrictive and racist Western asylum politics towards immigrants and asylum seekers.
This paper explores the application of human rights in the EU asylum policy. The prevention of terror and the strengthening of the area of Justice, Freedom and Security require tighter border controls, which consequently reflect negatively on asylum seekers and their human rights. Therefore this paper sets the aim to explore the application of human rights for EU asylum policy in respect to international obligations. There are three main objectives to be attained in the paper: to determine if...
Hjern, Anders; Brendler-Lindqvist, Maria; Nørredam, Marie Louise
authorities in determining whether a young asylum seeker is a child or an adult. Many different methods are currently employed in Europe for this purpose by dentists, paediatricians, radiographers and social workers, but no currently available method has been demonstrated to have the accuracy needed...... to be of real use in this decision. Unclear guidelines and arbitrary practices may lead to alarming shortcomings in the protection of this high-risk group of children and adolescents in Europe. Medical participation, as well as non-participation, in these dubious decisions raises a number of ethical questions....... CONCLUSION: To improve care for young asylum seekers with undetermined age, we suggest better legal procedures for the determination of age and a more flexible approach to chronological age....
Full Text Available This article aims at applying Derrida’s views displayed in his work “Hostipitality” to the issues of asylum and refugee and also providing an exposition of the asylum’s philosophy by this way. In the text, in addition to taking into consideration the translation indicated in the deepnote, texts that discusses Derrida’s views on deconstruction in the context of ethics and politics are also referred to and hospitality’s linguistic practices in the local culture (Turkish culture such as aphorisms and proverbs are revealed as short texts. The exploration held illustrates that the matter of asylum and refugee is neither ethical nor political nor cultural, on the contrary it is the probability amplitude (or state vector which includes more than their collections. When resolved through deconstructive techniques, being a refugee, which starts with seeking asylum, seems to include both linguistic and political apoiras. In order to overcome “refugeeism as a problem”, the aporias of binary/oppositional thinking should be perceived, totally-originally different thinking should be appealed within the multi-valued logical thinking and it should initiate “thinking the unthinkable” as Derrida suggests by abandoning the system thought. The small linguistic difference between hospitality and hostility pointed out by Derrida invites to re-think on the presence of hostility supperessed in the concept of hospitality, and invites to reconsideration those who are dealing with especially the matters of asylum and refugeeism, migration and policy of migration, ends and universality and even those known as hospitable. The main question whose answer is sought in all of them is as such: Is hospitality possible?
Nakash, Ora; Nagar, Maayan; Shoshani, Anat; Lurie, Ido
Past research has documented the role acculturation plays in the process of adjustment to new cultures among migrants. Yet little attention has been paid thus far to the role of acculturation in the context of forced migration. In this study we examined the association between acculturation patterns and mental health symptoms among a convenience sample of Eritrean and Sudanese asylum seekers (n = 118) who accessed health services at the Physicians for Human Rights Open-Clinic in Israel. Participants completed measures on sociodemographic information as well as detention history, mental health symptoms, exposure to traumatic events, and acculturation pattern, in their native language upon accessing services. Consistent with our predictions, findings showed that acculturation predicted depressive symptoms among asylum seekers beyond the effect of history of detention and reports of experiences of traumatic events. Assimilated compared with integrated asylum seekers reported higher depressive symptoms. Findings draw attention to the paradox of assimilation, and the mental health risks it poses among those wishing to integrate into the new culture at the expanse of their original culture. Asylum seekers may be particularly vulnerable to the risks of assimilation in the restrictive policies that characterize many industrial countries in recent years. (c) 2015 APA, all rights reserved).
Larsen, Birgitte Romme
This article investigates everyday practices of co-residency and ‘institutional neighbourliness’ amongst asylum seekers and local inhabitants in the small Danish town of Jelling. Where asylum centres in Denmark are sometimes faced with local opposition and are often isolated from nearby settlemen...
Oort, M. van; Devillé, W.; Bakker, D. de
In 2000 policymakers decided that primary care for asylum seekers should be organized as it is for Dutch residents. Nurses of the Community Health Services organize selection and referral to primary care. General practitioners have practice in the different Centres of Asylum Seekers or in their own
The body of literature examining the educational needs of asylum-seeker children is limited. Extending the body of knowledge has become increasingly important because of the increasing number of asylum seekers in the UK, with significant implications for local education authorities and schools. The main focus of the research was the situation in…
P. Mascini (Peter)
textabstractAbstract Th e goal of this research was to identify factors that account for procedural and substantive inequality in implementing asylum law. Th e decisions of ninety-eight caseworkers of the Dutch Immigration and Naturalization Service on an asylum application were related to their
Full Text Available Examination of the common EU asylum standards so far adopted suggests that there is still a long way to go before asylum policy and practice are harmonised and that this process of harmonisation may undermine the principles enshrined in the Refugee Convention.
Full Text Available Recent research indicates that CEE countries still lag far behind therest of Europe in their asylum practices in relation to LGBTI asylumclaims. Low levels of awareness, lack of guidance and cultural hostility are jeopardising asylum seekers’ prospects for fair treatment.
Filges, Trine; Montgomery, Edith; Kastrup, Marianne
to quantitatively synthesize the study results. Results: Primary study effect sizes for post-traumatic stress disorder, depression, and anxiety, while the asylum seekers were still detained lies in the range 0.35–0.99, all favoring the nondetained asylum group. Author’s Conclusions: There is some evidence...
When asylum seekers flee persecution or war in their home countries, they often arrive in a new country seeking asylum, without documentation that can prove their nationality. They are thus open to the accusation that they are not actually fleeing persecution and/or war, but they are from another country and they are merely seeking "a better…
Morgan, Gareth; Melluish, Steve; Welham, Alice
Numerous studies have linked the high rates of traumatic events experienced by refugees to the elevated rate of mental health problems in these populations. A growing body of evidence has also highlighted the importance of considering postmigratory stressors when making sense of displaced person distress. This study explored the relationship between mental health and postmigratory stress for asylum seekers and refused asylum seekers in Britain. The study further examined if those refused asylum experienced elevated distress and postmigratory stress compared to those awaiting the outcome of asylum applications. Results indicated that participants ( N = 97) had endured a range of pre- and postmigratory stressors and had high scores on measures of anxiety, depression, and PTSD. A postmigratory factor comprising items associated with isolation, restrictive policies, and stressors associated with having an insecure immigration status, was significantly associated with PTSD scores. This relationship remained when controlling for the variance accounted for by premigratory trauma predictors. Being refused asylum was the strongest predictor of depression and anxiety. Those refused asylum scored higher on a factor associated with barriers to accessing services. Social materialist theories of distress are drawn upon to contextualise the heightened vulnerability of those refused asylum. The paper concludes by emphasising the problems associated with taking an exclusively trauma-focussed approach when working with asylum seekers and argues for community orientated interventions to support displaced people to cope with the various stressors endured in exile.
Serre-Delcor, Núria; Ascaso, Carlos; Soriano-Arandes, Antoni; Collazos-Sanchez, Francisco; Treviño-Maruri, Begoña; Sulleiro, Elena; Pou-Ciruelo, Diana; Bocanegra-Garcia, Cristina; Molina-Romero, Israel
The rising rate of conflicts and the unsafe situation caused by reasons of ethnicity, religion, gender, sexual orientation, political opinion, or nationality entail an increase in the number of migratory movements. The goal of this article is to describe the health status of asylum seekers visited in an international health center. We conducted a retrospective study of the asylum seekers visited between July 2013 and June 2016. A total of 303 cases were included. The median age was 28.0 years (interquartile range [IQR]: 21-35), and 203 (67.0%) were men. Of the total, 128 cases (42.2%) were from Asia, 82 (27.1%) from Eastern Europe, 42 (13.9%) from sub-Saharan Africa, 34 (11.2%) from America, and 17 (5.6%) from Maghreb. The majority, 287 (94.7%), were asymptomatic. Seventy of the 303 (23.1%) cases were diagnosed with at least one infection, this being more prevalent in men; migrants from sub-Saharan Africa; and in those who took a land-maritime migratory route. Eight of the 303 (2.6%) cases were referred to the transcultural psychiatric department. Two important challenges of the study were the communication barriers and the legal or social situation that condition the psychological symptoms. In 48 of the 303 (15.8%) cases, there was diagnosed a noncommunicable diseases. The process of care was completed by 82.5%; although 21.9% completed the vaccination for hepatitis B. The asylum seekers in this study were in general healthy young men, although special attention was given to infectious diseases with certain geoepidemiological backgrounds. Unstable living arrangements, linguistic, and cultural barriers could account for the failure of the course of care.
J. Anna Cabot
Full Text Available Violence in Mexico rose sharply in response to President Felipe Calderón’s military campaign against drug cartels which began in late 2006. As a consequence, the number of Mexicans who have sought asylum in the United States has grown significantly. In 2013, Mexicans made up the second largest group of defensive asylum seekers (those in removal proceedings in the United States, behind only China (EOIR 2014b. Yet between 2008 and 2013, the grant rate for Mexican asylum seekers in immigration court fell from 23 percent to nine percent (EOIR 2013, 2014b. This paper examines—from the perspective of an attorney who represented Mexican asylum seekers on the US-Mexico border in El Paso, Texas—the reasons for low asylum approval rates for Mexicans despite high levels of violence in and flight from Mexico from 2008 to 2013. It details the obstacles faced by Mexican asylum seekers along the US-Mexico border, including placement in removal proceedings, detention, evidentiary issues, narrow legal standards, and (effectively judicial notice of country conditions in Mexico. The paper recommends that asylum seekers at the border be placed in affirmative proceedings (before immigration officials, making them eligible for bond. It also proposes increased oversight of immigration judges.
Mewes, Ricarda; Kowarsch, Lea; Reinacher, Hanna; Nater, Urs M
Introduction: The number of refugees and asylum seekers in Germany is high. Presumably, the need for psychotherapeutic care is high in this group. However, this need stands in contrast to a lack of a specialized and widespread provision of such care. Registered psychotherapists could help to partially reduce this gap. The present study aimed at learning more about the expected or experienced obstacles and opportunities of registered psychotherapists in regard to the psychotherapeutic treatment of asylum seekers in Germany. Methods: 198 Hessian registered psychotherapists (40% of all contacted persons) from the administrative districts Marburg-Biedenkopf, Gießen, Lahn-Dill-Kreis, Schwalm-Eder-Kreis und Waldeck-Frankenberg completed a questionnaire. The questionnaire assessed their views of different possible obstacles and advantages regarding the psychotherapy of asylum seekers, as well as possibilities to improve one's own willingness to provide such a treatment. Results: The majority of the participating psychotherapists indicated a modest willingness to provide psychotherapy for asylum seekers. One third had already treated (on average 1-2) asylum seekers. The strongest obstacles were the application of translators, the high formal costs, and the insecurity regarding the reimbursement of therapy sessions. Possible cultural divergences, being afraid of difficult themes, or a potentially reduced adherence of asylum seekers were not seen as meaningful obstacles. Becoming familiar with another culture and new experiences were seen as main advantages of psychotherapy with an asylum seeker. Conclusion: The psychotherapeutic care of asylum seekers could possibly be improved through the exchange of information among psychotherapists and with the responsible local administrative organizations. Moreover, administrative districts could mainly improve the situation by providing help with finding adequate translators, facilitate the formal costs, and secure the reimbursement
Stein, B N
For most of the 4 decades since World War II, US refugee and asylum policy has been generous but ad hoc, discretionary, and highly variable favoring some refugee groups and discriminating against or ignoring others. This paper: 1) tries to clarify some of the terminology of the refugee field and explains the distinctions between asylum and resettlement, 2) provides some of the historical background that has brought the US to its present condition and chronicles the US overseas refugee admission policy, and 3) examines some asylum issues and other refugee issues. Asylum is far more difficult to control than refugee resettlement. As a result of what is perceived to be abuse of the asylum system, the US has joined the growing tendency of states to treat asylum-seekers as illegal migrants. The greatest problem with American asylum policy is its lack of fairness of application; many critics believe that foreign policy factors dominate asylum hearings rather than the individual merits of the case. The 3 classic solutions to this problem are resettlement, voluntary repatriation, and settlement in a country of 1st asylum. Only in the Indochinese refugee crisis has resettlement been widely used as a solution for 3rd World refugees. Nationalism and nation-building conflicts are at the root of many refugee movements; hosts are often no less nationalistic than source countries, thus many non-integrated refugees live in peril. Developed country political will and statesmanship are needed to revive resettlement as a durable solution. Resettlement may be difficult and costly, but the pluralistic western societies do offer an integrated new life.
J. Anna Cabot
Violence in Mexico rose sharply in response to President Felipe Calderón’s military campaign against drug cartels which began in late 2006. As a consequence, the number of Mexicans who have sought asylum in the United States has grown significantly. In 2013, Mexicans made up the second largest group of defensive asylum seekers (those in removal proceedings) in the United States, behind only China (EOIR 2014b). Yet between 2008 and 2013, the grant rate for Mexican asylum seekers in immigration...
Reko, Amra; Bech, Per; Wohlert, Cathrine
predominantly male and married. The group consisted primarily (61%) of failed asylum seekers. Most patients (81%) presented with relevant mental health problems. The main reasons for presenting to the acute psychiatric emergency service were suicidal ideation and/or behaviour (60%). The most frequent diagnosis...... by asylum seekers in Denmark shows some of the acute mental health needs asylum seekers present with. The findings of high levels of suicidal ideation and possible diagnostic difficulties are discussed, as well as possible improvements of the referral and psychiatric evaluation processes....
Full Text Available In the context of a large number of arrivals, states may introduce blanket measures aimed at preventing irregular migration. These, however, may curtail the rights of asylum seekers.
Full Text Available The goods and services purchased by asylum seekers who were given an unconditional cash transfer demonstrate how their consumer behaviour extends beyond the fulfilment of immediate needs to addressing broader desires for community and belonging.
Full Text Available Refugees and asylum seekers detained in Kenya risk multiple convictions and protracted detention due to poor coordination between immigration officials, police and prison officers, coupled with lack of interpreters and low levels of knowledge among government officers.
Buch-Hansen, Gitte; Lorensen, Marlene Ringgaard
A growing number of asylum seekers with Muslim background choose to get baptized as Christians while their application is being treated. The practice of conversion among asylum seekers from the Middle-East is charged with critique and suspicion from government authorities and the general public....... The then Danish Minister for Ecclesiastical Affairs, Bertel Haarder, has suggested that pastors should refrain from baptizing migrants who are in the process of apply-ing for asylum. The Minister’s advice is problematic for a number of reasons: above all, be-cause the advice appears to reduce conversion...... to a simple instrument to obtain asylum. In this article, we show how his recommendation ignores the complexity of motives involved in the change of religious affiliation. By our adjustment of Bourdieu’s theory of social capital, we demonstrate how conversion is also a way of existential survival...
Bergrath, Sebastian; Skorning, Max; Rörtgen, Daniel; Beckers, Stefan Kurt; Brokmann, Jörg Christian; Mutscher, Christina; Rossaint, Rolf
To investigate if paper-based documentation in the authors' emergency medical service (EMS) satisfies scientific requirements. From 1 July 2007 to 28 February 2008, data from all paper-based protocols of a physician-run EMS in Aachen, Germany, were transferred to a SQL database (n=4815). Database queries were conducted after personal data had been anonymised. Documentation ratios of 11 individual parameters were analysed at two points in time (T1, scene; T2, arrival in emergency department). The calculability of the Mainz Emergency Evaluation Score (MEES, embracing seven vital parameters) was investigated. The calculability of the Revised Trauma Score (RTS) was also determined for all trauma patients (n=408). Fisher's exact test was used to compare differences in ratios at T1 versus T2. The documentation ratios of vital parameters ranged from 99.33% (Glasgow Coma Scale, T1) to 40.31% (respiratory rate, T2). The calculability of the MEES was poor (all missions: 28.31%, T1; 22.40%, T2; ptest population. The suitability of paper-based documentation is therefore limited. Electronic documentation that includes real-time plausibility checks might improve data quality. Further research is warranted.
O’Connell, Molly; Duffy, Richard; Crumlish, Niall
The number of people seeking refugee status in Ireland is increasing year on year and the burden of mental illness experienced by refugees and asylum seekers is high. The College of Psychiatrists of Ireland has recommended the establishment of a number of specialist refugee mental health teams. In this paper we discuss the Irish asylum system, the Irish evidence regarding mental illness in this population, and current health service policy regarding refugee mental health. We propose a model o...
Taala, Maria; Löf, Salla
The purpose of this functional thesis was to produce a useful booklet about health promotion for asylum seekers and refugees. The booklet provides knowledge about mental, social, and environmental health, since they were considered to be most important. The literature review provides knowledge for health care professionals. In this thesis, health, health promotion, asylum seekers and refugees were researched and health promotion considered via the different dimensions of health. There we...
van Berlaer, Gerlant; Bohle Carbonell, Francisca; Manantsoa, Sofie; de Béthune, Xavier; Buyl, Ronald; Debacker, Michel; Hubloue, Ives
In the summer of 2015, the exodus of Syrian war refugees and saturation of refugee camps in neighbouring countries led to the influx of asylum-seekers in European countries, including Belgium. This study aims to describe the demographic and clinical characteristics of asylum seekers who arrived in a huddled refugee camp, in the centre of a well-developed country with all medical facilities. Using a descriptive cross-sectional study design, physicians of Médecins du Monde prospectively registered age, gender, origin, medical symptoms and diagnoses of all patients presenting to an erected field hospital in Brussels in September 2015. Diagnoses were post hoc categorised according to the International Classification of Diseases. Of 4037 patients examined in the field hospital, 3907 were included and analysed for this study. Over 11% of patients suffered from injuries, but these were outnumbered by the proportion of patients with respiratory (36%), dental (9%), skin (9%) and digestive (8%) diagnoses. More than 49% had features of infections at the time of the consultation. Asylum seekers arriving in a refugee camp in Brussels after a long and hazardous journey suffer mostly from respiratory, dental, skin and digestive diseases. Still, one in seven suffers from injury. These findings, consistent with other reports, should be anticipated when composing emergency medical teams and interagency emergency health or similar kits to be used in a field hospital, even in a Western European country. ISRCTN13523620, Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Carmen Andrea Pfortmueller
Full Text Available Forced displacement related to persecution and violent conflict has reached a new peak in recent years. The primary aim of this study is to provide an initial overview of the acute and chronic health care problems of asylum seekers from the Middle East, with special emphasis on asylum seekers from Syria.Our retrospective data analysis comprised adult patients presenting to our emergency department between 01.11.2011 and 30.06.2014 with the official resident status of an "asylum seeker" or "refugee" from the Middle East.In total, 880 patients were included in the study. Of these, 625 (71.0% were male and 255 (29.0% female. The median age was 34 (range 16-84. 222 (25.2% of our patients were from Syria. The most common reason for presentation was surgical (381, 43.3%, followed by medical (321, 36.5% and psychiatric (137, 15.6%. In patients with surgical presentations, trauma-related problems were most common (n = 196, 50.6%. Within the group of patients with medical presentation, acute infectious diseases were most common (n = 141, 43.9%, followed by neurological problems (n = 70, 21.8% and gastrointestinal problems (n = 47, 14.6%. There were no differences between Syrian and non-Syrian refugees concerning surgical or medical admissions. The most common chronic disorder of unclear significance was chronic gastrointestinal problems (n = 132, 15%, followed by chronic musculoskeletal problems (n = 108, 12.3% and chronic headaches (n = 78, 8.9%. Patients from Syria were significantly younger and more often suffered from a post-traumatic stress disorder than patients of other nationalities (p<0.0001, and p = 0.05, respectively.Overall a remarkable number of our very young group of patients suffered from psychiatric disorders and unspecified somatic symptoms. Asylum seekers should be carefully evaluated when presenting to a medical facility and physicians should be aware of the high incidence of unspecified somatic symptoms in this patient population
William W Bostock
Full Text Available William W BostockSchool of Government, University of Tasmania, Hobart, Tasmania, AustraliaAbstract: Psychiatrists have long had involvement with the political process, both individually and as a profession. They have made valuable contributions to debate over such issues as war, conflict, terrorism, torture, human rights abuse, drug abuse, suicide and other public health issues. However, they have also been complicit in some gross atrocities. Over several years there has been debate over the Australian Government’s treatment of asylum seekers, and the Royal Australian and New Zealand College of Psychiatrists took the unusual step of publicly criticizing the Australian Government’s policy on grounds of its toxicity leading to a diagnosis of collective depression syndrome, particularly among child detainees, but also adult detainees. The official Ministerial response was to deny that collective depression exists and to assert that the concept is meaningless. Can this intervention by psychiatrists be interpreted as a product of earlier political behaviors by psychiatrists? The willingness of psychiatrists to cooperate with other professions, notably psychologists, pediatricians, physicians and lawyers, is noted, as is presence of minority voices within the Australian psychiatric profession. The significance of the debate over the mental condition of asylum-seeking detainees is that its outcome has implications for how Australia sees itself and is seen by the rest of the world, that is, its national identity.Keywords: collective depression syndrome, psychiatric profession, political intervention, asylum seeker, Australian national identity
... Status of Refugees and Aliens Granted Asylum CFR Correction In Title 8 of the Code of Federal Regulations... follows: Sec. 209.2 Adjustment of status of alien granted asylum. * * * * * [[Page 76353
Stellinga-Boelen, Annette A. M.; Wiegersma, P. Auke; Bijleveld, Charles M. A.; Verkade, Henkjan J.
Background: Growth assessment can be used to monitor health at individual and population level. For asylum seekers children with different geographic backgrounds, growth reference values are frequently not available. We assessed nutritional condition and growth of asylum seekers children upon
O. Ferguson Sidorenko
textabstractThe right of asylum is rooted in the history of mankind (religious right of asylum (sanctuary)) and since the beginning of the modern State it has been rooted in the sovereignty of the State itself (the right of territorial asylum). The State retains the right to grant its protection
Spura, Anke; Kleinke, Matthias; Robra, Bernt-Peter; Ladebeck, Nadine
In Germany basic medical care for asylum seekers is organized outside the statutory health insurance system. Currently there are few empirically based statements on how asylum seekers experience their access to healthcare. The aim is therefore to evaluate their experiences with healthcare focussing on subjective health, utilisation and access to medical care, and experiences with medical care. Between August and November 2015, we performed 16 qualitative problem-oriented guided interviews with asylum seekers, who received or sought medical care in Saxony-Anhalt. The interpreter-assisted interviews were evaluated with content analysis. Access begins with a voucher for medical treatment issued by the social security office. Asylum seekers experience that procedure as onerous and incapacitating. These experiences influence subjective health and utilisation of medical help. If their efforts for treatment certificates are rejected, people increasingly resign. If medical treatment is achieved, they experience medical staff mostly as competent and friendly, in spite of language difficulties and time pressure. Reducing the "voucher bureaucracy" by uniform rules and practices may bring about a relief to access and utilisation of healthcare. Introducing an electronic health insurance card for asylum seekers would retransfer decision making about treatment needs from the welfare system into the medical system.
Nakash, Ora; Langer, Benjamin; Nagar, Maayan; Shoham, Shahar; Lurie, Ido; Davidovitch, Nadav
Little is known about the experiences of displaced individuals en route to destination countries. We investigated the reported prevalence of exposure to traumatic experiences during migration among a consecutive sample of adult asylum seekers (n = 895 Eritrean, n = 149 Sudanese) who sought health services in the Physicians for Human Rights Open-Clinic in Israel. Percentage of Eritrean and Sudanese men and women who reported witnessing violence (Eritrea: men: 41.3 %, women: 29.3 %; Sudan: men: 16.8 %, women: 22.2 %) and/or being a victim of violence (Eritrea: men: 56.0 %, Women: 34.9 %; Sudan: men: 51.9 % women: 44.4 %) during migration varied by gender and country of origin. Findings highlight the need for a well-coordinated international cooperation to document and prevent these transgressions.
Noa Wirth Nogradi
Full Text Available The current international asylum regime recognizes only persecuted persons as rightful asylum applicants. The Geneva Convention and Protocol enumerate specific grounds upon which persecution is recognized. Claimants who cannot demonstrate a real risk of persecution based on one of the recognized grounds are unlikely to be granted asylum. This paper aims to relate real-world practices to normative theories, asking whether the Convention’s restricted preference towards persecuted persons is normatively justified. I intend to show that the justifications of the persecution criterion also apply to grounds currently lacking recognition. My main concern will be persecution on the grounds of gender.The first section introduces the dominant standpoints in theories of asylum, which give different answers to the question of who should be granted asylum, based on different normative considerations. Humanitarian theories base their claims on the factual neediness of asylum-seekers, holding that whoever is in grave danger of harm or deprivation should be granted asylum. Political theories base their justifications on conceptions of legitimacy and membership, holding that whoever has been denied membership in their original state should be granted asylum. Under political theories, Matthew Price’s theory will be discussed, which provides a normative justification of the currently recognized persecution criterion. The second section provides a descriptive definition of persecution based on Kuosmanen (2014, and evaluates the normative relevance of the different elements of this definition based on the theories presented previously. The third section is devoted to the examination of the normative justifiability of the nexus clause’s exclusive list of the bases (grounds upon which persons might be persecuted. The section argues that while the clause does not recognize that persecution might be based on gender, in fact many women experience harms based on
Schneider, Christine; Joos, Stefanie; Bozorgmehr, Kayvan
Scientific evidence on the health status of asylum seekers in Germany and their access to health care is fragmentary. There is a lack of appropriate questionnaires collecting indicators of health status and health care, which enable a meaningful comparison with a reference population. This article presents experiences in designing a questionnaire and findings available from a pilot testing to pave the way to improve design and methods in future studies. The questionnaire comprises 28 mainly closed questions on self-reported health status, access to medical care and sociodemographic indicators. In order to guarantee comparability with the general population in Germany, most questions are derived from national health surveys. The questionnaire was translated into seven languages. Pilot testing was conducted between October 2014 and February 2015 in the course of the monthly welfare payments to asylum seekers in three districts of the German federal state of Baden-Wuerttemberg. A total of 156 out of 614 contacted asylum seekers participated in the pilot study (response rate: 25.4 %). The completion rate for items concerning health status and health care was satisfactory (> 75 %). Several items regarding sociodemographic data and linguistically complex questions showed the lowest item response rates (< 50 %). We recommend streamlining the questionnaire and using precise, closed and culturally adapted items. The questionnaire proved to be expedient and practicable to assess relevant indicators of health status and health care provision. It appears that there is scope for improvement regarding the shortening and cultural adaptation of the questionnaire and the range of available translations. After addressing the mentioned limitations and further development, our approach could contribute to measuring regional disparities, differences between asylum seekers and the general population and temporal changes. In order to obtain representative data, the sampling strategy
Morville, Anne-Le; Erlandsson, Lena-Karin; Danneskiold-Samsøe, Bente
AIM: The aim of this study was to describe asylum seekers' satisfaction with daily occupations and activity level while in a Danish asylum centre, and whether this changed over time. Another aim was to describe whether exposure to torture, self-rated health measures, and ADL ability were related...... to their satisfaction with daily occupations and activity level. METHODS: A total of 43 asylum seekers at baseline and 17 at follow-up were included. The questionnaires Satisfaction with Daily Occupations, Major Depression Inventory, WHO-5 Wellbeing, Pain Detect, a questionnaire covering torture, and basic social...... information were used as well as Assessment of Motor and Process Skills. RESULTS: The results showed a low level of satisfaction with daily occupations at both baseline and follow-up. There was no statistically significant change in satisfaction or activity level between baseline and the follow...
Hopkinson, Rebecca A; Keatley, Eva; Glaeser, Elizabeth; Erickson-Schroth, Laura; Fattal, Omar; Nicholson Sullivan, Melba
Asylum seekers are a unique population, particularly those who have endured persecution for their sexual orientation or gender identity. Little data exist about the specific experiences and needs of asylum seekers persecuted due to lesbian, gay, bisexual, or transgender (LGBT) identity. Quantitative data were gathered regarding demographics, persecution histories, and mental health of 61 clients from a torture survivors program in New York City who reported persecution due to LGBT identity. Thirty-five clients persecuted due to their LGBT identity were matched by country of origin and sex with clients persecuted for other reasons to explore how persecution and symptoms may differ for LGBT clients. LGBT asylum seekers have a higher incidence of sexual violence, persecution occurring during childhood, persecution by family members, and suicidal ideation. Understanding the type of persecution experiences and how these influence mental health outcomes is an essential step toward designing and delivering effective treatments.
Vanino, Elisa; Tadolini, Marina; Attard, Luciano; Po, Claudio; Francia, Fausto; Giannini, Adriana; Viale, Pierluigi
The preliminary findings of a tuberculosis (TB) screening of asylum seekers performed in a reception center located in northern Italy reveal a post-entry screening prevalence rate of 535 per 100000 individuals screened. This result shows that systematic use of chest radiography is a useful tool for active TB screening among asylum seekers in Italy. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: firstname.lastname@example.org.
Buetow, Stephen A
... of misinterpretation as one barrier to recent calls to reconnect medicine to a culture of human kindness.1 This fear, the modern importance attached to scientific objectivity, and a risk to physicians of "compassion fatigue" can frequently overwhelm the impulse of physicians to draw closer to their patients. Although physicians spontaneously displaying emotions can ...
Canetti, Daphna; Snider, Keren L G; Pedersen, Anne; Hall, Brian J
Can different political ideologies explain policy preferences regarding asylum seekers? We focus on attitudes regarding governmental policy towards out-group members and suggest that perceptions of threat help to shape these policy attitudes. Study 1 compared public opinion regarding asylum policy in Israel (N = 137) and Australia (N = 138), two countries with restrictive asylum policies and who host a large number of asylum seekers; Study 2, a longitudinal study, was conducted during two different time periods in Israel-before and during the Gaza conflict. Results of both studies showed that threat perceptions of out-group members drive the relationship between conservative political ideologies and support for exclusionary asylum policies among citizens. Perceptions of threat held by members of the host country (the in-group) towards asylum seekers (the out-group) may influence policy formation. The effect of these out-groups threats needs to be critically weighed when considering Israeli and Australian policies towards asylum seekers.
Morville, Anne-Le; Erlandsson, Lena-Karin; Eklund, Mona
OBJECTIVE: The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impairment in newly arrived Danish asylum seekers. It was hypothesized that exposure to trauma and torture would negatively influence ADL performance and that measures of ADL ability would be l...
Kew Asylum in Melbourne, which by the 1890s was the largest in Australia, was planned in the 1850s, built on a prominent site in the 1860s, and opened in the early 1870s with accommodation for over 500 patients. Costing nearly 200,000 pounds sterling and visible for miles, it was hailed by some as a 'palace.' Yet, in terms of international asylum architecture, the building was already out-of-date when it received its first patients in 1871; within a few years it was being labelled 'backward.' Recently an article, published in a Berlin medical journal in 1867, has come to light that contains notes and a plan supplied by Kew's German architect. This enables us to study more closely the thinking behind the design of the asylum, the overseas models on which it was based and why it attracted so much criticism so quickly. Kew's problems reflect many of the fundamental shortcomings of mid-nineteenth-century asylum architecture in Australia and elsewhere.
This book is based on Pedzisai Maedza's Master's thesis 'Theatre of testimony: An investigation in devising asylum', winner of the African Studies Centre, Leiden's 2014 African Thesis Award. This annual award for Master's students encourages student research and writing on Africa and promotes the
Eklöf, Niina; Abdulkarim, Hibag; Hupli, Maija; Leino-Kilpi, Helena
Privacy has been recognized as a basic human right and a part of quality of care. However, little is known about the privacy of Somali asylum seekers in healthcare, even though they are one of the largest asylum seeker groups in the world. The aim of the study was to describe the content and importance of privacy and its importance in healthcare from the perspective of Somali asylum seekers. The data of this explorative qualitative study were collected by four focus group interviews with 18 Somali asylum seekers with the help of an interpreter. The data were analysed by inductive content analysis. Research permissions were obtained from the director of the reception centre and from the Department of Social Services. Ethical approval was obtained from the Ethics Committee of Turku University. The content of privacy includes visual privacy, physical privacy and informational privacy. All contents can be shared with healthcare professionals. The importance of privacy includes respect, dignity and freedom. Privacy is strongly connected to the collectivism of Somali culture and religion. Unlike the Western cultures, privacy is not important only for the individual; most of all, it is seen to support collectivism. Even though all contents of privacy can be shared with healthcare professionals, it is important to recognize the cultural aspect of privacy especially when using interpreters with Somali background. © The Author(s) 2015.
British attitudes toward immigrants are complex. The United Kingdom has received regular waves of immigrants, both political and economic asylum seekers and, especially in recent decades, recruited labor from the former nations of the British Empire. Throughout its history, ambivalence among the Britons is seen due to these developments. In this…
Gowin, Mary; Taylor, E Laurette; Dunnington, Jamie; Alshuwaiyer, Ghadah; Cheney, Marshall K
Mexican male to female transgender asylum seekers in the United States suffer from serious health issues that can be attributed to stressors related to their transgender, ethnic minority, and socioeconomic status. This study explored these stressors, the resulting health issues, and the needs of this particularly vulnerable population. Asylum seekers' (n = 45) sworn declarations and psychological evaluations were examined by a multidisciplinary research team using a systematic document review process. The review identified stressors that occurred both in Mexico and the United States: verbal, physical, and sexual assaults; unstable environments; fear for safety/security; hiding undocumented status; and economic insecurity. The health issues that resulted in part from these stressors include posttraumatic stress disorder, depression, anxiety, sleep issues, isolation, avoidance, drug/alcohol use, and suicidal tendencies. Despite suffering from multiple health issues, asylum seekers rarely sought health or social services. Health promotion practitioners can play an important role in serving this silent minority by (1) expanding community-based research focused on the intersection of transgender, ethnic minority, and socioeconomic status; (2) using trusted community members to connect this population to necessary resources; (3) providing communication training/resource development for health care providers; and (4) creating a network of service organizations that understand the needs of transgender asylum seekers.
Full Text Available The loss of hope over time has led to despair and a mental health crisis for refugees and asylum seekers on Manus Island and Nauru. The use of the principle of ‘reasonable hope’, however, can support their mental health and well-being.
Full Text Available What happens to people who are deported after their asylum applications have failed? Many who are deported are at risk of harm when they return to their country of origin but there is little monitoring done of deportation outcomes.
This essay investigates performance events that feature actual refugees, asylum seekers and immigrants, but in instances where presence and embodiment are mediated and made ambiguous. My focus is a fashion show by Catalan designer Antonio Miro, who uses refugees from Senegal as models, and Christoph Schlingensief's public art project…
Stellinga-Boelen, A. A. M.; Storm, H.; Wiegersma, P. A.; Bijleveld, C. M. A.; Verkade, H. J.
Objectives: To investigate, in asylum seekers' children in the Netherlands, biochemical iron status and the prevalence of iron deficiency (ID) and anemia in relation to age, region of origin, length of stay in the Netherlands, body mass index (BMI), and dietary iron intake. Patients and Methods:
Morville, Anne-Le; Erlandsson, Lena-Karin; Eklund, Mona
OBJECTIVE: The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impairment in newly arrived Danish asylum seekers. It was hypothesized that exposure to trauma and torture would negatively influence ADL performance and that measures of ADL ability would...
Full Text Available With some 71% of female EU asylum applicants from FGM-practising countries estimated to be survivors of this harmful traditional practice, it is time to accept that this subject demands greater scrutiny and a more dedicated response.
Full Text Available The paper deals with the theories of the transformation of the modern functions of the nation state and the immigrant membership associated with the (legally defined status of community members exemplified by asylum policies. In the process, two fundamental approaches to the issue are distinguished: the first one emphasizing changes in the institution of the traditional national citizenship and competences of the nation state, while stressing a predominantly national character of the institution of citizenship, and the second one, which emphasizes the transformation of traditional citizenships, stressing the weakening of the role of the nation state. Therefore, in the latter case, there is increasingly more talk about postnationalism, which is a term denoting the transformation of the substantive aspects of citizenship in the EU countries. The mentioned theoretical approaches are applied to three groups of issues. First, the impact of the EU on the processes of the globalisation of the rights of asylum migrants are examined. Second, the paper works out the details of the way of formulating the policy of asylum membership in the EU member states. Third, the question of whether universal postnational inclusion of asylum migrants is at work in the EU member states, or whether the status of this group of immigrants should be found within the limits of the traditional theory of state membership and national sovereignty is addressed
Carmen A Pfortmueller
Full Text Available PRINCIPALS: Over the last two decades, the total annual number of applications for asylum in the countries of the European Union has increased from 15,000 to more than 300,000 people. The aim of this study was to give a first overview on multimorbidity of adult asylum seekers. METHODS: Our retrospective Swiss single center data analysis examined multimorbidity of adult asylums seekers admitted to our ED between 1 January 2000 and 31 December 2012. RESULTS: A total of 3170 patients were eligible for the study; they were predominantly male (2392 male, 75.5% versus 778 female, 24.5. The median age of the patients was 28 years (range 28-82. The most common region of origin was Africa (1544, 48.7%, followed by the Middle East (736, 23.6%. 2144 (67.6% of all patients were not multimorbid. A total of 1183 (37.7% of our patients were multimorbid. The mean Charlson comorbidity index was 0.25 (SD 1.1, range 0-12. 634 (20% of all patients sufferem from psychiatric diseases, followed by chronic medical conditions (12.6%, 399 and infectious diseases (4.7%, 150. Overall, 11% (349 of our patients presented as a direct consequence of prior violence. Patients from Sri Lanka/India most often suffered from addictions problems (50/240, 20.8%, p<0.0001. Infectious diseases were most frequent in patients from Africa (6.6%, followed by the Balkans and Eastern Europe/Russia (each 3.8%. CONCLUSION: The health care problems of asylum seekers are manifold. More than 60% of the study population assessed in our study did not suffer from more than one disease. Nevertheless a significant percentage of asylum seekers is multimorbid and exhibits underlying psychiatric, infectious or chronic medical conditions despite their young age.
Full Text Available Abstract Background Hypovitaminosis D is well known in different populations, but may be under diagnosed in certain populations. We aim to determine the first diagnosis considered, the duration and resolution of symptoms, and the predictors of response to treatment in female asylum seekers suffering from hypovitaminosis D. Methods Design: A pre- and post-intervention observational study. Setting: A network comprising an academic primary care centre and nurse practitioners. Participants: Consecutive records of 33 female asylum seekers with complaints compatible with osteomalacia and with hypovitaminosis D (serum 25-(OH vitamin D Treatment intervention: The patients received either two doses of 300,000 IU intramuscular cholecalciferol as well as 800 IU of cholecalciferol with 1000 mg of calcium orally, or the oral treatment only. Main outcome measures: We recorded the first diagnosis made by the physicians before the correct diagnosis of hypovitaminosis D, the duration of symptoms before diagnosis, the responders and non-responders to treatment, the duration of symptoms after treatment, and the number of medical visits and analgesic drugs prescribed 6 months before and 6 months after diagnosis. Tests: Two-sample t-tests, chi-squared tests, and logistic regression analyses were performed. Analyses were performed using SPSS 10.0. Results Prior to the discovery of hypovitaminosis D, diagnoses related to somatisation were evoked in 30 patients (90.9%. The mean duration of symptoms before diagnosis was 2.53 years (SD 3.20. Twenty-two patients (66.7% responded completely to treatment; the remaining patients were considered to be non-responders. After treatment was initiated, the responders' symptoms disappeared completely after 2.84 months. The mean number of emergency medical visits fell from 0.88 (SD 1.08 six months before diagnosis to 0.39 (SD 0.83 after (P = 0.027. The mean number of analgesic drugs that were prescribed also decreased from 1.67 (SD
Bansak, Kirk; Hainmueller, Jens; Hangartner, Dominik
What types of asylum seekers are Europeans willing to accept? We conducted a conjoint experiment asking 18,000 eligible voters in 15 European countries to evaluate 180,000 profiles of asylum seekers that randomly varied on nine attributes. Asylum seekers who have higher employability, have more consistent asylum testimonies and severe vulnerabilities, and are Christian rather than Muslim received the greatest public support. These results suggest that public preferences over asylum seekers are shaped by sociotropic evaluations of their potential economic contributions, humanitarian concerns about the deservingness of their claims, and anti-Muslim bias. These preferences are similar across respondents of different ages, education levels, incomes, and political ideologies, as well as across the surveyed countries. This public consensus on what types of asylum seekers to accept has important implications for theory and policy. Copyright © 2016, American Association for the Advancement of Science.
Full Text Available Migration into Europe affects the Alps in various ways. The recent influx of refugees and a higher number of asylum requests has presented governance challenges for mountain communities. In Italy, the responsibility of regions to host asylum seekers increased when a national system was implemented to distribute asylum seekers throughout the country. This study explored the impact of current distributions through the analysis of 2 rural mountain municipalities in the northeast Italian Alps in the Autonomous Province of Bolzano (also known as South Tyrol in which reception facilities for asylum seekers have been established. A qualitative research approach offered empirical insights into the functioning of the reception system and governance in these communities. Our social network analysis of the research data, focusing on the labor integration of asylum seekers, indicated that stronger relational linkages among actors in rural mountain communities may facilitate access to the labor market for asylum applicants.
Bloch-Infanger, Constantine; B?ttig, Veronika; Kremo, J?rg; Widmer, Andreas F.; Egli, Adrian; Bingisser, Roland; Battegay, Manuel; Erb, Stefan
Objective The increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland. Methods At the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospit...
The purpose of this study was to look at housing and health care services provided for asylum seeking women in Bradford, and whether service delivery meets their needs and expectations. This study used a qualitative research approach; the method of data collection was focused group interviews. The participants were selected from the Bradford Ecumenical Asylum Concern (BEACON) project. 10 women seeking asylum were interviewed and the interview data was analysed through the method of conten...
Heeren, Martina; Mueller, Julia; Ehlert, Ulrike; Schnyder, Ulrich; Copiery, Nadia; Maier, Thomas
.... International research shows high levels of distress for asylum seekers. Little is known about actual psychiatric morbidity in this population, especially during the first few years postmigration...
Nikendei, Christoph; Huhn, Daniel; Adler, Guido; von Rose, Peta Becker; Eckstein, Torsten M; Fuchs, Birgit; Gewalt, Sandra C; Greiner, Bernhard; Günther, Thomas; Herzog, Wolfgang; Junghanss, Thomas; Krczal, Thomas; Lorenzen, Detlef; Lutz, Thomas; Manigault, Meryl A; Reinhart, Nico; Rodenberg, Michiko; Schelletter, Iris; Szecsenyi, Joachim; Steen, Rainer; Straßner, Cornelia; Thomsen, Mirjam; Wahedi, Katharina; Bozorgmehr, Kayvan
In 2015, more than 890,000 asylum seekers were registered in Germany. The provision of medical and psychosocial care for asylum seekers is facing numerous obstacles. Access to health care is mostly insufficient, particularly in initial reception centres. The present article describes the development and implementation of an interdisciplinary outpatient clinic for asylum seekers at the main registration authority in the state of Baden-Wuerttemberg operated by physicians of the University Hospital of Heidelberg and the local Medical Association in Heidelberg. A steering committee was appointed to plan and implement the interdisciplinary outpatient clinic. Semi-structured interviews with nine steering committee members were conducted to elucidate perceived barriers during the planning and implementation phase. The steering committee's strong personal commitment and the health authorities' impartial management were cited as the main contributing factors to the success of the implementation process. Significant barriers were seen in the funding of personnel, equipment, and language mediation as well as in legal liability and billing-related aspects. Results are discussed with a focus on financing, administrative and legal framework as well as language mediation, documentation and further matters that are essential to ensure high-quality care. Copyright © 2017. Published by Elsevier GmbH.
Full Text Available In the Indonesian West Java town of Cisarua, asylum seekers and refugees face prolonged periods of waiting in limbo. Australian government policies have contributed to the lengthy waiting times, particularly Operation Sovereign Borders. Those in protracted situations have found ways to ensure that during their time in Cisarua their basic needs are met and they demonstrate creativity and resilience in difficult circumstances. Education for children is a priority for asylum seeker and refugee communities and a learning centre developed by the community has provided hope for children and their families. The paper draws on the experiences of Author One during his waiting time in Cisarua and research conducted by Authors Two and Three in late 2013.
Full Text Available The Common European Asylum System (CEAS experienced significant developments during the Tampere programme (1999 – 2004. This article analyses how security is constituted or viewed by the European Union in the area of asylum policy; more importantly how the European Commission, in the face of the emerging discourse on the ‘war on terror’ decided to push for a more inclusive agenda. Thus, the European Commission can (though not always does play a significant role in this process - the role of a supranational policy entrepreneur that enables the normative construction of a policy. The article analyses the high-profile case of the first phase of the CEAS, particularly the four main directives, its legal and political construction, and suggests the significance of the Commission in the political and normative process. Despite the challenges of the ‘war on terror’, the Commission managed to keep the CEAS within the limits of the Geneva Convention.
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Visentin, Sindi; Pelletti, Guido; Bajanowski, Thomas; Ferrara, Santo Davide
Asylum seekers often experience situations of vulnerability, being frequently exposed to a heightened risk of harm, and thus require special care, support and protection. The categories of "vulnerable persons", identified by International Legislation, and an individual's classification as a "vulnerable asylum seeker", have important implications in the reception procedures, in the decision-making phase and in the definition of therapeutic needs and rehabilitation. The Istanbul Protocol, the first international guideline approved by the United Nations and applied in different contexts, is not applicable for the assessment of the totality of the conditions (medical and otherwise), and therefore, the identification and assessment of conditions of vulnerability is largely delegated to questionnaires administered by non-medical personnel. The proposed methodology, based on the modificatory reworking of the Guidelines of the International Academy of Legal Medicine concerning the "medicolegal ascertainment of personal injury and damage on the living person", takes into consideration all the medical issues relevant for the decision concerning the applicant, both in the reception procedures and in the outcome of the asylum application.
Hocking, Debbie C
The influence of psychosocial factors on the subjective wellbeing of asylum-seekers residing in host Western countries has scarcely been explored qualitatively. Qualitative data derived from a mixed methods prospective study investigated the subjective wellbeing of 56 community-dwelling asylum-seekers and refugees at baseline and an average of 15.7 months later. Positive and negative experiences over time were explored in relation to self-perceived emotional health. Nineteen positive and 15 negative categories of experience emerged. Distinct psychosocial and protective factors were salient regarding the valence of experiences over time, with positive experiences comprising employment, improved financial circumstances, and social support or connectivity. Negative experiences included news of adversity from one's homeland, un(der)employment, poor health, and factors relating to the refugee determination process. Positive and negative experiences were contemporaneous, indicating that employment and social support may ameliorate the detrimental impact of traversing the protracted process of refugee status determination for asylum-seekers in particular.
Full Text Available In 1980, China implemented one of the most controversial population policies in modern times. China’s one-child policy shaped population politics for thirty-five years until its dissolution in 2015. During this time, many women were subjected to routine gynecological examinations, pregnancy testing, abortions, and sterilizations, which were often forced upon them by family planning officials. Some women fled China and sought refuge in the United States after having experienced a forced abortion or forced sterilization or feared that they would be subjected to a forced abortion or forced sterilization. This article focuses on how the U.S. government responded to China’s one-child policy through the passage of immigration laws and policies that made asylum a viable option for Chinese nationals who had been persecuted or feared persecution because of coercive population control policies. Based on observations of asylum hearings and interviews with immigration judges and immigration attorneys, this article uses feminist ethnographic methods to show how China’s one-child policy and U.S. asylum laws shape the gender politics of reproduction and migration.
Full Text Available There has been no significant legislation related to the asylum process enacted in Congress in nearly a decade. In 1996, the Illegal Immigration Reform and Immigration Responsibility Act (IIRIRA became law, rolling back protections for asylum seekers by including a one-year deadline for filing asylum applications, subjecting asylum seekers to “expedited removal” procedures, and expanding the detention of asylum seekers. In 2005, Congress enacted the REAL ID Act, which created additional legal barriers to asylum, including new requirements for proving an asylum claim. During the past several sessions of Congress, bills have been introduced that would make significant changes to the country’s asylum laws and refugee admissions program. This paper provides an overview of the pending legislation and the changes proposed. This overview is instructive in understanding (1 which members of Congress have demonstrated interest and leadership in refugee and asylum issues; (2 which refugee and asylum reform issues have been of most interest to members of Congress in recent years; (3 the different approaches to refugee and asylum issues by members of Congress who have shown leadership on these issues; and (4 which provisions have been enacted, which have gained traction, and which remain pending without significant movement through the legislative process.While it is difficult to imagine in the current partisan climate how any asylum or refugee legislation could be enacted into law, some legislative provisions have been reintroduced over a number of sessions of Congress and some have a history of bipartisan support. Legislation focused on a group of particular interest or concern to members of Congress could gain traction. A more comprehensive legislative approach framed by the need generally to improve the system could be less effective, particularly in the context of the years-long stalemate on comprehensive immigration reform
Olsen, Preston Trent
The United Kingdom’s acceptance of lesbian, gay, bisexual, and transgender (LGBT) refugees has been heralded as a progressive shift in asylum law. Indeed, the scope for the protection of sexual minorities under the Refugee Convention has expanded. The interpretation of the Convention definition of refugee in Article 1A(2) has been continuously adapted, especially the “particular social group” (PSG) category as well as the recognised scope of “well-founded fear of being persecut...
Despite the enormous personal and social cost Of substance abuse, there is very little knowledge with respect to the mechanisms by which these drugs produce addiction as well as to the mechanisms of toxicity. Similarly, there is a lack of effective therapeutic intervention to treat the drug abusers. In this respect, nuclear medicine could contribute significantly by helping to gather information using brain imaging techniques about mechanisms of drug addiction which, in turn, could help design better therapeutic interventions, and by helping in the evaluation and diagnosis of organ toxicity from the use of drugs of abuse. This volume contains six short descriptions of presentations made at the 18th Meeting of the American College of Nuclear Physicians -- DOE Day: Substance Abuse and Nuclear Medicine.
Zevulun, Daniëlle; Post, Wendy J.; Zijlstra, A. Elianne; Kalverboer, Margrite E.; Knorth, Erik J.
The return of rejected asylum seekers has a high priority on the national agendas of European States. In order to make well-informed asylum decisions involving children, knowledge of how asylum-seeker children fare after their return to their countries of origin is needed. This study aims to gain
Wiegersma, P.A.; Stellinga-Boelen, A.A.M.; Reijneveld, S.A.
Children of asylum seekers are at risk for psychosocial problems because of their flight history and exceptional living circumstances. This study aims to assess the association of sociodemographic factors and asylum procedural factors with psychosocial problems of asylum seekers' children, and
Winter, Heinrich; Bolt, Korine
The Aliens Act 2000 aimed to speed up and improve decision-making in asylum cases. To what extent were these objectives attained and what can be said on the basis of the available data about the factors which determine the quality of asylum decisions? Acceleration of the asylum procedure has
Roof, David J.
This paper utilizes Henri Lefebvre's work to examine nineteenth century school architecture, in relation to asylums. The deployment of the asylums occurred in unison with the development of public schools. Based on archival research this paper seeks an examination of this interrelated development. The social/spatial arrangement of asylums and…
Sandahl, Hinuga; Norredam, Marie; Hjern, Anders; Asher, Henry; Nielsen, Signe Smith
Asylum-seeking children constitute a vulnerable group with high prevalence and risk for mental health problems. The aim of this study was to compare policies of access to healthcare services, including physical examination and screening for mental health problems on arrival, for accompanied asylum-seeking children in the Nordic countries. This study was based on the national reports "Reception of refugee children in the Nordic countries" written by independent national experts for the Nordic Network for Research on Refugee Children, supplemented by information from relevant authorities. In Sweden, Norway and Iceland, asylum-seeking children had access to healthcare services equal to children in the general population. On a policy level, Denmark imposed restrictions on non-acute hospitalisations and prolonged specialist treatments. Regarding health examinations, Sweden deviated from the Nordic pattern by not performing these systematically. In Denmark, Iceland, and some counties in Sweden, but not in Norway, screening for mental health problems was offered to asylum-seeking children. Access to healthcare services for asylum-seeking children differs in the Nordic countries; the consequences of these systematic differences for the individual asylum-seeking child are unknown. For asylum-seeking children, access to healthcare has to be considered in a wider context that includes the core conditions of being an asylum-seeker. A comparative study at policy level needs to be supplemented with empirical follow-up studies of the well-being of the study population to document potential consequences of policies in practice.
Goosen, S.; Uitenbroek, D.; Wijsen, C.; Stronks, K.
Background: Asylum seekers are assumed to be a vulnerable group with respect to sexual and reproductive health. The objective of this study was to quantify induced abortion and teenage birth indicators for this group. Methods: The population comprised all female asylum seekers aged 15-49 in The
Full Text Available Italy is the main recipient of asylum seekers in the European region, and Sicily is their first point of arrival. This geographical position creates a large job for Health Authorities to identify and deal with the health of immigrants. This study evaluates the prevalence of disease among asylum seekers, assessing which are associated factors.
Fanning, Bryan; Veale, Angela
This paper evaluates responses to asylum seeker children in Ireland from a child poverty perspective and from that of the United Nations Convention on the Rights of the Child. It draws upon research undertaken in early 2001 on behalf of the Irish Refugee Council among asylum seeker families with children in Cork, Limerick and Ennis on their…
Christie, Pam; Sidhu, Ravinder
This paper considers the educational provision for, and general treatment of, refugee and asylum seeker children in Australia, using a framework of governmentality. The paper describes the regimes of practices which govern refugees and asylum seekers in Australia, including mandatory detention and a complex set of visa categorisations, and…
Mascini, P.; van Bochove, M.
Attention for discrimination against women in asylum law has grown considerably during the last few decades. Yet it is male claimants who have had smaller success Rates in the asylum procedures of different countries. Using administrative data from the Dutch INS, we show this difference is caused by
Stellinga-Boelen, A. A. M.; Wiegersma, P. A.; Bijleveld, C. M. A.
Objective: To monitor the dietary intake of energy, macro- and micronutrients in asylum seeker children. Design and setting: Cross-sectional study in three asylum seeker centres in The Netherlands. Subjects: Hundred and sixteen children 2-12 years old (86% of the study cohort) provided a dietary
van Burg, J. L.; Verver, S.; Borgdorff, M. W.
OBJECTIVE: To identify low-risk groups among asylum seekers in the Netherlands that may be excluded from tuberculosis (TB) screening at entry or during follow-up. METHODS: A retrospective cohort study of medical records of asylum seekers entering the country between January 1994 and March 1997.
Recent plans to accommodate asylum seekers in a number of rural locales have fueled debates about the ability of the countryside to accommodate difference. In this paper, I explore these debates by examining community opposition to the proposed development of asylum centerers in Nottinghamshire and Oxfordshire (UK). Herein, a rhetoric of rejection…
Nationality underwrites a great deal of the Danish asylum process, and of the refugee regime as a whole. The housing and care of asylum seekers, handled by the Danish Red Cross, is based on classifications by nationality. Bending a phrase from Benedict Anderson, these might be called "appointed c...
Kröger, Christoph; Frantz, Inga; Friel, Pauline; Heinrichs, Nina
Background and Objectives: Currently, there is a large number of refugees that are coming to Germany from (civil) war zones. The aim of this study was to estimate the extent of posttraumatic stress and depressive symptoms amongst asylum seekers in Germany. Methods: In the summer of 2015, 280 adult refugees (88,2% men) were interviewed with the support of translators in the Lower Saxony State Refugee Reception Center, Brunswick. Data was categorized due to country of origin (Balkan States, Middle East, Northern Africa, Rest of Africa). The Posttraumatic Diagnostic Scale-8 (PDS-8) and the Patient-Health-Questionnaire (PHQ-8) were employed as screening measures. If the threshold values of 12 in the PDS-8 or 15 in the PHQ are exceeded, respectively, the diagnosis of PTSD or depression is highly likely. Results: Participants reported an overall high number of potentially traumatic experiences (72,5% war experiences; 67,9% violent attacks; 51,4% another very burdensome experience; 50,0% torture; 47,9% imprisonment; 11,1% sexual assault), whereby multiple answers were possible. The prevalence rates for possible PTSD were 16,1% (Balkan States), 20,5% (Middle East), 23,4% (Rest of Africa) and 28,1% (Northern Africa); rates for a possible depression varied between the countries of origin from 17,9, 35,9, 28,1 to 24,0%, respectively. Conclusions: Compared to the German population, the rates of traumatic experiences and the prevalence of a possible PTSD were significantly higher amongst asylum seekers of the present sample; this was not the case for depression. The integration of affected asylum seekers may be considerably complicated due to health impairments, e. g. with regard to learning the German language and admission to educational or occupational services. © Georg Thieme Verlag KG Stuttgart · New York.
Wiegersma, P Auke; Stellinga-Boelen, Annette A M; Reijneveld, Sijmen A
Children of asylum seekers are at risk for psychosocial problems because of their flight history and exceptional living circumstances. This study aims to assess the association of sociodemographic factors and asylum procedural factors with psychosocial problems of asylum seekers' children, and differences herein by informant (parents, teachers, and children). To this end, we obtained data on psychosocial problems among a random sample of 267 children aged 4 to 16, living in Dutch asylum seekers' centers, using the multi-informant Strength and Difficulties Questionnaire. The results show that the prevalence rate of psychosocial problems among asylum seekers' children was high. The occurrence was not associated with asylum-procedural variables but only with child-contextual factors such as mental health of the mother and leaving behind a parent in the country of origin. The associations varied in strength by informant. Therefore, preventive and supportive measures to improve psychosocial health of young asylum-seekers should concentrate on these contextual issues.
Ayse Devrim Basterzi
Full Text Available Social situation, social networks, power relationships, socioeconomic conditions, education and physical environment of people affect to encounter with trauma and disasters. These social factors also have an effect on traumatized peoples mental health. Gender roles are affected these entire social context and mental disorders. War and migration frequently lead to increasing inequality between men and women. This article reviews the studies about refugee, asylum seeker and immigrants women mental health and gender roles. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2017; 9(4.000: 379-387
Full Text Available Migrants are often referred to as an all encompassing group of people and the “many faces of migration”, the variety of people, legalities and complexities involved, can be overlooked. The same can be said for non-EU migrants in the Irish context. Non-EU migrants (or those that are not Caucasian are generally viewed to be a distinct cohort of comparable migrants. Indeed, these migrants are often portrayed in a broadly negative way by key Irish institutions (such as the parliament or the media, and these representations impact upon how Irish society views non-EU migration and indeed migration in general. While Ireland is by no means the only European country in which this type of practice occurs, this paper aims to draw attention to generalized, inaccurate and misleading representations of non-EU migrants in Ireland, by specifically examining representations of asylum seekers and illegal immigrants. There can be an overlap in how these “types” of migrants are conceptualized and this paper therefore aims to develop an understanding of the implications involved for migrants categorized as an “asylum seeker” or an “illegal immigrant.” Furthermore, these topics are under-researched within the Irish context, yet they receive much political and public attention. At the same time however, this paper aims to challenge the labels assigned to non-EU migrants and the terminology that is used to define their identity so concretely. In the Irish context there is much confusion in relation to the multiple “faces” of non-EU migration, as a range of terminology is used to refer to them. This terminology is often used in an interchangeable manner, in an array of societal contexts. There is a consistent (whether this happens intentionally or unintentionally is debatable misuse of categories and migration terminology in Irish institutional discourses. Quite often those seeking asylum are referred to as illegal immigrants and vice versa
Ingvarsson, Lilja; Egilson, Snæfrídur Thóra; Skaptadottir, Unnur Dís
An ever-increasing number of people seek asylum in Iceland. The wait for resolution on application for asylum can take up to three years. During this time participation in daily occupations is disrupted. This study was carried out to gain an understanding of the experience of living as an asylum seeker in Iceland. It explored asylum seekers' opportunities for participation in occupations as well as their overall experiences while waiting for the processing of their application. Eleven semi-structured interviews were conducted with nine participants, of whom six were asylum seekers. A constructivist grounded theory approach was applied to categorize and synthesize data. Four major categories emerged that reflected the participants' difficult living conditions, lack of opportunities for participation, lack of belonging, and feelings of powerlessness. The long processing time of their applications was enormously stressful as well as not being in charge of one's life, living conditions, or income. The results indicate that the long processing time of application for asylum has deteriorating effects on health. In order to promote asylum seekers' well-being and occupational rights attention needs to be focused on their living conditions and opportunities for participation in meaningful occupations, including work.
Full Text Available This article is a content analysis of the representation of Syrian asylum seekers in the Turkish press. The research sample includes news reports, columns and visuals published in 2014 in five national newspapers with the highest circulation figures (“Hürriyet”, “Sabah”, “Posta”, “Sözcü”, “Zaman”. The article is part of a larger research project, which is funded by TÜBİTAK, investigating the representation of Syrian asylum seekers between 2011 and 2015 in Turkish newspapers. Analysing news texts and columns is widely held in research projects. However, conducting a visual analysis on news photographs is usually overlooked. This study investigates news texts and news photographs together. The study shows that the coverage of Syrian asylum seekers has usually a positive or neutral content. However, the results also point out the ambivalence in the representations of asylum seekers. The representations of Syrian asylum seekers portray these individuals mostly as “poor” people “in need of help” as well as “threats” for social security. These frequently repeated representations and ambivalence show that the representation of Syrian asylum seekers in Turkish newspapers reproduces the stereotypical representation of asylum seekers as defined in international studies.
de Gier, Brechje; Suryapranata, Franciska S T; Croughs, Mieke; van Genderen, Perry J J; Keuter, Monique; Visser, Leo G; van Vugt, Michele; Sonder, Gerard J B
Malaria is a notifiable disease in the Netherlands, a non-endemic country. Imported malaria infections occur regularly among travellers, migrants and visitors. Surveillance data were analysed from 2008 to 2015. Trends in amounts of notifications among risk groups were analysed using Poisson regression. For asylum seekers, yearly incidence was calculated per region of origin, using national asylum request statistics as denominator data. For tourists, denominator data were used from travel statistics to estimate incidence per travel region up to 2012. A modest increase in overall imported malaria notifications occurred in 2008-2015 (from 222 in 2008 to 344 in 2015). Notably, in 2014 and 2015 sharp increases were seen in malaria among travellers visiting friends and relatives (VFR), and in asylum seekers. Of all Plasmodium falciparum infections, most (1254/1337; 93.8%) were imported from Africa; 1037/1337 (77.6%) were imported from Central and West Africa. Malaria in VFR was mostly caused by P. falciparum infection after visiting Ghana (22%) or Nigeria (19%). Malaria in asylum seekers was mostly caused by Plasmodium vivax infection from the Horn of Africa. The large number of notifications in asylum seekers resulted from both an increase in number of asylum seekers and a striking increase of malaria incidence in this group. Incidence of malaria in asylum seekers from the Horn of Africa ranged between 0.02 and 0.3% in 2008-2013, but rose to 1.6% in 2014 and 1.3% in 2015. In 2008-2012, incidence in tourists visiting Central and West Africa dropped markedly. Imported malaria is on the rise again in the Netherlands, most notably since 2013. This is mostly due to immigration of asylum seekers from the Horn of Africa. The predominance of P. vivax infection among asylum seekers warrants vigilance in health workers when a migrant presents with fever, as relapses of this type of malaria can occur long after arrival in the Netherlands.
Metsäniitty, Mari; Varkkola, Olli; Waltimo-Sirén, Janna; Ranta, Helena
In Finland, forensic age assessment is strictly regulated by legislation. According to the Aliens Act (301/2004) and the amendment of the Act (549/2010), the police authorities, the frontier guard authorities, and the immigration authorities have the right to refer asylum seekers to the University of Helsinki, Department of Forensic Medicine, for age assessment. These assessments are especially performed to solve if the person is of major age, the cutoff being 18 completed years. The forensic age assessment is largely based on dental development, since the special permit of the Radiation and Nuclear Safety Authority (STUK) to the Department of Forensic Medicine of the University of Helsinki, allowing the use of ionizing radiation for non-medical purposes, includes dental and hand X-rays. Forensic age assessment is always performed by two forensic odontologists. In 2015, the total number of forensic age assessment examinations was 149, and the countries of origin of the asylum seekers were most commonly Iraq, Afghanistan, and Somalia. The current legislation on forensic age assessment has been well received and approved. Radiological and other examinations can be performed in different parts of Finland, but the forensic odontologist at the University of Helsinki is always involved in the process and ensures joint quality standards for the forensic age assessment.
The Hungarian health care system faces new challenges with the unprecedented increased rate of migration. Asylum-seekers arriving are a heterogeneous group. Their health care needs vary depending on their country of origin and the quality of the health care they received prior to arrival, not to mention the impact of the migration process on their health. Described within this paper are the challenges an asylum seeker might face in obtaining care on arrival into the host country and the challenges clinicians face in providing that care. This review is designed to give health professionals the necessary knowledge to care for asylum-seekers in a culturally aware and clinically informed manner.
Wen, J K
This paper describes the spontaneous rise of an indigenous asylum for the chronic mentally ill, called Lung Hwa Tang (The Hall of Dragon Metamorphoses), in contemporary Taiwan. Sociocultural factors relevant to the asylum, including the roles played by Chinese families and the current situation of mental health care in Taiwanese communities, are discussed. Despite its detrimental effect on patients, this asylum stands for an alternative mental health care system in the folk sector; it reflects a great demand from the communities for access to modern mental health services, the development of which have been very slow and inadequate in the past four decades in this rapidly developing country.
Abbing, Henriette D C Roscam
In the European Union, unaccompanied asylum seekers below 18 years of age are entitled to specific treatment. Age assessment practices to verify the age-statement by the asylum seeker differ between EU Member States. Medical methods in use raise questions about accuracy, reliability and safety. The medical, legal and ethical acceptability of invasive methods (notably X-rays) in particular is controversial. Human rights are at stake. The lack of common practices results in different levels of protection (discrimination). The absence ofstandardisation is an obstacle for the functioning of the Common European Asylum System. EU Best Practice Guidelines should remedy the situation; such guidelines should reflect the best interest of the child.
Schneider, Christine; Mohsenpour, Amir; Joos, Stefanie; Bozorgmehr, Kayvan
There are more than 100,000 asylum seekers registered in Germany, who are granted limited access to health services. This study aims to provide a systematic overview of the empirical literature on the health status of and health-care provision to asylum seekers in Germany in order to consolidate knowledge, avoid scientific redundance, and identify research gaps. A systematic review and evidence mapping of empirical literature on the health status of and health-care provision to asylum seekers in Germany will be performed. We will apply a three-tiered search strategy: 1. search in databases (PubMed/MEDLINE, Web of Science, IBSS, Sociological Abstracts, Worldwide Political Science Abstracts, CINAHL, Sowiport, Social Sciences Citation Index, ASSIA, MedPilot, DNB), dissertation and theses databases, and the internet (Google); 2. screening references of included studies; 3. contacting authors and civil society organizations for grey literature. Included will be studies which report quantitative and/or qualitative data or review articles on asylum seekers in Germany, published in German or English language. Outcome measures will include physical, mental, or social well-being, and all aspects of health-care provision (access, availability, affordability, and quality). Search results will be screened for eligibility by screening titles, abstracts and full texts. Data extraction comprises information on study characteristics, research aims, and domains of health or health-care services analyzed. The quality of studies will be appraised and documented by appropriate assessment tools. A descriptive evidence map will be drawn by categorizing all included articles by research design and the health conditions and/or domains of health-care provision analyzed. The body of evidence will be evaluated, and a narrative evidence synthesis will be performed by means of a multi-level approach, whereby quantitative and qualitative evidence are analyzed as separate streams and the product
Laban, Cornelis J; Komproe, Ivan H; Gernaat, Hajo B P E; de Jong, Joop T V M
Refugees in western countries often face long juridical procedures before their requests for a resident permit is granted. The, still scanty, literature shows high prevalence rates of psychopathology among asylum seekers, but there has been little interest for other impaired dimensions of health. The present study is part of a community-based mental health survey among Iraqi asylum seekers in the Netherlands, conducted between November 2000 and September 2001, on the risks of a long asylum procedure. The objectives of this study were to explore quality of life (QoL), disability and physical health and their relationships with psychopathology and pre- and post-migration variables. Two groups of pre-stratified (length of asylum procedure), randomly selected Iraqi asylum seekers (N = 143 and N = 151), were interviewed with fully structured, culturally validated questionnaires. Quality of life was examined with QoLWHO-Bref, functional disability with the Brief Disability Questionnaire and physical health with a newly developed questionnaire. Psychiatric (DSM IV) disorders were measured with the WHO Composite International Diagnostic Interview 2.1. Multivariate logistic regression analyses were used to estimate the relationships between the outcome measures and socio-demographics, adverse life events in Iraq, post-migration living problems (PMLP) and psychopathology. Respondents with a long asylum procedure reported significantly lower QoL, higher functional disability and more physical complaints. Multivariate regression shows that length of stay is the strongest predictor for a low overall QoL. In addition, lower QoL was predicted by psychopathology, higher age, adverse life events in the Netherlands and the PMLP-clusters: family issues, socio-economic living conditions and socio-religious aspects. Disability was predicted by psychopathology, higher age and the PMLP clusters: family issues and socio-religious aspects. Physical complaints were predicted by length of
Ana Teresa A. Venancio
Full Text Available During the first decade of the twentieth century, the press of the republican capital disseminated representations and helped to form opinions about the National Hospice of Alienated Persons (HNA, the first Brazilian psychiatric institution, which began to function in the city of Rio de Janeiro in 1852. For this investigation we have analyzed the news about the hospice in two newspapers - O Paiz and Correio da Manhã. We follow here the most recent Brazilian historiography, as well as the history of psychiatry in Ibero-American countries, to discuss the emphasis given to the social control function of the asylum and to point out its hybrid and multifaceted character in the news that circulated in the press of the federal capital. In the two newspapers, the varied set of references to the HNA puts into circulation three points of view: the first two express how the institutional life, in its different aspects (administrative, welfare, scientific is described and portrayed by the press; while the third point of view brings together the situations in which the hospice is considered as a solution for events that disturb the life of the city.
Slonim-Nevo, Vered; Regey, Shirley; Millo, Yiftach
The study appraises the prevalence of pre-migration trauma exposure, the ability to secure basic living needs, and psychological functioning among Darfuri asylum-seekers and refugees living in Israel...
Gregurović, Margareta; Kuti, Simona; Župarić-Iljić, Drago
...: immigrant workers and asylum seekers. The research was conducted shortly after Croatia’s entry into the EU, in September 2013, and the presented data are a part of a larger survey that included various migration and ethnicity issues...
Müller, Martin; Klingberg, Karsten; Srivastava, David; Exadaktylos, Aristomenis K
... (AS). A retrospective single-centre analysis was performed of the data from all adult patients with the official status of "Asylum Seeker" or "Refugee" who consulted the ED of Bern University Hospital...
Full Text Available In this paper I would like to present Serbian migration policy concerning irregular migration and asylum in the context of the attempts of the Serbian state to become a member of the European Union. I would describe the history of the asylum system prior and after the implementation of the independent asylum system in Serbia in 2008. My presentation of the Serbian migration policy would be channelled by the analysis of some particular political issues, such as the externalization of the EU borders’ control, as well as some relevant elements of the European integration process, like visa liberalization. The second, more culturally specific dimension of the issue would be accessed through the demonstration of both legislative and public conceptualizations of the irregular migrants, asylum seekers and refugees in Serbia.
Refugees often find themselves in a protracted situation of temporariness, as applications for asylum are processed, deportations negotiated and possible extensions of temporary protection status considered within the context of increasingly restrictive governmental policies across Europe. Through...
Full Text Available The number of refugees and asylum seekers in Serbia is significantly increasing. Many have experienced traumatic events and suffer from posttraumatic stress disorder and depression. In order to provide them with adequate assistance, caregivers need adjusted assessment tools. The main goal of this research was the adaptation of the Harvard Trauma Questionnaire for working with refugees and asylum seekers in Serbia. A total of 16 focus groups were interviewed in two phases in order to create an adequate list of traumatic events for this population. The adapted list was subsequently administered to 226 persons seeking asylum in Serbia, along with the remaining parts of HTQ, HSCL-25 and BDI-II. Results show that the adapted list of traumatic events, as well as a shorter version, has good validity and other metric properties. The adaptation of the first assessment tool for working with refugees and asylum seekers in Serbia has significant practical implications.
Mayne, Jacinta; Lowrie, Daniel; Wilson, Jessie
The contexts into which refugees and asylum seekers resettle, particularly the socio-political context as represented through various discourses, shape their occupational opportunities, health, and well-being. This article explores current literature in regard to the contemporary Australian discursive climate, particularly in relation to the way it may shape the occupational experiences of refugees and asylum seekers. In addition, a synthesis of current research regarding the occupational experiences of refugees and asylum seekers during their period of resettlement is presented. These two topics of research, drawn from 42 articles, were thematically analyzed. Identified themes include imagined possibilities prior to arrival, establishing occupational routines on entry to the Australian community, and pursuing a personally meaningful life. The authors argue that consideration of the way in which discourse shapes the lived world, and in turn, the occupational opportunities of refugees and asylum seekers, is of key importance for those working with these marginalized groups. © The Author(s) 2016.
Birger, Lior; Peled, Einat
This study examined perceptions of marriage and sexuality among male asylum seekers from Eritrea. Semi-structured in-depth interviews were conducted with 14 men living in Israel. Their perceptions of marriage and sexuality were found to be influenced by their life as asylum seekers, and particularly by their encounter with a different culture, by their lack of legal status, and by the marked numerical imbalance between women and men within their community. Changes in their perceptions occurred after their arrival in Israel, and included greater relaxing of social codes and the transition from a relatively 'closed' sexual mindset to a more 'open' one. It is important to understand how lack of status affects male asylum seekers' intimate relationships with women, and to recognise such men as subjects with legitimate sexual and partnering needs, thereby broadening existing discourse in this field, which tends to present male asylum seekers primarily as sources of cheap labour and as sexual Others.
Shamai, Michal; Amir, Yair
The phenomenon of African asylum seekers in Israel is relatively new. The purpose of the study was twofold: (a) to investigate how the asylum seekers construct their life stories and (b) to discover which aspects of the constructed life stories can be taken into consideration by various mental health professionals when providing help to asylum seekers. In this study, we interviewed 16 asylum seekers residing in Israel using the narrative method. Based on holistic analysis, we collected three groups of stories: "Then see what course life takes in the future," "I'm not yet free," and "Open prison." In the discussion of the findings, we focus on the similarities and differences among the groups of stories, with reference to the role of the sociopolitical context and to the private and social self as part of the participants' well-being. We make implementation suggestions for mental health interventions. © The Author(s) 2015.
Full Text Available Based on a short field research conducted at the refugee transit center in Slavonski Brod, the paper analyzes contemporary asylum policies in Croatia. The author is suggesting that the structure and function of a centre plays a crucial role in the securitization and humanitarization of the asylum policy. The analysis has shown that the asylum policy in Croatia has the same structure as the dominant asylum policies in Europe. Both of them oscillate between two poles: compassion and repression. Humanitarian policy in Croatia is more restrictive and is based on radical inequality, nationalism, racism, the suspension of rights and the normalization of structural violence. Due to its exclusive national focus, it will not provide any long term solutions for dealing with refugees in the future.
If one thinks medicine, madness and the past, one image immediately pops into mind: that of the mental asylum. Following the famous work by Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason, many historians have thus considered that the medicalization of insanity in the modern age had mostly led to a "great confinement" and a greater segregation of all individuals deemed mentally unfit during the "asylum era': However, new research demonstrates that this classic narrative of the psychiatric past needs to be revised. It discloses that, ever since the 191h century, a whole other medical culture existed as a challenge to asylums, a culture that advocated the integration of the mad and fought to disassociate psychiatry from the dominant model of confinement all throughout the occidental world. This article aims at presenting the results of these historical works that depict another aspect of the psychiatric history, exploring "boarding out" practices, instead of asylum ones.
Mazur, V M-L; Chahraoui, K; Bissler, L
Refugees seeking asylum are a particularly vulnerable population. It has been observed that among the most commonly-occurring disorders exhibited in this population, there is a high incidence of post-traumatic stress disorder, generalized anxiety disorder, and depression. These disorders may be linked to the difficult paths that refugees are forced to undertake, as well as to different traumatic events which are particularly destructive psychologically (deliberate physical, sexual and/or psychological violence, traumatic bereavements in the context of war, or social and political instability, socio-economic, familial or administrative difficulties), which compromise their view of their short-term futures. In the face of the weight of these life events, the question of the psychological resources of the individual is at the forefront of our understanding of mental health and the capacity to adjust to trauma. Our study aims to apprehend in a dynamic way, the different strategies used by asylum seekers in our western countries to adjust psychologically to traumatic and stressful events. The aim of this research is to study the links between mental health and anxious and depressive psychopathologies as well as the defensive modalities of these subjects. One hundred and twenty adult asylum seekers, living in refugee centres in Slovakia, France and Norway have agreed to participate in this study. We tried to assess the psychopathological disorders manifesting in these populations, notably PTSD, major depression and generalized anxiety disorder. Using the DSQ-60 we also tried to establish the links between the psychopathologies observed in this population and the defence mechanisms employed. Our results reveal that 60% of subjects do indeed suffer from psychopathological disorders with an important comorbidity of PTSB and depression (64.2%). Furthermore, the seriousness of the symptoms is correlated with less adaptive defence mechanisms (a higher incidence of defence
Since the mid-1990s third-sector professionals and organizations have come under increasing pressure to help enforce restrictive and punitive policies towards refugees and asylum seekers. This paper presents one response, using an empirical case study to develop an Independent Anti-Racist Model for asylum rights organizing. This combines data from a three-year study comparing four organizations in a major city in England and reflections on the author's experience as a member of the case study...
This article examines the management and meaning of post-mortem examinations, and the spatial ordering of patients' death, dissection and burial at the Victorian asylum, referencing a range of institutional contexts and exploiting a case study of the Royal Edinburgh Asylum. The routinizing of dissection and the development of the dead-house from a more marginal asylum sector to a lynchpin of laboratory medicine is stressed. External and internal pressure to modernize pathological research facilities is assessed alongside governmental, public and professional critiques of variable necroscopy practices. This is contextualized against wider issues and attitudes surrounding consent and funereal rituals. Onus is placed on tendencies in anatomizing insanity towards the conversion of deceased lunatics--pauper lunatics especially--into mere pathological specimens. On the other hand, significant but compromised resistance on the part of a minority of practitioners, relatives and the wider public is also identified.
Premand, Natacha; Baeriswyl-Cottin, Rachel; Gex-Fabry, Marianne; Hiller, Nikol; Framorando, David; Eytan, Ariel; Giannakopoulos, Panteleimon; Bartolomei, Javier
A high prevalence of mental illness has been reported in asylum seekers. The present cross-sectional study examined suicidal thoughts, treatment modalities (outpatient crisis intervention, inpatient care), and their determinants in asylum seekers (n = 119) and permanent residents (n = 120) attending the same outpatient clinic in Geneva, Switzerland. The most frequent diagnoses were depressive disorders (64.7%) and posttraumatic stress disorder (34.5%) in asylum seekers and psychotic (55.0%) and depressive disorders (33.3%) in permanent residents. The frequency of suicidal thoughts was similar in both groups (>30%). Asylum seekers benefited from outpatient crisis intervention more frequently than residents did (26.9% vs. 5.8%), whereas inpatient care was less frequent (25.2% vs. 44.2%). In asylum seekers, acute suicidal thoughts were associated with increased frequency of outpatient crisis interventions, and, suicidal thoughts, psychosis, or personality disorders were associated with higher rates of hospitalization. Documenting clinical characteristics and service utilization of asylum seekers is a prerequisite to organizing targeted interventions.
Kadriye Kart Yaşar
Full Text Available Objective:This study aimed to determine prevalence of hepatitis B, C and HIV/AIDS in asylum seekers in Istanbul, Turkey. Methods: The data about asylum seekers who applied in Istanbul between March 2008 and March 2010 were evaluated retrospectively. Demographic features and markers of blood borne infections (HBsAg, anti-HCV and anti-HIV results of asylum seekers were reviewed. Results: In total 3043 asylum seekers were included into the study. The leading origin countries of the refugees were from Afghanistan, Turkmenistan and Azerbaijan and majority of them (2328 people, 77% were male. The young adults between 25 and 45 years constituted the most crowded group. Overall prevalence of HCV, HBsAg and HIV/AIDS were 12.2%, 5.9% and 0.7%, respectively. The highest seropositivity rate for anti-HCV, HBsAg and anti-HIV were found in Georgian males (47.1%; in Moldovan males (13.2% and in Somali males (3.1%, respectively. Conclusion:Mostly asylum seekers who have migrated to our country were young adult males from Asia. The highest prevalence rate of HCV was found in Georgian males. Therefore, the increased potential of migration to our country along the recent years necessitates development of an appropriate health approach concerning asylum seekers. J Microbiol Infect Dis 2014;4(1: 20-25
Mewes, R; Reich, H; Skoluda, N; Seele, F; Nater, U M
Recently fled asylum seekers generally live in stressful conditions. Their residency status is mostly insecure and, similar to other immigrants, they experience stress due to acculturation. Moreover, they often suffer from traumatization and posttraumatic stress disorder (PTSD). All of these factors can result in chronic maladaptive biological stress responses in terms of hyper- or hypocortisolism and, ultimately, illness. We believe the current study is the first to compare hair cortisol concentration (HCC) of recently fled asylum seekers with PTSD to those without PTSD, and to compare HCC of asylum seekers to HCC of permanently settled immigrants and non-immigrant individuals. HCC of the previous 2 months was compared between 24 asylum seekers without PTSD, 32 asylum seekers with PTSD, 24 permanently settled healthy Turkish immigrants and 28 non-immigrant healthy Germans as the reference group. Statistical comparisons were controlled for age, sex and body mass index. No significant difference in HCC was found between asylum seekers with and without PTSD. However, the asylum seekers showed a 42% higher HCC than the reference group. In contrast, the permanently settled immigrants exhibited a 23% lower HCC than the reference group. We found relative hypercortisolism in recently fled asylum seekers, but no difference between persons with and without PTSD. These findings add to the very few studies investigating HCC in groups with recent traumatization and unsafe living conditions. Contrary to the findings in asylum seekers, permanently settled immigrants showed relative hypocortisolism. Both hyper- and hypocortisolism may set the stage for the development of stress-related illnesses.
Full Text Available Starting the Arab spring in 2010 and going through the latest and ongoing Syrian conflict and crises, Balkans and Macedonian railways have been and are a place where many human destinies cross their paths walking to the Member States of the European Union. On the other side, Macedonia is struggling with an influx of refugees, finding itself in a status quo position, even looking as it does not know how to solve the situation. Migrants were killed on railways every day not being able to use any kind of public transportation; their smuggling became a normal business for organized crime groups; Macedonian citizens started to earn money on refugees’ misfortune. The paper using the comparative method and document analysis, gives an overview of the EU’s legislation in the area, its improvement and current impact on things, all of it concluded with the Macedonian legal solutions regarding asylum and authors’ recommendations.
Morville, Anne-Le; Amris, Kirstine; Eklund, Mona
impairment that increased during time spent in a centre, and that the increase may be associated with exposure to number of applied torture methods. Contribution to practice/evidence base of occupational therapy: The knowledge contributes to the planning and execution of preventive and rehabilitation...... occupational performance during time spent in a centre. Objectives: Our aim was to assess if newly arrived asylum seekers had impaired occupational performance and if this was associated with previous exposure to torture and/or self-reported psychological symptoms and pain measures. We also wanted to evaluate...... had an impaired occupational performance, but no differences between tortured and non-tortured were observed. There were weak to moderate correlations between self-reported psychological distress, pain measures and occupational performance. At follow-up the occupational performance impairment...
J. a. Franco
(p<0.00001, self-medication (p<0.0002, pain and concern during over 6 months due to disease or disability (p<0.00001, lack of confidence in scientific medicine (p<0.00001, the belief that «spiritual problems» (p<0.00001, «mental conditions» (p<0.003, and «emotional conditions» (p<0.00001, popular beliefs, particularly daño & envidia (p<0.00001, and mal de ojo (p<0.001 have triggered the disease. One third of the patients attended the hospital while undergoing an alternative therapy that may pose an interference or interaction hazard. Emphasis is placed on the importance of medical education to assess physician-patient relationship and the ability to convey trust in medical procedures and treatments, and scientific consulting for other practices.
Sofanne J Ravensbergen
Full Text Available Migration is one of the risk factors for the spread of multidrug-resistant organisms (MDRO. The increasing influx of migrants challenges local health care systems. To provide evidence for both hospital hygiene measure and empirical antibiotic therapy, we analysed all cultures performed in asylum seekers between January 1st 2014 and December 31st 2015 for methicillin resistant Staphylococcus aureus (MRSA and for multidrug-resistant Enterobacteriaceae (MDRE. We compared these with cultures from the Dutch patient population with risk factors for carriage of MDRO. A total of 7181 patients were screened for MRSA. 7357 S. aureus were isolated in clinical cultures. Of 898 screened asylum seekers, almost 10% were MRSA positive. Of 118 asylum seekers with S. aureus in clinical cultures almost 19% were MRSA positive. The general patient population had a 1.3% rate of MRSA in S. aureus isolates. A higher rate of Panton-Valentine leukocidin (PVL positive strains (RR: 2.4; 95% CI: 1.6-3.4 was found in asylum seekers compared to the general patient population. In 33475 patients one or more Enterobacteriaceae were obtained. More than 21% of the asylum seekers were carrier of MDRE, most of them producing extended spectrum beta-lactamases (20.3%. 5.1% of the general patient population was MDRE carrier. It can be concluded that asylum seekers present with higher rate of MDRO compared to the general patient population. These results justify continued screening of asylum seekers to anticipate multidrug-resistant organisms during hospital care of patients.
Ravensbergen, Sofanne J; Berends, Matthijs; Stienstra, Ymkje; Ott, Alewijn
Migration is one of the risk factors for the spread of multidrug-resistant organisms (MDRO). The increasing influx of migrants challenges local health care systems. To provide evidence for both hospital hygiene measure and empirical antibiotic therapy, we analysed all cultures performed in asylum seekers between January 1st 2014 and December 31st 2015 for methicillin resistant Staphylococcus aureus (MRSA) and for multidrug-resistant Enterobacteriaceae (MDRE). We compared these with cultures from the Dutch patient population with risk factors for carriage of MDRO. A total of 7181 patients were screened for MRSA. 7357 S. aureus were isolated in clinical cultures. Of 898 screened asylum seekers, almost 10% were MRSA positive. Of 118 asylum seekers with S. aureus in clinical cultures almost 19% were MRSA positive. The general patient population had a 1.3% rate of MRSA in S. aureus isolates. A higher rate of Panton-Valentine leukocidin (PVL) positive strains (RR: 2.4; 95% CI: 1.6-3.4) was found in asylum seekers compared to the general patient population. In 33475 patients one or more Enterobacteriaceae were obtained. More than 21% of the asylum seekers were carrier of MDRE, most of them producing extended spectrum beta-lactamases (20.3%). 5.1% of the general patient population was MDRE carrier. It can be concluded that asylum seekers present with higher rate of MDRO compared to the general patient population. These results justify continued screening of asylum seekers to anticipate multidrug-resistant organisms during hospital care of patients.
Morville, Anne-Le; Amris, Kirstine; Eklund, Mona
The aim was to assess change in activities of daily living (ADL) ability amongst asylum seekers and if there were any difference between tortured and non-torture following a 10 months post-arrival period, and if self-reported health and exposure to torture were factors related to change in ADL-ab...
Hanganu-Bresch, Cristina; Berkenkotter, Carol
This essay has been conceptually eclectic in that we have integrated concepts from genre theory and discourse analysis. In our interpretation of Merivale and Marshall's narratives, we have also drawn upon Frye's Anatomy of criticism, a canonical text in literary genre theory. Such an eclectic approach seems warranted by both the contextual and textual features of Merivale's and Marshall's narratives, and in particular by Merivale's use of Mennipean satire with its encyclopedic detail. In our discussion of Merivale and Marshall's Admissions Records we have drawn on speech act theory to suggest that the Order (to admit a patient), the two medical certificates that follow, and finally, the notice to admit a patient constitute a constellation of texts, a genre suite, with a powerful illocutionary force. These texts are the prelude to and the means of confinement; they are both act and process. At the heart of our comparison of the asylum records of Merivale and Marshall with their "survivor narratives" is our analytic conclusion that the Ticehurst case histories can be said to constitute a linear "chronicle" of what Hayes Newington, the writer of the two case histories observed and inferred about his two patients. As chronicles, the Ticehurst Asylum case histories are linear representations or realistic accounts. As such, these archival documents provide a genuine insight into the "ways that that reality offers itself to perception". The institutional accounts exist in--and mark a--"flat time," equalized by each dated entry depicting the writer's mechanical act of observing/noting in brief, stereotypical sentences, e.g., "Patient is better [or, conversely, no] better today." We dubbed this metronomic time: beating regularly and evenly, flattening out the individual trajectories of each patient's illness. Metronomic time is normative. Each beat is calculated precisely to be the same as next. The dispassionate nature of clinical observations and the metronymic rhythms of
Roman, Leslie G.; Brown, Sheena; Noble, Steven; Wainer, Rafael; Young, Alannah Earl
This article asks: How have disability, indigenous arts and cultural praxis transformed and challenged the historical sociological archival research into relationships among asylum-making, medicalized colonialism and eugenics in the Woodlands School, formerly the Victoria Lunatic Asylum, the Provincial Asylum for the Insane in Victoria, BC 1859-72…
Malmqvist, Erik; Furberg, Elisabeth; Sandman, Lars
According to European regulations and the legislations of individual member states, children who seek asylum have a different set of rights than adults in a similar position. To protect these rights and ensure rule of law, migration authorities are commonly required to assess the age of asylum seekers who lack reliable documentation, including through various medical methods. However, many healthcare professionals and other commentators consider medical age assessment to be ethically problematic. This paper presents a simplified and amended account of the main findings of a recent ethical analysis of medical age assessment in the asylum process commissioned by the Swedish National Board of Health and Welfare. A number of ethical challenges related to conflicting goals, equality and fairness, autonomy and informed consent, privacy and integrity, and professional values and roles are identified and analysed. It is concluded that most of these challenges can be met, but that this requires a system where the assessment is sufficiently accurate and where adequate safeguards are in place. Two important ethical questions are found to warrant further analysis. The first is whether asylum seekers' consent to the procedure can be considered genuinely voluntary. The second is whether and how medical age assessments could affect negative public attitudes towards asylum seekers or discriminatory societal views more generally.
Cheney, Marshall K; Gowin, Mary J; Taylor, E Laurette; Frey, Melissa; Dunnington, Jamie; Alshuwaiyer, Ghadah; Huber, J Kathleen; Garcia, Mary Camero; Wray, Grady C
To explore preimmigration experiences of violence and postimmigration health status in male-to-female transgender individuals (n = 45) from Mexico applying for asylum in the United States. We used a document review process to examine asylum declarations and psychological evaluations of transgender Mexican asylum seekers in the United States from 2012. We coded documents in 2013 and 2014 using NVivo, a multidisciplinary team reviewed them, and then we analyzed them for themes. Mexican transgender asylum applicants experienced pervasive verbal, physical, and sexual abuse from multiple sources, including family, school, community, and police. Applicants also experienced discrimination in school and in the workplace. Applicants immigrated to the United States to escape persistent assaults and threats to their life. Applicants suffered health and psychological effects from their experiences in Mexico that affected opportunities in the United States for employment, education, and social inclusion. Additional social protections for transgender individuals and antidiscrimination measures in Mexican schools and workplaces are warranted as are increased mental health assessment and treatment, job training, and education services for asylum seekers in the United States.
Michaelis, Kai; Wenzel, Jürgen J; Stark, Klaus; Faber, Mirko
From September 2015 to March 2016, hepatitis A notifications in Germany increased by 45% to 699 cases compared to 482 cases in the same period of the previous year. Children aged five to nine years were predominantly affected (22% of all cases in this period). We hypothesized that this increase could be explained by the marked influx of asylum seekers in this time period. We analysed national surveillance data and estimated the number of imported and autochthonous hepatitis A cases in asylum seekers. We also investigated molecular signatures of hepatitis A viruses sampled from asylum seekers to identify chains of transmission. We found that 40% (278 cases) of all 699 hepatitis A cases notified between September 2015 and March 2016 in Germany concerned asylum seekers. Most infections were acquired abroad, but at least 24% accounted for autochthonous infections. Among asylum seekers, children aged five to nine years were overrepresented with 97 of 278 (35%) notified cases. The analysed hepatitis A virus sequences were primarily subgenotype IB strains and clustered with previously isolated samples from the Middle East, Turkey, Pakistan and East Africa. Except one transmission from an asymptomatic child to a nursery nurse working in a mass accommodation, we are not aware of infection chains involving asylum seekers and German residents. We conclude that asylum-seeking children and adolescents are susceptible to hepatitis A virus infections, particularly children aged five to nine years. Measures to prevent secondary infections in asylum seekers such as extended hygiene measures and post-exposure prophylaxis seem advisable.
Tenenbaum, Harriet R.; Ruck, Martin D.
This study examined British young people's understanding of the rights of asylum-seeking young people. Two hundred sixty participants (11-24 years) were read vignettes involving asylum-seeking young people's religious and nonreligious self-determination and nurturance rights. Religious rights were more likely to be endorsed than nonreligious…
This article contains data concerning the movement of extra-EU asylum seekers in Europe. Data used in this paper were collected from the Eurostat database and the UNHCR database. The data consist of some socio-economic features related to 30 European countries where extra-EU asylum seekers have applied for protection. All variables were transformed into their natural logs. The degree of statistical correlation is evaluated from Pearson׳s coefficient, using the 0.05 level of significance. Regression analysis is conducted to identify some socio-economic predictors of countries attracting asylum migration. Six models are presented, where 'first time asylum applicants' in 2015 (1,324,215 individuals) in 30 European countries were regressed on 2014 predictors. The multilinear regression model was tested by using data on asylum seekers in 2014, regressed on the same predictors referred to 2013. The data here shared provide a resource for researchers working in the topical field of migration.
Toikkanen, Salla E; Baillot, Armin; Dreesman, Johannes; Mertens, Elke
The number of asylum seekers arriving in Germany has increased rapidly since 2014 and cases of vaccine-preventable diseases at reception centres were reported. Asylum seekers 12 years and older arriving in Lower Saxony were serologically screened for antibodies against measles, rubella and varicella between November 2014 and October 2015. We calculated the seroprevalence from the screening data by disease, country of origin and age group and compared them to literature-based herd immunity thresholds in order to identify immunisation gaps. In total, 23,647 specimens were included in our study. Although the vast majority of asylum seekers tested positive for antibodies against measles, rubella and varicella, the seroprevalences were not sufficient to ensure herd immunity. The seroprevalences varied substantially between countries of origin and increased with age. Immunisation of asylum seekers against measles, rubella and varicella is needed and the detailed information on seroprevalences among subgroups of asylum seekers can be used for targeted immunisations at reception centres.
Full Text Available Based on the assumption that credibility assessments function as 'normative leakage' within the asylum process, we analyse how narratives of gender and class are articulated, rendered meaningful, or silenced in credibility assessments. Two cases concerning male applicants are selected in order to illustrate these processes. In relation to the existing concepts of internal/external credibility, we wish to introduce the concept of social credibility, which focuses on how the assessors read different socio-cultural narratives. While previous research has shown that the postcolonial will to protect women favours women as victims of patriarchal cultures, we wish to point out the continuity of this line of argumentation in relation to male and female applicants by adopting a theoretical generalization: male applicants instead become situated at the other end of the spectrum of postcolonial notions of modernity as non-victims, victims of other circumstances or perpetrators. We argue that these processes are accentuated in relation to credibility assessments. In order to prevent processes of social exclusion and to enhance inclusive practice, authorities need to acknowledge the 'normative leakage' associated with the assessment process.
Full Text Available Turkey itself has a line in one of the poet and poetry, which completed its maturation in this area is Attila Ilhan. the battle before him, our ideology and poetry together with İlhan urban structure organized by social changes associated with them and noticed its different returns. Even personally it has been involved in these changes and transformations. a phenomenon known as social realism and serious in the sense that the first mention of a unique structure and format began with İlhan can say. Urban people as the hero of the language revealed a partial half rebellious types. their whole life "can say that rowdy" behavior affects the entire text. Long life and different values, Ilhan manner in which they live period, Turkey has revealed a retrospective of his works.Poetry is one of the personal values of women. the pursuit of a woman image without actually wrote and lived. Characters typical feminist women from the traditional women formed until the time women entered the effort to witness the world. The different categories and will be quite comprehensive Attila Ilhan women will just try to look at the context of motherhood. Although the essential qualities of motherhood denominator, though the move permanent asylum women, fertility, lover, attitude, such as home-space has important referent are feminine values in poetry. Unknown women converted to the known values of Ilhan poetry. Motherhood seems to just this one known value structuring holdings.
Kurzthaler, Ilsemarie; Kemmler, Georg; Fleischhacker, W Wolfgang
Burnout is a syndrome characterized by emotional exhaustion, depersonalization and low personal accomplishment. The primary objective of this study was to investigate both the prevalence and severity of burnout symptoms in a sample of clinical physicians from different speciality disciplines. A total of 69 clinical physicians ≤55 years who are working at the Medical University/regional Hospital Innsbruck were included into a cross-sectional study. Next to the assessment of sociodemographic and work-related variables the Maslach Burnout Inventory (MBI) was used to investigate burnout symtoms. Overall, 8.8% of the study population showed high emotional exhaustion with high or moderate depersonalization and low personal accomplishment and therefore had a high risk to develop a burnout syndrom. 11.8% showed a moderade burnout risk. Neither sociodemographic variables nor the degree of educational qualification or speciality discipline had an influence on burnout symptoms. However, there was a positive correlation between scientific activity and personal accomplihment. Our results suggest that the dimension of burnout symtoms among clinical physicians in Austria has be taken seriously. Further research is needed to develop specific programs in terms of burnout prevention and burnout therapy.
Scotland's parochial asylums are unfamiliar institutional spaces. Representing the concrete manifestation of the collision between two spheres of legislation, the Poor Law and the Lunacy Law, six such asylums were constructed in the latter half of the nineteenth century. These sites expressed the enduring mandate of the Scottish Poor Law 1845 over the domain of 'madness'. They were institutions whose very existence was fashioned at the directive of the local arm of the Poor Law, the parochial board, and they constituted a continuing 'Scottish Poor Law of Lunacy'. Their origins and operation significantly subverted the intentions and objectives of the Lunacy Act 1857, the aim of which had been to institute a public district asylum network with nationwide coverage.
van der Velden, J
The article 'Mental and physical health problems of and the use of healthcare by Afghan, Iranian and Somali asylum seekers and refugees' in this issue shows, as expected, that the health status of all three groups is poorer than that of the Dutch population. Even worse is that the care offered is far from optimal. To interpret these results, it would be important to know who the asylum seekers and refugees are in comparison with their fellow countrymen in their countries of origin, to have a better understanding of the background of their health problems, and to view the care offered to these people critically. Since they are a very heterogeneous and relatively small group, it is not easy to organise appropriate care for asylum seekers and refugees. Although attempts are being made to improve the situation, Dutch society should invest more so as to provide the same quality of care to its guests as it provides for its own population.
Verdasco Martinez, Andrea
and for their everyday lives to belong to, or to be excluded from, ascribed asylum categories, while finding themselves in complex situations of uncertainty. Using ethnographic material gathered during the refugee crisis of 2015-2016, I show that the young refugees’ narratives point to contradictions......This article explores and unfolds the category of the ‘unaccompanied asylum-seeking minor’ in Denmark. By studying the notions that are embedded in the category, namely age and childhood, I analyse, through the narratives of the young refugees, what it means for both their sense of self...... in their understandings of the ‘self’, which are linked respectively to the notions of chronological age, upheld by the asylum system, and relational age operating within the context of their family relations. I further describe the changes that take place when a young refugee’s status changes from minor to adult...
Mary Anne Kenny
Full Text Available This article examines processes and challenges attendant upon an asylum seekers arriving by boat to Australia obtaining legal assistance for their claims. The authors set about explaining the experiences of asylum seekers in the ‘legacy caseload’ who have been waiting for around 4 years to have their protection claims assessed. The provision of legal assistance for this group will be essential to ensuring that the refugee status determination process is fair and allows asylum seekers to understand and participate more fully in the process. It describes the complex interplay between legal assistance to support refugee claims and the way those making claims inevitably struggle to understand, engage and participate in the process. Recent changes to the assessment of claims combined with a reduction in funding for legal assistance create significant hurdles and combine to compound existing stress and adversity.
Li, Susan S Y; Liddell, Belinda J; Nickerson, Angela
Refugees demonstrate high rates of post-traumatic stress disorder (PTSD) and other psychological disorders. The recent increase in forcible displacement internationally necessitates the understanding of factors associated with refugee mental health. While pre-migration trauma is recognized as a key predictor of mental health outcomes in refugees and asylum seekers, research has increasingly focused on the psychological effects of post-migration stressors in the settlement environment. This article reviews the research evidence linking post-migration factors and mental health outcomes in refugees and asylum seekers. Findings indicate that socioeconomic, social, and interpersonal factors, as well as factors relating to the asylum process and immigration policy affect the psychological functioning of refugees. Limitations of the existing literature and future directions for research are discussed, along with implications for treatment and policy.
Based on narratives of asylum-seekers from sub-Saharan Africa in northern Italy, in this article I analyze the narrative strategies used by immigrants to meet the eligibility criteria established by asylum law. For many of them, this means "arranging" biographical details within what I call "a moral economy of lying." The first question I discuss is what types of experience and 'subject positions' these narrative strategies reveal or generate. I then examine the arbitrariness and the bureaucratic violence of the asylum evaluation process, and the role of these procedures in the making of nation-language and current technologies of citizenship. Finally, I consider the politics of testification, recognition, and memory these discourses and practices combine to shape. I analyze these issues from an historical point of view of the politics of identity, truth, and falsehood as imposed in a recent past by colonizers onto the colonized.
Eiset, Andreas Halgreen; Wejse, Christian
An unprecedented rise in the number of asylum seekers and refugees was seen in Europe in 2015, and it seems that numbers are not going to be reduced considerably in 2016. Several studies have tried to estimate risk of infectious diseases associated with migration but only very rarely these studies...... make a distinction on reason for migration. In these studies, workers, students, and refugees who have moved to a foreign country are all taken to have the same disease epidemiology. A common disease epidemiology across very different migrant groups is unlikely, so in this review of infectious diseases...... in asylum seekers and refugees, we describe infectious disease prevalence in various types of migrants. We identified 51 studies eligible for inclusion. The highest infectious disease prevalence in refugee and asylum seeker populations have been reported for latent tuberculosis (9–45%), active tuberculosis...
Slobodin, Ortal; de Jong, Joop T V M
The prevalence of trauma-related problems among refugees and asylum seekers is extremely high due to adverse experiences associated with forced migration. Although the literature presents a considerable number of guidelines and theoretical frameworks for working with traumatized refugees and asylum seekers, the efficacy, feasibility and applicability of these interventions have little empirical evidence. The purpose of this article is to critically review the literature to provide a rationale for developing culturally sensitive, evidence-based interventions for refugees and asylum seekers. A literature review integrating research findings on interventions designed especially for traumatized asylum seekers and refugees was conducted. Retained studies had to use some quantitative measurements of post-traumatic stress and to have pre- and post-measurements to evaluate the efficacy of the intervention. Studies included in this review cover a wide variety of interventions, including trauma-focused interventions, group therapy, multidisciplinary interventions and pharmacological treatments. The majority of studies with traumatized refugees and asylum seekers reported positive outcomes of the intervention in reducing trauma-related symptoms. There is evidence to support the suitability of cognitive-behavioral therapy (CBT) and narrative exposure therapy (NET) in certain populations of refugees. Other intervention studies are limited by methodological considerations, such as lack of randomization, absence of control group and small samples. This review has again highlighted the shortage of guiding frameworks available to investigators and clinicians who are interested in tailoring interventions to work with refugees and asylum seekers. Theoretical, ethical and methodological considerations for future research are discussed. © The Author(s) 2014.
In 1802, the director of the Berlin Royal Deaf-Mute Asylum, Ernst Adolph Eschke, performed an experiment to investigate the possibility of curing deafness by means of galvanism. This article explores the hope for a cure for deafness that was connected to the voltaic pile, and concludes that the treatment was based on insufficient knowledge of the aetiology of deafness. Furthermore, it uncovers the competition between the medical and the pedagogic approach to deafness that resulted from the purported cure. Comparing the approaches of different directors of galvanic experiments, divergences in attitudes between the medical and pedagogic realms are revealed. This is explained with reference to the contrasting motives and experiences of educational and medical professionals: the former had reasons to resist a cure to protect their profession, whereas the latter hoped for a medical breakthrough. Since the former had personal and long-lasting relationships to deaf people, while the latter only had brief encounters with deaf patients, the physicians were also more prone to objectify their trial subjects. The report from Eschke's trials is presented as an early document of deaf reactions to attempts to restore their hearing, showing that resistance to medical interventions were prevalent among the deaf already in the early nineteenth century.
In 1885, Holloway Sanatorium, an asylum for the 'mentally afflicted of the middle classes' opened in Egham, Surrey, 20 miles outside London. Until 1910, photographs of about a third of the patients--both those 'Certified Lunatic by Inquisition' and the 'Voluntary Boarders' who admitted themselves--were pasted into the asylum's case books. This paper analyses the photographs that were included in the very first of these, when there was a great uncertainty as to how to represent these patients, or whether to represent them at all. The photographs are unlike any other institutional images of the period, and raise critical questions about the imagined incompatibility between documentary photography and personal agency.
Since the mid 1990s third sector professionals and organisations have come under increasing pressure to help enforce restrictive and punitive policies toward refugees and asylum seekers. This paper presents one response, using an empirical case study to develop a new ‘Independent Anti-Racist Model’ for asylum rights organising. This uses data from a three-year study comparing four organisations in a major city in England. The study data is combined with reflections on the author’s own experie...
Finland received 32.500 asylum seekers in 2015. That is the 4th highest number in Europe per 100.000 inhabitants. 3000 (9%) of all the asylum seekers in Finland were Unaccompanied Minors, i.e children under 18 years of age who arrived without parents or guardians. In addition to them, this review also included children who arrived accompanied with parents or guardians. Most children have arrived to Finland from Afghanistan, Iraq and Somalia, countries with ongoing conflicts and war. Experienc...
This paper uses the unique collection of Scottish outsider art, labelled Art Extraordinary, as a window into the often neglected small spaces of asylum care in the early twentieth century. By drawing upon materials from the Art Extraordinary collection and its associated archives, this paper demonstrates the importance of incorporating small and everyday spaces of care - such as gardens, paths, studios and boats - into the broader historical narratives of psychiatric care in Scotland. Examples of experiential memorialization and counterpoints to asylum surveillance culture will be illuminated. The significance of using 'outsider' art collections as a valuable source in tracing geographical histories will be highlighted.
Schmuel, E; Schenker, J G
Violence against women is one reflection of the unequal power relationship between men and women in societies. Reflections of this inequality include marriage at a very young age, lack of information or choice about fertility control and forced pregnancy within marriage. The different forms of violence against women are: domestic violence and rape, genital mutilation or, gender-based violence by police and security forces, gender-based violence against women during armed conflict, gender-based violence against women refugees and asylum-seekers, violence associated with prostitution and pornography, violence in the workplace, including sexual harassment. Violence against women is condemned, whether it occurs in a societal setting or a domestic setting. It is not a private or family matter. The FIGO Committee for the Study of Ethical Aspects of Human Reproduction released statements to physicians treating women on this issue. Physicians are ethically obliged to inform themselves about the manifestations of violence and recognize cases, to treat the physical and psychological results of violence, to affirm to their patients that violent acts toward them are not acceptable and to advocate for social infrastructures to provide women the choice of seeking secure refuge and ongoing counselling.
The medical literature contains numerous articles dealing with Sherlock Holmes and his companion Dr. Watson. Some of the articles are concerned with the medical and scientific aspects of his cases. Other articles adopt a more philosophical view: They compare the methods of the master detective with those of the physician--the ideal clinician should be as astute in his profession as the detective must be in his. It this article the author briefly reviews the abilities of Sherlock Holmes as an amateur physician. Often Holmes was brilliant, but sometimes he made serious mistakes. In one of his cases (The Adventure of the Lion's Mane) he misinterpreted common medical signs.
Carta, Mauro Giovanni; Moro, Maria Francesca; Preti, Antonio; Lindert, Jutta; Bhugra, Dinesh; Angermeyer, Mattias; Vellante, Marcello
The migrants crossing the Mediterranean towards Europe have dramatically been increased in 2015 as the number of incidents and deaths. This editorial summarizes the results of our work and highlights some critical aspects that hinder the care to asylum seekers with stress disorders. Screening for mental disorders was performed in all migrants joint three camps in Sardinia (January-September 2015) using K6, Short Screening Scale for Post Traumatic Stress Disorder (PTSD) and with an interview. Positives were evaluated by psychiatrists and if they needed, have been treated and evaluated at the start of treatment and three months later. 22.1% of the sample, (22.6% female, 38.5±12.9 years) were positive for at least one screener; 8.7%, (24% female) had a diagnosis of depressive or bipolar DSM5 disorders and 7.6%, (25% female) of PTSD. After three months of treatment: 51 treated people (26.8%) had left the camps. 53.1% of those remaining declared had relatives in northern Europe that they wanted to reach. Only 8.3% showed a significant clinical improvement. Clinical improvement was dramatically poor in people who stay in the camps. Dissatisfaction and feeling they could not join relatives may have had a negative impact. In PTSD, with the experience of torture and seeing family members killed, staying with surviving relatives in stable conditions would be an important part of treatment. From this point of view the UE Dublin Regulation seems not to be in agreement with the UN Convention on the rights of persons with disabilities.
This article analyses the relationship between time and subjectification, focusing on the temporal structures created within Danish asylum centres and politics, and on children's experiences of and reactions to open-ended waiting. Such waiting leads to existential boredom which manifests in the children as restlessness, fatigue and despair. The…
The present article analyzes a campaign by the Mexican government, among the public and the medical profession, to disseminate a health care reform that culminated with the opening of thirteen Farms for the mentally ill and the ideological abolition of the insane asylum in the sixties of the twentieth century. To do this, renowned psychiatrists who held public positions built a black legend over the most emblematic insane asylum of the country, pointing out as the main cause of failure the constraint to which patients were subjected. In doing so, they resembled the mental hospital to a prison and the insane to a social threat, because they reduced that institution's function and denied the many experiences that would ?t in it: a place of confinement and refuge, a therapeutic and knowledge production space. Even though Mexican psychiatry was professionalized in the space of the asylum, the State wanted to erase the memory of that past to suggest the establishment of a new era in mental health, where the patients would no longer be subject to any restrictions which could curtail their freedom. Overcoming the asylum model meant creating "open door" therapeutic alternatives, but the decision was to distort the past to exalt the future.
Velden, J. van der
The article 'Mental and physical health problems of and the use of healthcare by Afghan, Iranian and Somali asylum seekers and refugees' in this issue shows, as expected, that the health status of all three groups is poorer than that of the Dutch population. Even worse is that the care offered is
Loenhout-Rooyackers, J.H. van; Sebek, M.M.; Verbeek, A.L.M.
BACKGROUND: The diagnosis of tuberculosis in asylum seekers is followed by contact tracing, which is routinely performed by the Municipal Health Service (MHS). We investigated cases of tuberculosis whose symptoms became apparent after closure of regular contact tracing. METHODS: Analysis of data
..., application processing, and workflow management are carried out for all credible fear and reasonable fear... analyzing and managing program workflows and provides the Asylum Program with statistical reports to assist... (APSS). RAPS is a comprehensive case management tool that enables USCIS to handle and process...
Asylum seekers in South Africa experience extreme difficulties lodging their claims at the Department of Home Affairs. This paper utilizes new survey data to measure the extent of the Department’s failures to provide access to the status determination process. The principal finding is that South
Filges, Trine; Montgomery, Edith; Kastrup, Marianne
, and/or ensure that a deportation order is carried out. A number of clinicians have expressed concern that detention increases mental health difficulties in asylum seekers, who is already a highly traumatized population, and have called for an end to such practices. This is clearly in conflict...
Lisa K. Hartley
Full Text Available While most of the world's refugees reside in developing countries, their arrival to western countries is highly politicised, giving rise to questions about the types of entitlements and rights that should, or should not, be granted. In this study, using a mixed-methods community questionnaire (N = 185, we examined attitudes towards social policies aimed at providing assistance to two categories of new arrivals to Australia: resettled refugees (who arrive via its official refugee resettlement program and asylum seekers (who arrive via boat and then seek refugee status. Social policy attitude was examined as a consequence of feelings of anger, fear, and threat, as well as levels of prejudice. Participants felt significantly higher levels of anger, fear, threat, and prejudice towards asylum seekers compared to resettled refugees. For both resettled refugees and asylum seekers, prejudice was an independent predictor of more restrictive social policy attitudes. For resettled refugees, fear and perceived threat were independent predictors for more restrictive social policy whereas for asylum seekers anger was an independent predictor of restrictive social policy. The qualitative data reinforced the quantitative findings and extended understanding on the appraisals that underpin negative attitudes and emotional responses. Practical implications relating to challenging community attitudes are discussed.
Wiseman, Martin; O'Gorman, Shannon
This article describes one school's response to the inclusion and education of refugee and asylum seeker students within a mainstream educational setting. Australian government statistics released on 31 March 2016 stated that there were presently 50 children being held on Nauru, 17 children held in detention on the mainland and 317 children held…
Devillé, W.; Goosen, S.
Reception and integration of asylum seekers and refugees are high on the political agenda in most European countries. Reception conditions, including the provision of health care, differ considerably between countries. The European Commission tries to harmonise the reception standards in the
Ravensbergen, Sofanne J.; Berends, Matthijs; Stienstra, Ymkje; Ott, Alewijn
Migration is one of the risk factors for the spread of multidrug-resistant organisms (MDRO). The increasing influx of migrants challenges local health care systems. To provide evidence for both hospital hygiene measure and empirical antibiotic therapy, we analysed all cultures performed in asylum
Full Text Available Over the past decade, UK courts and administrative tribunals havebecome increasingly comfortable relying on international human rightstreaties in cases where non-citizens claim asylum or other means ofprotection from persecution. However, this trend does not mean thatthese treaties have always been deployed by refugee lawyers in wayswhich benefit their clients.
Doherty, S M; Craig, R; Gardani, M; McMillan, T M
Individuals who seek asylum are frequently fleeing violent persecution and may experience head injury (HI). However, little is known about the prevalence of HI in asylum seekers and refugees (ASR) despite the potential for HI to significantly affect cognitive and emotional functioning and to compromise asylum outcomes. This preliminary study investigates the prevalence of HI in ASR referred to a complex psychological trauma service. Participants were 115 adult ASR referred to a community psychological trauma service with moderate to severe mental health problems associated with psychological trauma. They were screened for a history of HI using a questionnaire developed for the study. Interpreters were used when required. The overall prevalence of HI was 51%. At least 38% of those with HI had a moderate-severe HI that could cause persisting disability. In 53% of those with HI, the cause was torture, human trafficking or domestic violence. Repeat HI can have cumulative effects on function; it was common, and was reported in 68% of those with HI. An injury to the head was not known to mental health clinicians prior to screening in 64% of cases. The emotional and cognitive consequences of HI in ASR may increase the vulnerability of this disadvantaged group, and can be associated with neurobehavioural problems affecting daily life and may compromise asylum outcomes. Routine screening for HI in ASR is needed, as are links to neuropsychology and brain injury services for advice, assessment and intervention.
Bozorgmehr, Kayvan; Wahedi, Katharina; Noest, Stefan; Szecsenyi, Joachim; Razum, Oliver
Screening asylum seekers for infectious diseases is widely performed, but economic evaluations of such are scarce. We performed a policy analysis and economic evaluation of such screening in Germany, and analysed the effect of screening policies on cost differences between federal states. Of the 16 states, screening was compulsory for tuberculosis (TB) in asylum seekers ≥ 16 years of age in all states as well as in children < 16 years of age and pregnant women in six states, hepatitis B and enteropathogens in three, syphilis in two and human immunodeficiency virus (HIV) in one state. Of 441,899 asylum seekers, 88.0% were screened for TB, 22.9% for enteropathogens, 16.9% for hepatitis B, 13.1% for syphilis and 11.3% for HIV. The total costs for compulsory screening in 2015 were 10.3 million euros (EUR). Costs per case were highest for infections with Shigella spp. (80,200 EUR), Salmonella spp. (8,000 EUR), TB in those ≥ 16 years of age (5,300 EUR) and syphilis (1,150 EUR). States with extended screening had per capita costs 2.84 times those of states that exclusively screened for TB in asylum seekers ≥ 16 years of age (p < 0.0001, 95% confidence interval (CI): 1.96-4.10). Screening practices in Germany entailed high costs; evidence-based approaches to infectious disease screening are needed.
This paper analyses the contribution of student agency and teacher contingency in the construction of classroom discourse in adult English for speakers of other languages (ESOL) classes for refugees and asylum seekers, for whom the identity of student itself can constitute a stable point in a highly unstable and potentially threatening lifeworld.…
Seeberg, Marie Louise; Bagge, Cecilie; Enger, Truls Andre
Drawing on empirical material from fieldwork among young children living with their families in two Norwegian reception centres for asylum-seekers, this article compares their realities to the norms and realities for other children in Norway. Children's spatial and social situations within the centres stand out in stark contrast to Norwegian…
Community-based performance often facilitates participation through story-based processes and in this way could be seen as enacting a form of inclusive democracy. This paper examines a playback theater performance with a refugee and asylum seeker audience and questions whether inclusive, democratic participation can be fostered. It presents a…
Full Text Available While the democratic paradigm of governance and its constituent political processes are well established in Australia, consistently negative media representations of people seeking asylum may be viewed as justification for institutional decisions allowing continued punitive treatment of people seeking asylum on Australian shores. Historically, notions of Australian sovereignty exist as a changing discourse with reference to land claims and the Australian Indigenous population (O’Dowd 2011; Due 2008. However, in terms of contemporary political claims about Australia’s need to enforce border protection policies, notions of sovereignty are consistently framed through the themes, images and language of military discourses. Media scholar, John Street suggests that although there is disagreement about whether specific political outcomes can be attributed to press influence, the role of television in politics has been more comprehensively established as shaping broader world views in regards to ideas, values and practices that are considered ‘common-sense’ (Street 2011; Craig 2013. This paper argues that the increasing role of the military in the treatment and processing of people seeking asylum may be justified, through repetitive negative media representations of asylum seekers which secures public support for such practices, thereby undermining the very principles of the democratic paradigm, and indeed the role of the media or ‘fourth estate’(Schultz 1998 in a functioning democracy.
Watts, Michael F.
This paper explores the changing attitudes of a group of young adults towards asylum seekers in the UK. Based on the experience of sixth form students attending a workshop hosted by a former refugee from Pinochet's Chile, it argues for the importance of personal stories and their wider contexts and suggests that each is necessary to enable…
Full Text Available Public and political claims about the employment of people from a refugee background in Australia do not always reflect the research findings in this area. For example, recent claims by a senior Coalition Government Minister about people seeking asylum who arrived to Australia by boat during the previous Labor Government’s terms in office (2007-13 posit that many have limited employment prospects. However, given there is little research or government reporting on the experiences of asylum seekers who arrived during this time, and none that focuses specifically on their employment, there is no evidence to support this. A review of research on the employment experiences of people from a refugee background, and Australian policies, suggests a more nuanced picture. This includes research that found while initially people from a refugee background are more likely to be unemployed, have temporary jobs and lower incomes than other newly arrived immigrants, second-generation refugees have higher levels of labour market participation than the general population. Research also highlights that refugees may experience a range of barriers to accessing employment, including discrimination, and a review of Australian policies indicates these are likely to have exacerbated some of these barriers for asylum seekers who arrived to Australia by boat. In addition, given previous findings that public attitudes can be influenced by representations made in public and political discourses, the public statements of senior Ministers may be further deepening barriers to accessing employment faced by asylum seekers who arrived by boat.
Slobodin, O.; de Jong, J.T.V.M.
Background: The prevalence of trauma-related problems among refugees and asylum seekers is extremely high due to adverse experiences associated with forced migration. Although the literature presents a considerable number of guidelines and theoretical frameworks for working with traumatized refugees
Reijneveld, S.A.; Boer, J.B.de; Bean, T.; Korfker, D.G.
We assessed the effects of a stringent reception policy on the mental health of unaccompanied adolescent asylum seekers by comparing the mental health of adolescents in a restricted campus reception setting and in a setting offering more autonomy (numbers [response rates]: 69 [93%] and 53 [69%],
Theories of language policy increasingly emphasise focusing on the specific contexts in which language management occurs. In government settings, policy seeks to shape how individuals interact with officials. Australian asylum procedure is an area where policy aims at tight control. I examine how communication is managed in this setting, in which…
The advent of democracy in the country has not only seen the liberation of the oppressed South African society, but it has also turned South Africa into a safe haven for displaced people of the world to seek asylum or refugee status. South Africa currently faces signifi cant migration-related challenges which need to be ...
This is the first study undertaken in the UK that investigates the notion of professional identity among practitioners who work with asylum seekers and refugees. Drawing on a social constructionist epistemology and a Foucauldian theoretical and methodological framework of power and discourse, I analysed extracts from semi-structured interviews…
Each year the Dutch authorities categorize scores of people as being “out of procedure” (uitgeprocedeerd). Th ese are mostly “failed asylum seekers” who have exhausted all legal appeals in search of regularizing their status in the Netherlands. Out-of-procedure subjects, or OOPSs, have no formal
This study appraises the particular challenges that minor asylum-seeking migrants who are in the 16-18 age category confront when pursuing their studies in a vocational college in Malta, a central Mediterranean island which is the smallest EU member state. The study explores how they exercise resilience in their desire to forge a future for…
... further notes that DOS' cultural and country condition information may safeguard against immigration... Immigration Review 8 CFR Parts 1208 and 1240 RIN 1125-AA65 Forwarding of Asylum Applications to the Department of State AGENCY: Executive Office for Immigration Review, Department of Justice. ACTION: Final rule...
ter Heide, F.J.J.; Mooren, T.M.; Kleyn, W.; de Jongh, A.; Kleber, R.J.
Background: Traumatised asylum seekers and refugees are clinically considered a complex population. Discussion exists on whether with this population treatment guidelines for post-traumatic stress disorder (PTSD) should be followed and Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT) or Eye
López-Bech, Laura; Zúñiga, Rodolfo
As new stories from asylum seekers and refugees permeate the reality of European societies today, a whole new set of challenges and opportunities arise for building a common sense of belonging. Spaces for intercultural dialogue become crucial in connecting us all in a way that allows us to discover "the other" through our own process of…
... the economic, environmental, or federalism effects that might result from this rule. Comments that... the resources to review many of the asylum applications forwarded to it. DOS has determined that the... additional resources, either in the training or hiring of personnel at EOIR or DOS or in the expenditure of...
van Veldhuizen, T.S.; Horselenberg, R.; Landström, S.; Granhag, P.A.; van Koppen, P.J.
The aim of the current vignette study is to map the style, type, and themes of questions that are asked when assessing the credibility of asylum seekers' claims. Sixty-five officials from the Swedish Migration Agency (Migrationsverket), were asked to respond to one out of four different vignettes
In institutional settings of globalization, labelled languages are generally preferred over multilingual repertoires and mobile language resources. Drawing on linguistic-ethnographic analysis of the way English is treated as an invariable "ad hoc" idiom in the Belgian asylum interview, this article demonstrates how institutional measures…
the study draws upon Foucauldian concepts like disciplinary power, confession, pastoral power and subjectivation. I will argue that the critique of the patient provides us with an example of the way that disciplinary power works in the case of an informal indictment of the methods and practice at an asylum...
Keygnaert, I.; Dias, S.F.; Degomme, O.; Devillé, W.; Kennedy, P.; Kovats, A.; Meyer, S. de; Vettenburg, N.; Roelens, K.; Temmerman, M.
Background: Refugees, asylum seekers and undocumented migrants are at risk of sexual and gender-based violence (SGBV) and subsequent ill-health in Europe; yet, European minimum reception standards do not address SGBV. Hence, this paper explores the nature of SGBV occurring in this sector and
Keygnaert, I.; Dias, S.F.; Degomme, O.; Devillé, W.; Kennedy, P.; Kováts, A.; De Meyer, S.; Vettenburg, N.; Roelens, K.; Temmerman, M.
Background: Refugees, asylum seekers and undocumented migrants are at risk of sexual and gender-based violence (SGBV) and subsequent ill-health in Europe; yet, European minimum reception standards do not address SGBV. Hence, this paper explores the nature of SGBV occurring in this sector and
Keygnaert, Ines; Dias, Sonia F.; Degomme, Olivier; Devillé, Walter|info:eu-repo/dai/nl/217201490; Kennedy, Patricia; Kováts, András; De Meyer, Sara; Vettenburg, Nicole; Roelens, Kristien; Temmerman, Marleen
Background: Refugees, asylum seekers and undocumented migrants are at risk of sexual and gender-based violence (SGBV) and subsequent ill-health in Europe; yet, European minimum reception standards do not address SGBV. Hence, this paper explores the nature of SGBV occurring in this sector and
... such a refugee or to have been physically present in the United States for at least one year after...) or (a)(3) of this section, the status of any alien who has been granted asylum in the United States...) Applies for such adjustment; (ii) Has been physically present in the United States for at least one year...
... of any alien who has been granted asylum in the United States may be adjusted by USCIS to that of an...; (ii) Has been physically present in the United States for at least one year after having been granted... admissible to the United States as an immigrant under the Act at the time of examination for adjustment...
Kos, S.; Maussen, M.; Doomernik, J.
There is a major gap in Dutch refugee and immigration control policies between its ambitions and outcomes. It results in considerable numbers of rejected asylum seekers who, while they cannot be expelled from the country, are excluded from government support and from opportunities to work in the
Gorp, B. van
In this article an empirically oriented conceptualization of frames is developed, using the issue of asylum and illegal immigration in the Belgian press as a test case. The methodological focus of this study is on the question of how these frames can be detected in the coverage. How can they be
Ruth L. HEALEY
Full Text Available Previous work suggests that female asylum seekers and refugees have more constraints on their actions than their male counterparts, as structural forces from the country of origin are reproduced in the host country. This paper explores the use of structuration theory in interpreting the impact of gender upon asylum seeker and refugee experiences in the UK. The experiences of, and coping strategies used by 8 male and 10 female asylum seekers and refugees from two different cities are analysed. Their experiences are examined in relation to different patriarchal forces. In comparison to the males, differences are apparent in the level and types of agency of the female asylum seekers and refugees. Within this study certain types of patriarchy are reproduced in British society particularly at the household level, whilst individuals are also influenced by institutional patriarchy within the wider society. The variation in experiences found here suggests the need for policy to recognise the heterogeneity of these groups, so as to provide the most appropriate support for individuals.
Full Text Available Abstract Background Adult refugees and asylum seekers living in Western countries experience a high prevalence of mental health problems, especially post traumatic stress disorder (PTSD, depression and anxiety. This study compares and contrasts the prevalence of health problems, and potential risk factors as well as the utilisation of health services by asylum seekers and refugees in the Irish context. Methods Cross sectional study using validated self reported health status questionnaires of adult asylum seekers (n = 60 and refugees (n = 28 from 30 countries, living in Ireland. Outcome measures included: general health status (SF-36, presence of PTSD symptoms and anxiety/depression symptoms. Data on chronic conditions and pre or post migration stressors are also reported. The two groups are compared for utilisation of the health care system and the use of over the counter medications. Results Asylum seekers were significantly more likely than refugees to report symptoms of PTSD (OR 6.3, 95% CI: 2.2–17.9 and depression/anxiety (OR 5.8, 95% CI: 2.2–15.4, while no significant difference was found in self-reported general health. When adjusted by multivariable regression, the presence of more than one chronic disease (OR 4.0, 95%CI: 1.3–12.7; OR 3.4, 95% CI: 1.2–10.1, high levels of pre migration stressors (OR 3.6, 95% CI: 1.1–11.9; OR 3.3, 95% CI: 1.0–10.4 or post migration stressors (OR 17.3, 95% CI: 4.9–60.8; OR 3.9, 95% CI: 1.2–12.3 were independent predictors of self reported PTSD or depression/anxiety symptoms respectively, however, residence status was no longer significantly associated with PTSD or depression/anxiety. Residence status may act as a marker for other explanatory variables; our results show it has a strong relationship with post migration stressors (χ2 = 19.74, df = 1, P In terms of health care utilisation, asylum seekers use GP services more often than refugees, while no significant difference was found
BACKGROUND: Adult refugees and asylum seekers living in Western countries experience a high prevalence of mental health problems, especially post traumatic stress disorder (PTSD), depression and anxiety. This study compares and contrasts the prevalence of health problems, and potential risk factors as well as the utilisation of health services by asylum seekers and refugees in the Irish context. METHODS: Cross sectional study using validated self reported health status questionnaires of adult asylum seekers (n = 60) and refugees (n = 28) from 30 countries, living in Ireland. Outcome measures included: general health status (SF-36), presence of PTSD symptoms and anxiety\\/depression symptoms. Data on chronic conditions and pre or post migration stressors are also reported. The two groups are compared for utilisation of the health care system and the use of over the counter medications. RESULTS: Asylum seekers were significantly more likely than refugees to report symptoms of PTSD (OR 6.3, 95% CI: 2.2-17.9) and depression\\/anxiety (OR 5.8, 95% CI: 2.2-15.4), while no significant difference was found in self-reported general health. When adjusted by multivariable regression, the presence of more than one chronic disease (OR 4.0, 95%CI: 1.3-12.7; OR 3.4, 95% CI: 1.2-10.1), high levels of pre migration stressors (OR 3.6, 95% CI: 1.1-11.9; OR 3.3, 95% CI: 1.0-10.4) or post migration stressors (OR 17.3, 95% CI: 4.9-60.8; OR 3.9, 95% CI: 1.2-12.3) were independent predictors of self reported PTSD or depression\\/anxiety symptoms respectively, however, residence status was no longer significantly associated with PTSD or depression\\/anxiety. Residence status may act as a marker for other explanatory variables; our results show it has a strong relationship with post migration stressors (chi2 = 19.74, df = 1, P < 0.001).In terms of health care utilisation, asylum seekers use GP services more often than refugees, while no significant difference was found between these groups
Meeting the health and social care needs of pregnant asylum seekers; midwifery students' perspectives: part 3; "the pregnant woman within the global context"; an inclusive model for midwifery education to address the needs of asylum seeking women in the UK.
Haith-Cooper, Melanie; Bradshaw, Gwendolen
to describe the conceptualisation and development of an inclusive educational model. The model is designed to facilitate pre-registration midwifery students' learning around the health and social care needs of pregnant women seeking asylum in the United Kingdom. current literature has identified a concern about the standard of maternity care experienced by asylum seeking women accessing maternity services in the United Kingdom. In response to this, a doctorate study was undertaken which focused on examining the way in which a group of midwifery students approached the provision of care for asylum seekers. This study revealed difficulties that these students had both in identifying these women's needs and also in the wider care issues in practice. Consequently, one of the recommendations was to ameliorate these difficulties through midwifery education. the key findings from this study were used together with relevant supporting literature to construct "the pregnant woman within the global context" model for midwifery education. The model is designed to facilitate a holistic assessment of need rather than focusing on the physical assessment at the expense of other aspects of care. It incorporates wider factors, on a global level, which could impact on the health and social care needs of a pregnant woman seeking asylum. It also prompts students to consider the influence of dominant discourses on perceptions of asylum seek;ing and is designed to encourage students' to question these discourses. this model can be used in midwifery education to prepare students in caring for pregnant women seeking asylum. It may be especially helpful when students have close contact with pregnant women seeking asylum, for example through caseloading. Further research is recommended to evaluate the effectiveness of this model in enhancing the care of asylum seeking women in the United Kingdom. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.
Pfortmueller, Carmen Andrea; Schwetlick, Miriam; Mueller, Thomas; Lehmann, Beat; Exadaktylos, Aristomenis Konstantinos
.... Our retrospective data analysis comprised adult patients presenting to our emergency department between 01.11.2011 and 30.06.2014 with the official resident status of an "asylum seeker" or "refugee" from the Middle East...
Full Text Available The article questions the binomial that associates the chronicity and incurability of mental illness with the custodialism of the asylum through a case study, Asylum La Castañeda in Mexico, from 1910 to 1968. We contrast the discourses about the cure and chronicity constructed by Mexican psychiatrists and the statistical trends of patients admitted: new admissions, readmissions, discharges, length of stay, and diagnoses in the light of new treatments. We concluded that according to the doctors, the asylum therapeutic function was severely affected by chronicity and overpopulation, but according to statistics, 80% of the patients had only one admission with a 15-month hospitalization and the long-term confinement rates of readmissions did not impact statistically; two-thirds of the patients left the asylum, and since the 1950s in the context of new therapeutics.
Silvia Lucía Forero Castañeda
Full Text Available This article examines how the recent evolution of asylum migration has affected the construction of the European Common Foreign and Security Policy (EU-CFSP, taking the Greek case during the 2001-2012 period as a starting point. With this in mind, the normative progress of the EU-CFSP facing the reception of asylum seekers in Greece is analyzed, under the scope of what Barry Buzan and Ole Waever would call Securitization Process. Both legal and political frameworks on asylum migration in Greece and in the European Union are approached, in the context of the evolution of the EU-CFSP in three main areas: Neighborhood Policy, Development and Cooperation Policy, and Human Rights Protection. The conclusión points toward the partial influence of asylum migration in the configuration of the UE-CFSP during the studied period.
Goranka Lalić Novak
Full Text Available The European Union and other countries on the Balkan route for migrants have recorded a large increase in the number of asylum seekers. In parallel with the increased number of refugees trying to enter the territory of the EU, measures for migration management have tightened, and the right to asylum at the level of the Member States has been interpreted more and more restrictive. Search for protection from persecution has become a reason for closing borders and disabling access to territory and asylum system. However, access to asylum system is the first step in the realization of the right to asylum as guaranteed by international, European and national law. In addition to allowing access to territory and asylum system, which implies an obligation of states to accept refugees in order to confirm the need for international protection in a fair and efficient procedure, the states are obliged to respect the principle of non-refoulement. The aim of this paper is to clarify the connection between providing access to asylum system and respect for the principle of non-refoulement. Analysis in the paper was done by legal-dogmatic method of research and interpretation of legal acts and other authorities, as well as of UNHCR relevant recommendations and documents. The assumption is that without the provision of access to territory and asylum system the principle of non-refoulement cannot be respected. Apart from the international refugee law and doctrinal interpretations, it derives from the practice of the European Court of Human Rights regarding the prohibition of torture or other inhuman treatment or punishment guaranteed by the Convention for the Protection of Human Rights and Fundamental Freedoms. The conclusion is that the states must take into account international and European standards regarding the protection of the principle of non-refoulement when considering the introduction of new measures to manage migration movements.
Bozorgmehr, Kayvan; Razum, Oliver; Szecsenyi, Joachim; Maier, Werner; Stock, Christian
Newly arriving asylum seekers in many European Union countries are assigned a place of residence based on administrative quota. This may have important consequences for the exposure to contextual health risks. We assessed the association between regional deprivation and the distribution of asylum seekers in Germany considered as vulnerable (women, children 64 years) because of their increased health needs. Using nationally representative data, we analysed the rates of observed to expected numbers of asylum seekers and vulnerable subgroups in Bayesian spatial models. Regional deprivation was measured by the German Index of Multiple Deprivation. The analyses were performed at the district level (N=402) and adjusted for district population size, effects of federal states as well as spatial effects. Of the 224 993 asylum seekers, 38.7% were women, 13.8% children aged 64 years. The adjusted number of asylum seekers (totals and vulnerable subgroups) was higher in more deprived districts (Q3, Q4 and Q5) relative to districts in the lowest deprivation quintile (Q1). The adjusted rate ratios for districts with highest relative to those with lowest deprivation were 1.26 (1.03-1.53) for women, 1.28 (1.04-1.58) for children aged <7 years and 1.50 (1.08-2.08) for older asylum seekers. The adjusted number of vulnerable asylum seekers was higher in districts with medium and highest deprivation compared with districts with lowest deprivation. The disproportionate distribution was highest for older asylum seekers and children <7 years. Vulnerable subgroups tend to be exposed to more deprived places of residence, which may further increase health risks and healthcare needs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Thommessen, S.; Corcoran, P.; Todd, B
Unaccompanied refugee minors are particularly vulnerable to stress and risk during the journey to asylum-countries and in the post-migration environment. This study aimed to determine ways in which positive post-migration development and integration could be achieved for this group. Thematic analysis of interviews based on Personal Construct assessments reflected young asylum-seeking and refugee individuals' experiences of their social situation in England. Participants emphasised the importa...
Nickerson, J B
"From the creation of the Comprehensive Plan of Action (CPA) in 1989 through December 1994, about sixty-eight thousand asylum seekers have voluntarily repatriated to Vietnam. In response to this reverse migration, the international community has funded numerous reintegration assistance programs to facilitate the asylum seekers' return. This article examines reintegration assistance programs currently operating in Vietnam and presents an argument that small scale income generation projects constitute the most effective and efficient use of scarce repatriation funding." excerpt
The article questions the binomial that associates the chronicity and incurability of mental illness with the custodialism of the asylum through a case study, Asylum La Castañeda in Mexico, from 1910 to 1968. We contrast the discourses about the cure and chronicity constructed by Mexican psychiatrists and the statistical trends of patients admitted: new admissions, readmissions, discharges, length of stay, and diagnoses in the light of new treatments. We concluded that according to the doctor...
Gerritsen, Annette A M; Bramsen, Inge; Devillé, Walter; van Willigen, Loes H M; Hovens, Johannes E; van der Ploeg, Henk M
Although asylum seekers have been coming to The Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants, or on the refugees who have resettled in this country. The objective of this study is to estimate the use of health care services by refugees and asylum seekers and to identify determinants for this utilisation. A population-based study was conducted in The Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran, and Somalia. A total of 178 refugees and 232 asylum seekers, living in 3 municipalities and 14 reception centres, participated. This study showed that there are no differences between refugees and asylum seekers in the self-reported use of health care services. Respondents from Somalia reported less contacts with a general practitioner, less use of mental health services, and less medication use than respondents from Afghanistan and Iran. Both female gender and older age were related to more contacts with a general practitioner and a medical specialist, and with higher medication use. Poor general health was related to more contacts with a medical specialist and mental health services, and with higher medication use. Asylum seekers and refugees seem to have equal access to the Dutch health care system in general. However, there are differences in the self-reported use of health care services by the different ethnic groups.
Nosè, Michela; Turrini, Giulia; Imoli, Maria; Ballette, Francesca; Ostuzzi, Giovanni; Cucchi, Francesca; Padoan, Chiara; Ruggeri, Mirella; Barbui, Corrado
In recent years there has been a progressive rise in the number of asylum seekers and refugees displaced from their country of origin, with significant social, economic, humanitarian and public health implications. The aim of this study is to describe the frequency and correlates of psychological distress and psychiatric disorders in asylum seekers and refugees resettled in an Italian catchment area. In the catchment area of Verona, all male asylum seekers and refugees aged 18 or above included in the Italian protection system for asylum seekers and refugees during a period of 1 year were screened for psychological distress and psychiatric disorders using validated questionnaires. During the study period, 109 asylum seekers or refugees were recruited. The frequency of traumatic events experienced was very high. More than one-third of the participants (36%) showed clinically relevant psychological distress, and one-fourth (25%), met the criteria for a psychiatric diagnosis, mainly PTSD and depressive disorders. In multivariate analyses, time after departure, length of stay in the host country and number of traumatic events were independent factors associated with psychological distress and psychiatric disorders. In an unselected sample of male asylum seekers and refugees, after around 1 year of resettlement in an Italian catchment area, the frequency of psychological distress and psychiatric disorders was substantial and clinically relevant. Health care systems should include a mental health component to recognise and effectively treat mental health conditions.
Metzner, Franka; Reher, Cornelia; Kindler, Heinz; Pawils, Silke
Germany is one of the most important host countries for minor refugees and asylum seekers in Europe. The number of children who leave their home country has significantly risen worldwide in recent years; a further rise is to be expected due to the increasing number of crisis zones. A literature review demonstrates the state of research on traumatization, post-traumatic stress disorders and psychotherapy in minor refugees and asylum seekers. Many minor refugees and asylum seekers have made mainly interpersonal traumatic experiences within their home country or during their flight and develop simple or complex post-traumatic stress disorders. Left untreated, there is a risk of chronification. The psychotherapeutic treatment of minor refugees and asylum seekers in Germany takes place primarily in specialized psychosocial treatment centers. For an involvement of therapists in private practices, a reduction of organizational barriers as well as evidence-based treatment methods for interpreter-aided psychotherapy of minor refugees and asylum seekers that also consider their developmental state, are still lacking. In research, as well as in practice, there is further need for an early and systematic identification and treatment of minor refugees and asylum seekers with post-traumatic stress disorders or high risk of disease in Germany.
Toar, Magzoub; O'Brien, Kirsty K; Fahey, Tom
Adult refugees and asylum seekers living in Western countries experience a high prevalence of mental health problems, especially post traumatic stress disorder (PTSD), depression and anxiety. This study compares and contrasts the prevalence of health problems, and potential risk factors as well as the utilisation of health services by asylum seekers and refugees in the Irish context. Cross sectional study using validated self reported health status questionnaires of adult asylum seekers (n = 60) and refugees (n = 28) from 30 countries, living in Ireland. Outcome measures included: general health status (SF-36), presence of PTSD symptoms and anxiety/depression symptoms. Data on chronic conditions and pre or post migration stressors are also reported. The two groups are compared for utilisation of the health care system and the use of over the counter medications. Asylum seekers were significantly more likely than refugees to report symptoms of PTSD (OR 6.3, 95% CI: 2.2-17.9) and depression/anxiety (OR 5.8, 95% CI: 2.2-15.4), while no significant difference was found in self-reported general health. When adjusted by multivariable regression, the presence of more than one chronic disease (OR 4.0, 95%CI: 1.3-12.7; OR 3.4, 95% CI: 1.2-10.1), high levels of pre migration stressors (OR 3.6, 95% CI: 1.1-11.9; OR 3.3, 95% CI: 1.0-10.4) or post migration stressors (OR 17.3, 95% CI: 4.9-60.8; OR 3.9, 95% CI: 1.2-12.3) were independent predictors of self reported PTSD or depression/anxiety symptoms respectively, however, residence status was no longer significantly associated with PTSD or depression/anxiety. Residence status may act as a marker for other explanatory variables; our results show it has a strong relationship with post migration stressors (chi2 = 19.74, df = 1, P refugees, while no significant difference was found between these groups for use of dentists, medication, hospitalisation or mental health services. Asylum seekers have a higher level of self reported
Full Text Available Introduction: In a human rights based approach, the Parliamentary Assembly of the Council of Europe has recently released a resolution about migrants and refugees and the fight against HIV (1. It states that “an HIV positive migrant should never be expelled when it is clear that he will not receive adequate health care and assistance in the country to which he is being sent back. To do otherwise would amount to a death sentence for that person.” Nevertheless, in Belgium, for the last 2 years, none of the HIV-infected migrants in care in the AIDS Reference Centers (ARC received the right to stay in Belgium for medical reasons. Methods: We identified all HIV-infected asylum seekers in care between 1 July 2012 and 1 July 2014 in the ARC of Charleroi, Belgium, and we analyzed their medical and social files. Results: Among the 302 patients in active follow up in our ARC, 45 HIV positive asylum seekers were in care during the last 2 years. Male/female ratio was 0/96. Mean age was 35 years. Countries of origin and reasons for migration are detailed in the Table 1. 18% (8/45 knew their seropositivity before arriving in Europe. All the patients introduced an asylum request, 29 (64% have received a negative answer and an order to leave the territory, 4 (9% were regularized for non-medical reasons (see Table 1, 4 (9% are waiting for an answer and for 8 (18% outcome is unknown due to lost follow up (LFU. 31 (69% patients have also introduced a request to stay for medical reasons: 18 (58% have received a refusal, 7 (23% are still waiting for an answer, and 6 (19% are LFU. Only 23 (51% patients are still in care in our ARC on 1 July 2014 (see Table 1. The immigration office bases its decisions on availability of the treatment in the country even if accessible only to a limited number of patients. Conclusions: Decisions taken by the Belgian authorities for the last two years concerning HIV-infected asylum seekers do not guarantee the continuity of care of
Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research
Luke Robertshaw; Surindar Dhesi; Laura L Jones
Objectives To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries...
Lindkvist, Pille; Johansson, Eva
Background: National statistics have shown that only about 40% of asylum seekers actually attend the optional health assessment offered upon their arrival in Sweden, but the reasons for this have not been fully explored. Health assessments for newly arrived asylum seekers have become a regular practice in most EU countries, but what is performed, how it is organized and whether it is mandatory or not varies between countries. Aim: The aim of the study was to explore and improve our understanding of how former asylum seekers from Eritrea perceived and experienced the health assessment during their asylum-seeking process. Methods: We used a qualitative research approach guided by grounded theory. Semi-structured interviews were conducted with 11 former asylum seekers from Eritrea. Data were analysed based on constant comparative analysis. Findings: The asylum seekers expressed feelings of ambiguity and mistrust and felt that they were seen only as objects by the Swedish healthcare system during their asylum-seeking process. Poor communication and inability to overcome language and cultural barriers seemed to be the most important findings in the narratives. The core category was defined as ‘A state of limbo – in transition between two contexts’. Conclusions: There are reasons to believe that these issues with communication negatively affected both the quality of the health assessment and the number of asylum seekers attending the health assessment. Improved communication by the authorities towards the asylum seekers is, therefore, of vital importance. PMID:25902741
Jonzon, Robert; Lindkvist, Pille; Johansson, Eva
National statistics have shown that only about 40% of asylum seekers actually attend the optional health assessment offered upon their arrival in Sweden, but the reasons for this have not been fully explored. Health assessments for newly arrived asylum seekers have become a regular practice in most EU countries, but what is performed, how it is organized and whether it is mandatory or not varies between countries. The aim of the study was to explore and improve our understanding of how former asylum seekers from Eritrea perceived and experienced the health assessment during their asylum-seeking process. We used a qualitative research approach guided by grounded theory. Semi-structured interviews were conducted with 11 former asylum seekers from Eritrea. Data were analysed based on constant comparative analysis. The asylum seekers expressed feelings of ambiguity and mistrust and felt that they were seen only as objects by the Swedish healthcare system during their asylum-seeking process. Poor communication and inability to overcome language and cultural barriers seemed to be the most important findings in the narratives. The core category was defined as 'A state of limbo - in transition between two contexts'. There are reasons to believe that these issues with communication negatively affected both the quality of the health assessment and the number of asylum seekers attending the health assessment. Improved communication by the authorities towards the asylum seekers is, therefore, of vital importance. © 2015 the Nordic Societies of Public Health.
Bartolomei, Javier; Baeriswyl-Cottin, Rachel; Rathelot, Thomas; Premand, Natacha; Dechoux, Didier; Benzakour, Lamyae
Recent conflicts in the Middle East and Africa generated the displacement of millions of refugees seeking a safe haven. It led to a transformation in the population of asylum seekers attending our community psychiatry clinic serving refugees and asylum seekers in Geneva. That patient population doubled in a couple of years, comprising a higher number of young men, migrating alone, mostly from the Middle East and Afghanistan. Higher demand on our system and specific mental health needs brought us to transform our setting. We have set up a new evaluation step, we developed outreach interventions, we work more closely with people in the patients' networks and we have dedicated meetings to discuss cases within the team and with supervisors with expertise in working in transcultural settings.
Full Text Available During the late nineteenth century, a high percentage of male deaths in asylums was attributed to various forms of tertiary syphilis, most notably General Paralysis of the Insane (GPI and tabes dorsalis. It was not unusual for patients to present symptoms of both conditions, the latter of which could be agonizingly painful. Some patients also suffered from persecutory delusions, believing that electricity was running through them or that their limbs were gnawed by lions and wolves at night. Drawing on a theory advanced by a number of key alienists and pathologists of the period, I suggest that these delusions were misinterpretations of felt sensations and, as such, illusions rather than delusions. Despite the well-known problems around using these historical sources, I contend that recorded delusions in asylum case notes can be treated as narratives of pain that provide invaluable insights into patients' subjective experiences.
Full Text Available Abstract Background Asylum procedures are known to be protracted, stretching to over ten years in many host countries. International research shows high levels of distress for asylum seekers. Little is known about actual psychiatric morbidity in this population, especially during the first few years postmigration. Methods The mental health status of two groups of asylum seekers was assessed: Group 1 (n = 43 had arrived in Switzerland 2.9 (SD 1.1 months prior to assessment, while Group 2 (n = 43 had arrived 15.5 (SD 3.2 months prior to assessment. Psychiatric disorders were diagnosed using the Mini International Neuropsychiatric Interview (MINI. Symptom severity of posttraumatic stress disorder (Posttraumatic Diagnostic Scale, anxiety (Hopkins Symptom Checklist, depression (Hopkins Symptom Checklist, and pain (Verbal Rating Scale were assessed using self-report questionnaires. Postmigratory factors such as German language proficiency and social contacts were also assessed. Interviews were conducted with the assistance of trained interpreters. Results Four out of ten participants met diagnostic criteria for at least one DSM-IV disorder. Groups did not differ with respect to psychiatric morbidity or symptom levels. Major depression (31.4% and PTSD (23.3% were diagnosed most frequently. The number of experienced traumatic event types was highly correlated with psychiatric morbidity. Conclusions Psychiatric morbidity in asylum seekers in the first two years after arrival is high, with no indication of a decrease in mental distress over time. Traumatic experiences seem to play a major role in morbidity during this time. Considering the magnitude of clinically relevant distress, a short psychological screening upon arrival with a focus on traumatic experiences may be warranted.
Meier, Volker; Artelt, Tanja; Cierpiol, Stefanie; Gossner, Johannes; Scheithauer, Simone
In the European Union tuberculosis prevalence-rates are among the lowest in the world. The prevalence of active tuberculosis in migrant populations has to be analyzed to get valid data on the risk of tuberculosis and for the decision of screening activities. Therefore, we prospectively quantified the risk of active tuberculosis among asylum seekers at time of arrival. Investigation was performed as regular part of the admission screenings for people arriving at Friedland, Germany, a primary major receiving center during one year. In 11.773 newly arrived asylum seekers 16 X-ray investigations gave the suspicion of active tuberculosis, thereof 11 cases could be verified by culture, thereof 9 cases were classified as microscopically positive. These data translate into rates of 136 per 100.000 suspected cases, 93 per 100.000 verified cases, and finally 76 per 100.000 infectious cases, respectively. Prevalence was higher in asylum seekers coming from Eritrea and Russia compared to the main origins of current migration Syria, Afghanistan, Iraq, Iran, and Lebanon. One case of MDR-tuberculosis could be detected in a migrant from Russia. Prevalence rates of tuberculosis in newly arrived asylum seekers are higher than in native European populations. Rates seem to reflect the prevalence in the home countries. X-ray investigation during first examination may help identifying people needing further tests for detecting infectious tuberculosis and therefore may prevent transmission. However due to the low prevalence rates screening procedures have to be reviewed. Copyright © 2016 Elsevier GmbH. All rights reserved.
Full Text Available Abstract Background Most new cases of active tuberculosis in Norway are presently caused by imported strains and not transmission within the country. Screening for tuberculosis with a Mantoux test of everybody and a chest X-ray of those above 15 years of age is compulsory on arrival for asylum seekers. We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis. Methods All asylum seekers who arrived at the National Reception Centre between January 2005 - June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008. Cases reported within two months after arrival were defined as being detected by screening. Results Of 4643 eligible asylum seekers, 2237 were included in the study. Altogether 2077 persons had a Mantoux ≥ 6 mm and 314 had an abnormal chest X-ray. Of 28 cases with tuberculosis, 15 were detected by screening, and 13 at 4-27 months after arrival. Abnormal X-rays on arrival were more prevalent among those detected by screening. Female gender and Somalian origin increased the risk for active TB. Conclusion In spite of an imperfect follow-up of screening results, a reasonable number of TB cases was identified by the programme, with a predominance of pulmonary TB.
Sane, Jussi; Sorvari, Tiina; Widerström, Micael; Kauma, Heikki; Kaukoniemi, Ulla; Tarkka, Eveliina; Puumalainen, Taneli; Kuusi, Markku; Salminen, Mika; Lyytikäinen, Outi
In December 2015, an asylum seeker originating from Afghanistan was diagnosed with respiratory diphtheria in Finland. He arrived in Finland from Sweden where he had already been clinically suspected and tested for diphtheria. Corynebacterium diphtheriae was confirmed in Sweden and shown to be genotypically and phenotypically toxigenic. The event highlights the importance of early case detection, rapid communication within the country and internationally as well as preparedness plans of diphtheria antitoxin availability.
Kibria, Ayisha A; Metcalfe, Neil H
William Tuke was a 19th-century reformist and philanthropist notable for his work in mental health. He was known for his strict self-discipline and judicious manner. He was also a firm believer in the Quaker faith and actively supported the group and employed many of their principles in his work, especially in his chef d'oeuvre, The Retreat, established in 1792, a mental asylum in York. Possibly catalysed by the very public mismanagement of King George III's 'madness', he pioneered the use of moral treatment, a new humane method of treating mental illness. This focussed on allowing patients to live in a community, partake in daily activities and not be subjected to the brutality of the commonplace asylum, all of which were very rare in the treatment of lunatics at that time. Described as 'The Period of Humane Reform', his work coincided with the emergence of similar approaches in France, most famously by Philippe Pinel (1745-1826) and his pupil Jean Esquirol (1772-1840) in Paris. Tuke eventually went on to aid in the reform of the law with regards to asylums. © The Author(s) 2016.
Full Text Available In the institutional pathway for recognition of asylum right, the narrative becomes, according to current regulations, the element to be sieved in order to ascertain title to international protection. The aim of this essay is analyzing the various declensions assumed by the narrative in this institutional process. Weaving together clinical and ethnographic data, drawn from the main phases that foreigners have to pass through in this event, I would like to highlight how, in the asylum system, the narrative takes the value of a tool directed, first of all at checking the applicant’s past, and second at co-producing a subject fitting to the media and legal dominant imaginary features. In this specific context, the treatment of traumatic injuries, recognized as basis of interrupted narratives, emerges as issue played in its turn on a double register: as adherence to specific schemes of "therapeutic governance" and as further control of specific events, experienced by asylum seekers in the past.
Bertelsen, Nathan S; Selden, Elizabeth; Krass, Polina; Keatley, Eva S; Keller, Allen
Effective screening in primary care among asylum-seekers in the US is critical as this population grows. This study aimed to evaluate disease prevalence and screening methods in this high-risk group. Two hundred ten new clients from 51 countries, plus Tibet, who were accepted into a program for asylum seekers from 2012 to 2014 were included. Screening rates and outcomes for infectious, non-communicable, and mental illnesses were evaluated. Screening rates were highest for PTSD, depression, hepatitis B, and latent tuberculosis. Seventy-one percent of clients screened positive for depression and 55 % for PTSD, followed by latent tuberculosis (41 %), hypertension (10 %), hepatitis B (9.4 %), and HIV (0.8 %). Overall screening rates were high. Point of care testing was more effective than testing that required a repeat visit. A large psychiatric and infectious disease burden was identified. These findings can inform future primary care screening efforts for asylum seekers in the US.
Hainmueller, Jens; Hangartner, Dominik; Lawrence, Duncan
European governments are struggling with the biggest refugee crisis since World War II, but there exists little evidence regarding how the management of the asylum process affects the subsequent integration of refugees in the host country. We provide new causal evidence about how one central policy parameter, the length of time that refugees wait in limbo for a decision on their asylum claim, affects their subsequent economic integration. Exploiting exogenous variation in wait times and registry panel data covering refugees who applied in Switzerland between 1994 and 2004, we find that one additional year of waiting reduces the subsequent employment rate by 4 to 5 percentage points, a 16 to 23% drop compared to the average rate. This deleterious effect is remarkably stable across different subgroups of refugees stratified by gender, origin, age at arrival, and assigned language region, a pattern consistent with the idea that waiting in limbo dampens refugee employment through psychological discouragement, rather than a skill atrophy mechanism. Overall, our results suggest that marginally reducing the asylum waiting period can help reduce public expenditures and unlock the economic potential of refugees by increasing employment among this vulnerable population.
Full Text Available The case of refugees and asylum-seekers constitutes one of the most important problems of today’s developed and developing countries. Immigration and sanctuary which arise generally from economic causes have reached a more intensified state due to deficiencies in the process of democratization and establishment of an environment of peace. Although it is difficult to provide an exact number, it is observed that a population of more than 10 million people in the world today continue their lives outside their home countries and seek new environments for survival. It is known that refugee mobility follows a route from the south to northern countries and in the case of Turkey it is realized along the coastal lines and through east/south highways, and occupies a significant area of coverage in the Turkish printed media. This article aims to analyze and evaluate the media language and discourse on the lives of refugees or asylum seekers through the perspective of democratization and human rights. Critical discourse analysis will be used to analyze the main axes of enquiry which include the news released in the Turkish printed media on refugees and asylum seekers, the approach adopted in shaping such news coverage, the messages they convey, and their role in molding public opinion
To examine the Australian Border Force Act (BFA) and its context, its implications for asylum-seeker healthcare and professionals, and contemporary and historical parallels. Prolonged immigration detention and policies aiming to deter irregular migration cause maritime asylum-seekers undeniable, well-publicised harms and (notwithstanding claims about preventing drownings) show reckless indifference and calculated cruelty. Service personnel may be harmed. Such policies misuse helping professionals to underwrite state abuses and promote public numbing and indifference, resembling other state abuses in the 'war on terror' and (with qualification) historical counterparts, e.g. Nazi Germany. Human service practitioners and organisations recently denounced the BFA that forbids disclosure about these matters.Continuing asylum-seeker healthcare balances the likelihood of effective care and monitoring with lending credibility to abuses. Boycotting it might sacrifice scrutiny and care, fail to compel professionals and affect temporary overseas workers. Entirely transferring healthcare from immigration to Federal and/or State health departments, with resources augmented to adequate standard, would strengthen clinical independence and quality, minimise healthcare's being securitised and politicised, and uphold ethical codes. Such measures will not resolve detention's problems, but coupled with independent auditing, would expose and moderate detention's worst effects, promoting changes in national conversation and policy-making. © The Royal Australian and New Zealand College of Psychiatrists 2016.
Haith-Cooper, Melanie; Bradshaw, Gwendolen
Current literature has indicated a concern about standards of maternity care experienced by pregnant women who are seeking asylum. As the next generation of midwives, it is important that students are educated in a way that prepares them to effectively care for these women. To understand how this can be achieved, it is important to explore what asylum seeking means to midwifery students. This article is the first of three parts and reports on one objective from a wider doctorate study. It identifies dominant discourses that influenced the perceptions of a group of midwifery students' about the pregnant asylum seeking woman. The study was designed from a social constructivist perspective, with contextual knowledge being constructed by groups of people, influenced by underpinning dominant discourses, depending on their social, cultural and historical positions in the world. In a United Kingdom University setting, during year two of a pre-registration midwifery programme, eleven midwifery students participated in the study. Two focus group interviews using a problem based learning scenario as a trigger for discussion were conducted. In addition, three students were individually interviewed to explore issues in more depth and two students' written reflections on practice were used to generate data. Following a critical discourse analysis, dominant discourses were identified which appeared to influence the way in which asylum seekers were perceived. The findings suggested an underpinning ideology around the asylum seeker being different and of a criminal persuasion. Although the pregnant woman seeking asylum was considered as deserving of care, the same discourses appeared to influence the way in which she was constructed. However, as the study progressed, through reading alternative sources of literature, some students appeared to question these discourses. These findings have implications for midwifery education in encouraging students to challenge negative discourses
Full Text Available Asylum seekers are considered to be a particularly vulnerable group with respect to HIV. Data on the HIV prevalence among asylum seekers, however, are scarce. The aim of this study is to map the HIV prevalence among asylum seekers who gave birth in The Netherlands.We used a nationwide electronic medical records database from the community health services for asylum seekers (MOA. The study population consisted of 4,854 women and girls who delivered in asylum reception between 2000 and 2008. A unique electronic health data base was used and case allocation was based on ICPC-codes.The number of women and girls that was HIV positive during their last pregnancy was 80, of which 79 originated from sub-Saharan Africa. The prevalence for women from this region of origin (3.4% was high compared to women from all other regions of origin (0.04%; OR = 90.2; 95%CI 12.5-648.8. The highest HIV prevalence rates were found for women from Rwanda (17.0% and Cameroon (13.2%. HIV prevalence rates were higher among women who arrived in reception without partner (OR = 1.82; 95%CI 0.75-4.44 and unaccompanied minors (OR = 2.59; 95%CI 0.79-8.49, compared to women who arrived in reception with partner.We conclude that, among asylum-seeking women from sub-Saharan Africa giving birth in The Netherlands, the HIV prevalence is high compared to the host population. For women from other regions of origin, the prevalence is at the same level as in the host population. The high HIV prevalence underlines the importance of preventive interventions and voluntary HIV testing for sub-Saharan African asylum seekers as from shortly after arrival.
Full Text Available Croatia’s accession to the EU has brought new challenges and issues in researching and analysing migration flows and trends as well as attitudes and perceptions of real and potential newcomers. The aim of this paper is to explore attitudes of the residents of the two most easterly Croatian counties towards two distinct categories of newcomers: immigrant workers and asylum seekers. The research was conducted shortly after Croatia’s entry into the EU, in September 2013, and the presented data are a part of a larger survey that included various migration and ethnicity issues. The survey was applied on a convenience sample of 1 110 adult respondents in two counties: Osijek-Baranja and Vukovar-Srijem. Data were analysed in a series of multivariate procedures. Results indicated significant perceptions of immigrant workers within the dimension of cultural threat, along with the expression of a considerable degree of social distance towards them. Asylum seekers were further perceived as a security and economic threat. Within two analysed regression models, the effects on attitudes towards immigrant workers and asylum seekers were similar. Among the spectrum of socio-demographic variables, a statistically significant effect on both dependent variables came from age and political orientation, indicating that older and politically right-oriented respondents expressed more negative attitudes towards both groups. Among other socio-demographic variables, education was significant in predicting attitudes towards immigrant workers, while ethnicity was significant in predicting the attitudes towards asylum seekers. The second model analysed the effect of selected political attitudes and value orientations resulting in significant prediction of negative attitudes towards both groups by pronounced conservativism, support of aggression and submission, social-dominance, dominant submissive authoritarianism and social alienation, rejecting socially oriented
Full Text Available Wars, conflict, and persecution have forced more people to flee their homes and seek refuge and safety elsewhere than at any time since the end of World War II. As displaced people and other migrants increasingly move out of the conflict-ridden and less developed regions of their displacement and into relatively rich and stable regions of the world, the countries of destination are increasingly working to contain and even stem the migration flow before it reaches their shores. Perversely, countries that have developed generally rights-sensitive standards and procedures for assessing protection claims of asylum seekers within their jurisdictions have simultaneously established barriers that prevent migrants, including asylum seekers, from setting foot on their territories or otherwise triggering protection obligations. Consequently, those who would otherwise have been able to avail themselves of asylum procedures, social support, and decent reception conditions are often relegated to countries of first arrival or transit that have comparatively less capacity to ensure protection of human rights in accordance with international standards.This paper seeks to develop a working definition of the externalization of migration controls and how such externalization of the border implicates the human rights of migrants, and asylum seekers in particular. Although the majority of those migrants seeking legal protections stay in countries neighboring their own, hundreds of thousands continue their journeys in search of protection and stability in more distant states, including in the European Union, the United States, and Australia. In response to the significant increase in asylum seekers arriving at their borders, all three entities have significantly increased deterrence measures with the hopes of keeping new arrivals from entering. This paper will thus highlight a number of the most troubling externalization strategies used by the European Union, the
Full Text Available Carolyn L Tobin,1 Jo Murphy-Lawless2 1Department of Nursing, College of Health and Human Services, University of New Hampshire, Durham, NH, USA; 2School of Nursing and Midwifery, Trinity College, Dublin, Ireland Background: Immigration and asylum seeking has been an important social and political phenomenon in Ireland since the mid 1990s. Inward migration to Ireland was seen in unprecedented numbers from 1995 onward, peaking in 2002 with 11,634 applications for refugee status. Asylum and immigration is an issue of national and international relevance as the numbers of displaced people worldwide continues to grow, reaching the highest level in 20 years at 45.2 million in 2012. Midwives provide the majority of care to childbearing women around the world, whether working as autonomous practitioners or under the direction of an obstetrician. Limited data currently exist on the perspectives of midwives who provide care to childbearing women while they are in the process of seeking asylum. Such data are important to midwifery leaders, educators, and policy-makers. The aims of this study were to explore midwives' perceptions and experiences of providing care to women in the asylum process and to gain insight into how midwives can be equipped and supported to provide more effective care to this group in the future.Methods: Data were collected via indepth unstructured interviews with a purposive sample of ten midwives from two sites, one a large urban inner city hospital, and the second, a smaller more rural maternity hospital. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using content analysis. Results: Five themes emerged from the data, barriers to communication, understanding cultural difference, challenges of caring for women who were unbooked, the emotional cost of caring, and structural barriers to effective care. Conclusion: Findings highlight a need to focus on support and education for midwives, improved
Full Text Available Abstract Background About 80% of new tuberculosis cases in Norway occur among immigrants from high incidence countries. On arrival to the country all asylum seekers are screened with Mantoux test and chest x-ray aimed to identify cases of active tuberculosis and, in the case of latent tuberculosis, to offer follow-up or prophylactic treatment. We assessed a national programme for screening, treatment and follow-up of tuberculosis infection and disease in a cohort of asylum seekers. Methods Asylum seekers ≥ 18 years who arrived at the National Reception Centre from January 2005 to June 2006, were included as the total cohort. Those with a Mantoux test ≥ 6 mm or positive x-ray findings were included in a study group for follow-up. Data were collected from public health authorities in the municipality to where the asylum seekers had moved, and from hospital based internists in case they had been referred to specialist care. Individual subjects included in the study group were matched with the Norwegian National Tuberculosis Register which receive reports of everybody diagnosed with active tuberculosis, or who had started treatment for latent tuberculosis. Results The total cohort included 4643 adult asylum seekers and 97.5% had a valid Mantoux test. At least one inclusion criterion was fulfilled by 2237 persons. By end 2007 municipal public health authorities had assessed 758 (34% of them. Altogether 328 persons had been seen by an internist. Of 314 individuals with positive x-rays, 194 (62% had seen an internist, while 86 of 568 with Mantoux ≥ 15, but negative x-rays (16% were also seen by an internist. By December 31st 2006, 23 patients were diagnosed with tuberculosis (prevalence 1028/100 000 and another 11 were treated for latent infection. Conclusion The coverage of screening was satisfactory, but fewer subjects than could have been expected from the national guidelines were followed up in the community and referred to an internist. To
U.S. Department of Health & Human Services — This website is designed to provide information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides more than 10,000 physician services,...
Full Text Available The main purpose of the article is to identify key criteria being used for physician appraisals and to find how communication skills of physicians are valued in those appraisals. ScienceDirect and EBSCOhost databases were used for this search. The results show that a physician appraisal is underestimated both theoretically and empirically. The particular gap exists with respect to the communication skills of physicians, which are rarely present in medical training syllabi and physician assessments. The article contributes to the theoretical discourse on physician appraisals and points out at the inconsistency between the high status of physicians as a key hospital resource on the one hand and, on the other hand, at inadequate and poorly researched assessment of their performance with a special emphasis on communication skills. The article may inspire health managers to develop and implement up-to-date assessment forms for physicians and good managerial practices in this respect in hospitals and other health care units.
van Oostrum Irene EA
Full Text Available Abstract Background Several suicide and suicidal behaviour risk factors are highly prevalent in asylum seekers, but there is little insight into the suicide death rate and the suicidal behaviour incidence in this population. The main objective of this study is to assess the burden of suicide and hospital-treated non-fatal suicidal behaviour in asylum seekers in the Netherlands and to identify factors that could guide prevention. Methods We obtained data on cases of suicide and suicidal behaviour from all asylum seeker reception centres in the Netherlands (period 2002-2007, age 15+. The suicide death rates in this population and in subgroups by sex, age and region of origin were compared with the rate in the Dutch population; the rates of hospital-treated suicidal behaviour were compared with that in the population of The Hague using indirect age group standardization. Results The study included 35 suicide deaths and 290 cases of hospital-treated suicidal behaviour. The suicide death rate and the incidence of hospital-treated suicidal behaviour differed between subgroups by sex and region of origin. For male asylum seekers, the suicide death rate was higher than that of the Dutch population (N = 32; RR = 2.0, 95%CI 1.37-2.83. No difference was found between suicide mortality in female asylum seekers and in the female general population of the Netherlands (N = 3; RR = 0.73; 95%CI 0.15-2.07. The incidence of hospital-treated suicidal behaviour was high in comparison with the population of The Hague for males and females from Europe and the Middle East/South West Asia, and low for males and females from Africa. Health professionals knew about mental health problems prior to the suicidal behaviour for 80% of the hospital-treated suicidal behaviour cases in asylum seekers. Conclusions In this study the suicide death rate was higher in male asylum seekers than in males in the reference population. The incidence of hospital-treated suicidal behaviour
Conclusion: It is urgent and necessary to improve physician working conditions and their working pattern to ... an employee's well-being Examples of job resources ... physicians. In Kuwait, some physicians quit their hospital posts and then open their own clinics or move to other hospitals with better working conditions.(8).
Full Text Available This article contains data concerning the movement of extra-EU asylum seekers in Europe. Data used in this paper were collected from the Eurostat database and the UNHCR database. The data consist of some socio-economic features related to 30 European countries where extra-EU asylum seekers have applied for protection. All variables were transformed into their natural logs. The degree of statistical correlation is evaluated from Pearson׳s coefficient, using the 0.05 level of significance. Regression analysis is conducted to identify some socio-economic predictors of countries attracting asylum migration. Six models are presented, where ‘first time asylum applicants’ in 2015 (1,324,215 individuals in 30 European countries were regressed on 2014 predictors. The multilinear regression model was tested by using data on asylum seekers in 2014, regressed on the same predictors referred to 2013. The data here shared provide a resource for researchers working in the topical field of migration.
Zijlstra, A. Elianne; Kalverboer, Margrite E.; Post, Wendy J.; Knorth, Erik J.; Ten Brummelaar, Mijntje D. C.
The Best Interest of the Child Questionnaire (BIC-Q) has been designed as an instrument for screening the quality of the rearing situation of asylum-seeking or refugee children. It is intended to aid legal decisions in asylum procedures. The aim of this study was to determine the reliability and the
Mattila, Anni; Ghaderi, Peyvand; Tervonen, Laura; Niskanen, Leena; Pesonen, Paula; Anttonen, Vuokko; Laitala, Marja-Liisa
The number of asylum seekers and immigrants arriving in European countries is growing explosively. The aim of this pilot study was to investigate self-reported oral health, oral health habits, dental fear and use of dental health care services among asylum seekers and immigrants in Finland. The interview study carried out in 2012 comprised 38 participants (18 males and 20 females) from 15 different countries, nine of whom were asylum seekers and 29 immigrants. The youngest participant was 17 and the oldest 53 years old. Each interview took approximately 30 min. The participants reported high need for dental treatment. Compared with the immigrants, the asylum seekers reported significantly more frequently dental pain and other symptoms and were less satisfied both in getting a dental appointment and in the quality of treatment they had received. All the asylum seekers and almost half of the immigrants found it difficult to get an appointment. The immigrants were more aware of good oral health habits than the asylum seekers. The asylum seekers suffered from dental fear more often than the immigrants. Despite the small number of participants, our interview-based study indicates that asylum seekers and immigrants have need for acute and basic dental treatment and health education. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Padilla, Brenda Lisa
This study highlights the development of a graduate training program at The Wright Institute in Berkeley, CA, which provides assessment services for undocumented immigrants seeking asylum. This program focuses on the needs of a general asylum seeking population, with a specific relevance to some of the populations that may be served in the…
Swanson, Elizabeth; Primack, Craig
This article, co-authored by a patient affected by obesity and an obesity medicine specialist, discusses the patient's experience of living with the disease and using many different weight loss approaches until finding a lifestyle program that was appropriate for her metabolism. The physician discusses the scientific basis of insulin resistance, and why the chosen lifestyle program worked so well for this individual.
Full Text Available Protection of asylum seeker and Illegal migrants human rights, has often been difficult due to the need of states to regulate unwanted migration flows. European Court of Human Rights plays an important role in protecting the rights of these individuals, through a set of human rights. Requests for interim measures under Rule 39 of the Rules of Court also have great importance. In cases involving illegal migrants and asylum-seekers, Court was often in difficult position, given the contradictions that could arise from the protection of human rights and the legitimate aim of the Contracting States to control the entry, residence and expulsion of aliens. Recent Courts judgment in case of M. S. S. against Belgium is particularly important, because of its remarkable influence on the perception of a common asylum system in the EU, as well as the judgment in the case of Jama Hirsi and Others v. Italy.
Espirito Santo, Wanda; Araujo, Inesita Soares de; Amarante, Paulo
The article analyzes two posters that with the same slogan - "Asylums nevermore" - promote National Anti-Asylum Day. The analysis was based on principles of the symptomatology of social discourse, articulating analytical concepts and practices arising from the French School and the pragmatic dimension of discourse analysis. The results revealed affirmation strategies of the movement for the qualification and exacerbation of the issues of the enunciation and other enunciators, namely political actors of the anti-asylum movement and their allies. It also reveals the attempt to disqualify competitive discourse, especially that which discloses the serious problems of its institutional models, but also by juxtaposing the positive presence of the issuers and enunciators of the posters.
Anderson, Joel R
This paper reports the initial psychometric properties for the recently developed prejudice against asylum seekers scale (PAAS) - a new measure of the classical and conditional components of negative attitudes towards asylum seekers. Across three studies the initial psychometric evidence is presented: An exploratory factor analysis suggested that the 16 items of the PAAS accurately factor onto the two hypothesized subscales (Study 1), which was ratified using a confirmatory factor analysis (Study 2). The presented reliability estimates (internal consistency: Studies 1-3; test-retest reliability: Study 3) verified the stability of the measure. Finally, evidence of the validity for the scale (criterion, construct, and known-groups; Study 2) and for the independent predictive validity of each subscale is presented. In summary, the evidence presented here suggests that the PASS is a psychometrically sound measure of classical and contemporary prejudice against asylum seekers.
McBride, Jacquie; Russo, Alana; Block, Andrew
Asylum seekers and refugees experience a range of barriers to health service access and competent use. The Refugee Health Nurse Liaison initiative was piloted at a hospital in a high-settlement region of Victoria, Australia. This initiative aimed to build capacity within the health sector to more effectively respond to the needs of asylum seekers and refugees. A mixed-methods evaluation was undertaken to: describe issues encountered by asylum seekers and refugees within the hospital setting; capture the nature of the Refugee Health Nurse Liaison position; and document key outputs. Throughout the pilot period, 946 patients were referred to the role, of which 99% received an assessment of physical, mental, and social health. Refugee Health Nurse Liaisons effectively provided clinical support, advocacy, education, referrals, and both formal and informal capacity building. Learnings from this model are transferable to services in high-settlement regions, and could have application in improving patient care more broadly.
Brown, T E
The 1970s witnessed an intense, often acrimonious debate between revisionist and Whig/neo-Whig historians over the origins and nature of the nineteenth-century asylum experience. By the early 1980s, however, there had emerged no "new synthesis" (as one might have expected given the dialectical nature of the historical enterprise) but rather a new counter-revisionist paradigm grounded in the precepts of the "new social history." This counter-revisionist paradigm has become, in turn, the "new orthodoxy" in asylum studies in the 1990s. This article argues that the counter-revisionist account is itself highly problematic, offering no convincing synthetic overview of the nineteenth-century asylum experience.
In recent years search engines have become an essential tool in the work of physicians. This article will review advanced search techniques from the world of information specialists, as well as some advanced search engine operators that may help physicians improve their online search capabilities, and maximize the yield of their searches. This article also reviews popular dedicated scientific and biomedical literature search engines.
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Full Text Available Abstract Background QuantiFERON®TB Gold (QFT is a promising blood test for tuberculosis infection but with few data so far from immigrant screening. The aim of this study was to compare results of QFT and tuberculin skin test (TST among newly arrived asylum seekers in Norway and to assess the role of QFT in routine diagnostic screening for latent tuberculosis infection. Methods The 1000 asylum seekers (age ≥ 18 years enrolled in the study were voluntarily recruited from 2813 consecutive asylum seekers arriving at the national reception centre from September 2005 to June 2006. Participation included a QFT test and a questionnaire in addition to the mandatory TST and chest X-ray. Results Among 912 asylum seekers with valid test results, 29% (264 had a positive QFT test whereas 50% (460 tested positive with TST (indurations ≥ 6 mm, indicating a high proportion of latent infection within this group. Among the TST positive participants 50% were QFT negative, whereas 7% of the TST negative participants were QFT positive. There was a significant association between increase in size of TST result and the likelihood of being QFT positive. Agreement between the tests was 71–79% depending on the chosen TST cut-off and it was higher for non-vaccinated individuals. Conclusion By using QFT in routine screening, further follow-up could be avoided in 43% of the asylum seekers who would have been referred if based only on a positive TST (≥ 6 mm. The proportion of individuals referred will be the same whether QFT replaces TST or is used as a supplement to confirm a positive TST, but the number tested will vary greatly. All three screening approaches would identify the same proportion (88–89% of asylum seekers with a positive QFT and/or a TST ≥ 15 mm, but different groups will be missed.
Wahedi, Katharina; Nöst, Stefan; Bozorgmehr, Kayvan
A health examination of newly arrived asylum seekers, aimed at detecting infectious diseases and preventing disease outbreaks in accommodation facilities, is mandated by national law in all German states. Due to the decentralized German federal system, different state policies are in place and lead to substantial variation in the content and implementation of the health examination. To compare health examination policies in the 16 German states with a focus on conducted tests, preventive measures and the general procedure. A comparative content analysis of policy documents addressing the health examination was conducted. Relevant documents were identified through a nationwide search (conducted June-October 2015) through public sources, inquiries at responsible authorities and interviews with representatives of public health services. In the study period, relevant policy documents for 13 states were identified, of which eight were administrative decrees of the responsible state ministries. Policies differed strongly with respect to the content of the health examination and the selection of compulsory screening measures. We identified three main groups: (A) states with compulsory screening limited to measures enshrined in federal law, (B) states with extended tuberculosis screening for children and pregnant women, and (C) states with extended mandatory screening measures for further infectious diseases beyond tuberculosis. Considerable differences were also found with regard to the implementation of the examinations, and the purchasing and re-imbursement policies. The stark heterogeneity in health examination policies between the states cannot be rationally explained from a public health perspective. The indication for certain measures remains unclear. A broad discussion of the medical necessity of screening tests, combined with further systematic analyses, is necessary in order to develop nationwide evidence-based recommendations and decision-making tools for
Full Text Available Background : Procedures for determining refugee status across Europe are being speeded up, despite the high prevalence of mental health difficulties among asylum seekers. An assurance given is that ‘‘vulnerable applicants’’ will be identified and excluded from accelerated procedures. Although experts have recommended assessments to be undertaken by experienced clinicians, this is unlikely to happen for political and financial reasons. Understanding how non-clinically qualified personnel perform assessments of mental health issues is timely and crucial. Misrecognition of refugees due to the inappropriate use of accelerated procedures involves the risk of returning the very people who have the right to protection from further persecution. Objective : To examine the decision making of immigration lawyers, who are an example of a group of nonclinicians who decide when and whether to refer asylum-seekers for psychiatric assessment. Method : Semi-structured interviews were conducted with 12 legal representatives working with people seeking refugee or human rights protection in the United Kingdom. The resultant material was analysed using Framework Analysis. Results : Themes clustered around the legal case, the client, the representative and the systems, all with sub-themes. A mapping exercise integrated these themes to show how representatives brought together questions of (1 evidential reasons for a report, influenced by their legal, psychological and case law knowledge, and (2 perceived evidence of mental distress, influenced by professional and personal experiences and expectations. Conclusions : The legal representatives interviewed were well-informed and trained in psychological issues as well as clearly dedicated to their clients. This helped them to attempt quasi-diagnoses of common mental health problems. They nonetheless demonstrated stereotypical understanding of post-traumatic stress disorder and other possible diagnoses and the
Full Text Available This paper examines the rise of an asylum seeker and refugee advocacy movement in Australia in recent years. It situates this phenomenon within Alberto Melucci's understanding of social movements as variable and diffuse forms of social action involved in challenging the logic of a system. Following this theoretical framework, it explores the empirical features of this particular collective action, as well as the struggle to redefine the nature of the relationship between citizens of a sovereign state and 'the other' in the personage of asylum seekers and refugees.
. To develop a more adequate way of capturing what is at stake in interdisciplinarity, I suggest drawing inspiration from the contemporary philosophical literature on scientific representation. The development of a representation based approach to the analysis of interdisciplinarity, and the discussion...... of the concept of “scientific discipline” and disciplinary difference. This chapter provides reasons to assume that conventional scientific taxonomies do not provide a good basis for analysing epistemic aspects of interdisciplinary science. On this background it is argued that the concept of “approaches...... accepted arguments against the relevance of philosophy to understanding scientific activities (in general). In chapter 5 and onwards I argue in favour of construing interdisciplinarity and interdisciplinary activities in light of the philosophy of scientific represen- tation. I go through discussions...
Lobo Pacheco, Lubin; Jonzon, Robert; Hurtig, Anna-Karin
Swedish law entitles asylum seekers to a voluntary health assessment and to "health care that cannot be postponed". The last expression suggests, however, restrictions on the entitlement, and what it may or may not include remains ultimately a decision for health professionals in the specific case. Indeed, the health assessment constitutes the sole active effort from Swedish authorities to fulfill this right. This study was therefore aimed at assessing how the information, procedures and services related to the health assessment are accessible and acceptable to fulfill the right to health of asylum seekers, from their own perspective. The study has a cross-sectional design. A questionnaire was administrated in 16 language schools for immigrants, in four counties of Sweden. Three hundred eighty-six individuals fulfilled the inclusion criteria. The frequency of their answers was tabulated to estimate how the information, procedures and services related to the health assessment correspond to the criteria for accessibility and acceptability regarding the right to health. Forty-eight (12.4%) respondents did not undergo the health assessment. Thirty-one of them did not even receive the invitation letter. They said they lost the opportunity to know their health status, to obtain treatment for or advice about their health problems. Additionally, 55.2% of those who attended the health assessment indicated that their needs were overlooked, particularly when these were of a psychological nature. Two in three participants also considered the health assessment to be a communicable disease control, rather than an effort to take care of their health needs. Nevertheless, the respondents had a positive attitude towards the health assessment as such. Although being an important contribution, the health assessment does not suffice to fulfill the right to health of asylum seekers because there are shortcomings regarding the accessibility and acceptability of the information
Based on the wider thesis of the "grand renfermement", psychiatric asylums as well as hospitals (and prisons) should have developed to "total institutions" from late 18th century onwards by gaining public space and further resources devoted to the healing of the (mental) ill who had to be isolated from the healthy citizen following criteria of the modernising medicine. But vis-a-vis to the enormous problems of the early general hospitals to separate the curable based on strictly medical criteria one is astonished, why modern medicine developed two types of institutions and thus doubling its claims on public resources. The article aims to take a look at an early 19th century psychiatric asylum in the town of Dusseldorf from the perspective of the general hospital. That way it tries to get into account the difficult allocation of ill people to one or another hospital. As both had to prove their ability to effectively cure their patients they had to be quite aware whom to let in--and whom to refuse. As they were financed, organised and administrated on different political levels and thus dependent to different governmental bodies (town vs. region) a couple of conflicts become visible which had to be solved in order to establish institutionalisation. Finally, in the long run both had to gain public recognition and acceptance, which only could mean the acceptance of potential patients. The perspective opened by the theorem of the "total institution" seems not to be all-to helpful to that purpose, as it tends to neglect institutional competition as well as the process of gaining the potential patients' acceptance. A more useful perspective could be a comparative analysis based on local examples, which could open the view to the competing establishment of prisons, psychiatric asylums and general hospitals as "useful" types of organizations in a modernising society.
Lubin Lobo Pacheco
Full Text Available Swedish law entitles asylum seekers to a voluntary health assessment and to "health care that cannot be postponed". The last expression suggests, however, restrictions on the entitlement, and what it may or may not include remains ultimately a decision for health professionals in the specific case. Indeed, the health assessment constitutes the sole active effort from Swedish authorities to fulfill this right. This study was therefore aimed at assessing how the information, procedures and services related to the health assessment are accessible and acceptable to fulfill the right to health of asylum seekers, from their own perspective.The study has a cross-sectional design. A questionnaire was administrated in 16 language schools for immigrants, in four counties of Sweden. Three hundred eighty-six individuals fulfilled the inclusion criteria. The frequency of their answers was tabulated to estimate how the information, procedures and services related to the health assessment correspond to the criteria for accessibility and acceptability regarding the right to health.Forty-eight (12.4% respondents did not undergo the health assessment. Thirty-one of them did not even receive the invitation letter. They said they lost the opportunity to know their health status, to obtain treatment for or advice about their health problems. Additionally, 55.2% of those who attended the health assessment indicated that their needs were overlooked, particularly when these were of a psychological nature. Two in three participants also considered the health assessment to be a communicable disease control, rather than an effort to take care of their health needs. Nevertheless, the respondents had a positive attitude towards the health assessment as such.Although being an important contribution, the health assessment does not suffice to fulfill the right to health of asylum seekers because there are shortcomings regarding the accessibility and acceptability of the
Full Text Available Abstract Background Language barriers have a major impact on both the quality and the costs of health care. While there is a growing body of evidence demonstrating the detrimental effects of language barriers on the quality of health care provision, less is known about their impact on costs. This purpose of this study was to investigate the association between language barriers and the costs of health care. Methods The data source was a representative set of asylum seekers whose health care was provided by a Swiss Health Maintenance Organisation (HMO. A cross-sectional survey was conducted: data was collected on all the asylum seekers' health care costs including consultations, diagnostic examinations, medical interventions, stays in the clinic, medication, and interpreter services. The data were analysed using path analysis. Results Asylum seekers showed higher health care costs if there were language barriers between them and the health professionals. Most of these increased costs were attributable to those patients who received interpreter services: they used more health care services and more material. However, these patients also had a lower number of visits to the HMO than patients who faced language barriers but did not receive interpreter services. Conclusion Language barriers impact health care costs. In line with the limited literature, the results of this study seem to show that interpreter services lead to more targeted health care, concentrating higher health care utilisation into a smaller number of visits. Although the initial costs are higher, it can be posited that the use of interpreter services prevents the escalation of long-term costs. A future study specially designed to examine this presumption is needed.
Bischoff, Alexander; Denhaerynck, Kris
Language barriers have a major impact on both the quality and the costs of health care. While there is a growing body of evidence demonstrating the detrimental effects of language barriers on the quality of health care provision, less is known about their impact on costs. This purpose of this study was to investigate the association between language barriers and the costs of health care. The data source was a representative set of asylum seekers whose health care was provided by a Swiss Health Maintenance Organisation (HMO). A cross-sectional survey was conducted: data was collected on all the asylum seekers' health care costs including consultations, diagnostic examinations, medical interventions, stays in the clinic, medication, and interpreter services. The data were analysed using path analysis. Asylum seekers showed higher health care costs if there were language barriers between them and the health professionals. Most of these increased costs were attributable to those patients who received interpreter services: they used more health care services and more material. However, these patients also had a lower number of visits to the HMO than patients who faced language barriers but did not receive interpreter services. Language barriers impact health care costs. In line with the limited literature, the results of this study seem to show that interpreter services lead to more targeted health care, concentrating higher health care utilisation into a smaller number of visits. Although the initial costs are higher, it can be posited that the use of interpreter services prevents the escalation of long-term costs. A future study specially designed to examine this presumption is needed.
Full Text Available Abstract Background There has been much debate regarding the refugee health situation in the UK. However most of the existing literature fails to take account of the opinions of refugees themselves. This study was established to determine the views of asylum seekers and refugees on their overall experiences in primary care and to suggest improvements to their care. Methods Qualitative study of adult asylum seekers and refugees who had entered the UK in the last 10 years. The study was set in Barnet Refugee Walk in Service, London. 11 Semi structured interviews were conducted and analysed using framework analysis. Results Access to GPs may be more difficult for failed asylum seekers and those without support from refugee agencies or family. There may be concerns amongst some in the refugee community regarding the access to and confidentiality of professional interpreters. Most participants stated their preference for GPs who offered advice rather than prescriptions. The stigma associated with refugee status in the UK may have led to some refugees altering their help seeking behaviour. Conclusion The problem of poor access for those with inadequate support may be improved by better education and support for GPs in how to provide for refugees. Primary Care Trusts could also supply information to newly arrived refugees on how to access services. GPs should be aware that, in some situations, professional interpreters may not always be desired and that instead, it may be advisable to reach a consensus as to who should be used as an interpreter. A better doctor-patient experience resulting from improvements in access and communication may help to reduce the stigma associated with refugee status and lead to more appropriate help seeking behaviour. Given the small nature of our investigation, larger studies need to be conducted to confirm and to quantify these results.
Full Text Available More than ten million people are stateless today. In a world of nation states, they live on the margins without membership in any state, and, as a consequence, have few enforceable legal rights. Stateless individuals face gaps in protection and in many cases experience persecution that falls within the refugee paradigm. However, US asylum policy does not adequately address the myriad legal problems that confront the stateless, who have been largely invisible in the jurisprudence and academic literature. Two federal appellate court opinions shed new light on the intersection of statelessness and refugee law in the United States. In 2010, Haile v. Holder examined the asylum claim of a young man rendered stateless when the Ethiopian government issued a decree denationalizing ethnic Eritreans. In a 2011 case, Stserba v. Holder, the court reviewed an asylum claim by a woman who became stateless when the Soviet Union collapsed, and the successor state of Estonia enacted citizenship legislation that included a language requirement. This article analyzes the opinions which suggest that state action depriving residents of citizenship on ethnic and other protected grounds warrants a presumption of persecution. This article also identifies additional circumstances in which stateless individuals may have a well-founded fear of persecution that qualifies them for asylum in the United States.In addition, this article notes that although far too many stateless individuals face persecution, not all of them do. Stateless persons who do not fear persecution, however, are also vulnerable. The absence of state protection condemns them to a precarious existence and their inability to obtain passports or other travel documents often prevents their return to states where they formerly resided. The refusal of most states to admit noncitizens frequently keeps stateless persons in limbo. Stateless individuals stranded in the United States live under a supervisory
Muller, Hana; Mwano, Geoffrey
The purpose of this study was to find out the challenges experienced by the representatives of unaccompanied minor asylum seekers (UMAS). It answers the question: what challenges do rep-resentatives encounter in their work? The study is under the Empowering Work Research and Development Path of Laurea University of Applied Sciences (Otaniemi). It was done with the approval of Espoo Group and Family Group Homes (Espoon ryhmä- ja perheryhmäkoti). This unit belongs to the city of Espoo and consi...
Turrini, Giulia; Purgato, Marianna; Ballette, Francesca; Nosè, Michela; Ostuzzi, Giovanni; Barbui, Corrado
In recent years there has been a progressive rise in the number of asylum seekers and refugees displaced from their country of origin, with significant social, economic, humanitarian and public health implications. In this population, up-to-date information on the rate and characteristics of mental health conditions, and on interventions that can be implemented once mental disorders have been identified, are needed. This umbrella review aims at systematically reviewing existing evidence on the prevalence of common mental disorders and on the efficacy of psychosocial and pharmacological interventions in adult and children asylum seekers and refugees resettled in low, middle and high income countries. We conducted an umbrella review of systematic reviews summarizing data on the prevalence of common mental disorders and on the efficacy of psychosocial and pharmacological interventions in asylum seekers and/or refugees. Methodological quality of the included studies was assessed with the AMSTAR checklist. Thirteen reviews reported data on the prevalence of common mental disorders while fourteen reviews reported data on the efficacy of psychological or pharmacological interventions. Although there was substantial variability in prevalence rates, we found that depression and anxiety were at least as frequent as post-traumatic stress disorder, accounting for up to 40% of asylum seekers and refugees. In terms of psychosocial interventions, cognitive behavioral interventions, in particular narrative exposure therapy, were the most studied interventions with positive outcomes against inactive but not active comparators. Current epidemiological data needs to be expanded with more rigorous studies focusing not only on post-traumatic stress disorder but also on depression, anxiety and other mental health conditions. In addition, new studies are urgently needed to assess the efficacy of psychosocial interventions when compared not only with no treatment but also each other
Clément, Renaud; Lebossé, David; Barrios, Lucia; Rodat, Olivier
Over a 6-year period, 570 survivors gave consent to this study and were examined by forensic medical doctors in academic French hospital. They evaluated with the aim of cataloguing the physical evidence of torture. Sociological data, declared violence (single physical altercation, repeated physical violence less than one year or more than one year, incarceration not more than one week or more than 1 week), and method of violence (blows by blunt object, crushing, burns, electrical shocks, attempted drowning, smothering, incision, or gunshot) were studied. An association between victims' statements and physical evidence of torture was determined. 70% were male with an average age of 31.9 years and ages between 1 and 70 years old. Dagestan, Guinea-Conakry and Guinea-Bissau were the countries most represented among asylum seekers. Beatings were reported by 27.89%, confinement was reported by 40.22%, and repeated violence by 30.16% of refugees. The average time interval between the first assault and forensic evaluation was 53 months. Forms of torture reported included: blunt force trauma (82.51%) truncheon blows (27.50%), arm incision (30%), and burns (16.3%). Statistically, truncheon blows were experienced more often by males in confinement due to political conflict. The use of crushing methods and electrical shocks also were experienced more often by males during confinement. Victims who had received incision wounds were significantly younger. Gunshots were statistically associated with male survivors of political conflict. Men experienced drowning and electrical shocks while in confinement in the Balkans, Asia, and Russia. Electrical shocks were reported by males during confinement and in northern Caucasus countries. The association was significant between assertions of burns and the presence of cutaneous scars (p = 0.0105); similarly, assertions of incision wounds were significantly corroborated by evidence of scars (p = 0.0009). Asylum seekers assessed were
Hytönen, Jukka; Khawaja, Tamim; Grönroos, Juha O; Jalava, Anna; Meri, Seppo; Oksi, Jarmo
We report two cases of louse-borne relapsing fever (LBRF) in young Somali asylum seekers having recently arrived to Finland. They had sought medical attention for a febrile illness. Blood smears were examined for suspected malaria, but instead, spirochete shaped bacteria were observed. The bacteria were confirmed as Borrelia recurrentis by PCR and sequencing. The patients survived, but their treatment was complicated by Jarisch-Herxheimer reaction. We conclude that LBRF must be considered as a diagnostic option in febrile refugees also in the northernmost parts of Europe. © 2016 APMIS. Published by John Wiley & Sons Ltd.
committee-to-hold-hearing-on-asylum-abuse. 178 Laura Wides-Munoz, “Honduran Teens , Mom Navigate Life after U.S. Reunion,” Associated Press, August...of membership in a particular social group. Concern about financial status or lack of opportunity may create fear and anxiety in people; nonetheless...Laura. “Honduran Teens , Mom Navigate Life after U.S. Reunion.” Associated Press, August 11, 2014. http://hosted.ap.org/dynamic/stories/U/US_
Frid-Nielsen, Snorre Sylvester
-2014, scaling MEPs along a unidimensional policy space. Debates on asylum predominantly concern positions for or against European Union (EU) security measures. Surprisingly, national party preferences for EU integration were not the dominant factor. The strongest predictors of MEPs' positions are their national...... parties’ general ‘right-left’ preferences, and duration of EU membership. Generally, MEPs from Central and Eastern Europe and the European People's Party take up pro-security stances. Wordfish was effective and valid, confirming the relevance of automated content analysis for studying the EU....
Romani, Maya; Ashkar, Khalil
Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to ...
Scientific diving plays an important role in helping EPA protect our oceans and waterways. EPA's divers set a high standard for safety and operational procedures in dangerous polluted water conditions.
Full Text Available Southern European countries have come to constitute the most vulnerable external border of the European Union (EU over the last decade. Irregular migration pressures have been acutely felt on the EU’s southern sea borders, and particularly on four sets of islands: Canary Islands (Spain, Lampedusa and Linosa (Italy, Malta, and Aegean Islands (Greece. This quartet is, to a large extent, used as stepping stones by irregular migrants and asylum seekers to reach the European continent. This paper studies the role of these islands as ‘outposts’ of a framework of externalization. It starts by discussing the notion of externalization and its different facets. It considers how externalization is linked to both fencing and gate-keeping strategies of migration and asylum control. The second part of the paper focuses on the special role of the island quartet with respect to the externalization web cast by national and EU-wide migration policies. It concludes with a critical reflection on the multi-level character of externalization policies and practices that occur both within the EU and between the EU and third countries.
Full Text Available The influx of asylum-seekers and refugees from across Africa into democratic South Africa has increased significantly. The aim of this paper is to determine the factors that influences the expect well-being of this unique group. Expected well-being is an important determinant of both the decision to migrate and the choice of a country of destination. Knowledge about this determinant therefore informs refugee policies. The results show that only a few of the factors found in the literature explaining the expected well-being of voluntary migrants also explain the expected well-being of forced migrants. However, a number of factors found in the literature that explain the subjective well-being and well-being in general of refugees and asylum-seekers also went towards explaining the expected well-being of this group. These factors include: government assistance, culture, the time spent in South Africa, economic factors, crime, refugee status, reasons for leaving the home countries and the number of people staying in a house in the receiving country. The findings of this study emphasise the differences between forced and voluntary migrants and highlight the factors that influence the expected well-being of forced migrants. These in turn shed light on migration decisions and the choice of destination countries.
Thaiz Silva Menezes
Full Text Available The present situation of the refugee international regime is a result of the historical affirmation of human rights, so that refuge and human rights are intrinsically related. The detention of asylum-seekers is an example of how intern procedures of the countries can oppose their commitments to human rights and to international protection: it is an usual practice during the process of refugee status determination, punishing the person forced to leave his/her country and seek international protection, introducing him/her into the penal system or into a prison-like system and, thus, systematically violating the rights of people who only seek the guaranty of their rights. This paper analyzes the characteristics of this practice and aims to demonstrate how it, because violates human rights, undermines the refuge – which exists exactly because of the imperative of respect for these rights. We concentrate specifically on the detention of asylum-seekers in the United States, because it was a great booster for the creation of the human rights and refugee international regimes, because it frequently uses, in its discourse, the sign of the human rights as parameter for the action of the states and for being one of the countries which have the largest numbers of refugees.
Hocking, Debbie C; Kennedy, Gerard A; Sundram, Suresh
The impact of industrialised host nations' deterrent immigration policies on the mental health of forced migrants has not been well characterised. The present study investigated the impact of Australia's refugee determination process (RDP) on psychiatric morbidity in community-based asylum-seekers (AS) and refugees. Psychiatric morbidity was predicted to be greater in AS than refugees, and to persist or increase as a function of time in the RDP. The effect on mental health of demographic and socio-political factors such as health cover and work rights were also investigated. Psychiatric morbidity was measured prospectively on five mental health indices at baseline (T1, n=131) and an average of 15.7 months later (T2, n=56). Psychiatric morbidity in AS significantly decreased between time points such that it was no longer greater than that of refugees at T2. Caseness of PTSD and demoralisation reduced in AS who gained protection; however, those who maintained asylum-seeker status at T2 also had a significant reduction in PTS and depression symptom severity. Reduced PTS and demoralisation symptoms were associated with securing work rights and health cover. Living in the community with work rights and access to health cover significantly improves psychiatric symptoms in forced migrants irrespective of their protection status. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Reher, Cornelia; Metzner, Franka
Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders Due to the Convention on the Rights of the Child and § 6 of the Asylum Seekers' Benefit Act, there are legal and ethical obligations for the care of minor refugees suffering from trauma-related disorders. In Germany, psychotherapeutic care of adolescent refugees is provided by specialized treatment centers and Child and Adolescent psychiatries with specialized consultation-hours for refugees. Treatment of minor refugees is impeded by various legal and organizational barriers. Many therapists have reservations and uncertainties regarding an appropriate therapy for refugees due to a lack of experience. This means that only a fraction of the young refugees with trauma-related disorders find an ambulatory therapist. In a review of international literature, empirical findings on (interpreter-aided) diagnostics and therapy of young refugees were presented. Practical experiences on therapeutic work with traumatized young refugees were summarized in a decision tree for therapy planning in the ambulatory setting. The decision tree was developed to support therapists in private practices by structuring the therapy process.
Full Text Available Background: Current knowledge is limited regarding patient characteristics related to treatment outcome of posttraumatic stress disorders (PTSD in refugees and asylum seekers. Objective: Gender, torture status, offender status, level of anger, and level of depression were investigated for possible effects on the treatment outcome. Method: Patient characteristics were explored in 54 refugees and asylum seekers who had completed a treatment program for PTSD. Non-responders (10, those who had the same or higher levels of symptom severity after treatment, were compared with responders, those who had lower symptom severity after treatment (44. Symptom severity was measured by Clinician-Administered PTSD Scale. The non-responders and responders constituted the dichotomous, dependent variable. The independent variables were gender, torture status, offender status, level of anger, and level of depression. T-tests and Exact Unconditional Homogeneity/Independence Tests for 2X2 Tables were used to study the relationship to treatment outcome. Results: Being male and reporting to have been a violent offender were significantly more frequent characteristics among the non-responders compared to the responders. The levels of pretreatment anger, depression and torture status did not affect the treatment outcome. Conclusions: The study adds support to findings that females benefit more from treatment of PTSD than males and that violent offenders are difficult to treat within the standard treatment programs.
Verran, Alice; Evans, Sarah; Lin, Daniel J; Griffiths, Frances
Chinese family planning policy is unique. There is limited sex education and the state is highly influential. This has resulted in extremely wide coverage of contraception with long-acting methods being favoured. The Chinese constitute a large proportion of asylum applicants to the UK. This study examines how their experiences and decisions about family planning in the UK are shaped by their cultural background. Data were drawn from 10 semi-structured qualitative interviews with female Chinese asylum seekers recruited through a family planning clinic in the UK. The increased autonomy provided by the UK system was appreciated by the participants. Choice of contraceptive method was influenced by traditional cultural beliefs and values, and the effect of hormonal contraception on menstruation was particularly concerning. Women arrived from China with little knowledge of contraception. Friends from a similar background were the most trusted source of advice. When transitioning from China to the UK unwanted pregnancies had occurred amongst unmarried women who had missed out on sex education while living in China. Chinese societal and cultural practices continue to influence family planning decisions made within the UK. Culturally competent health strategies are needed to ensure Chinese immigrant women fully benefit from family planning within the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Full Text Available According to the United Nations High Commissioner for Refugees (UNHCR, nowadays, 65,3 million individuals have been forcibly displaced worldwide. In Europe, Italy is one of the countries with the highest number of asylum seeker arrivals per year and the emergency nature of the present-day migratory flows are increasingly involving researchers and clinicians to come up with and develop new models of research and interventions. This article aims to conduct a review of the Italian psychological research in the field of forced migration in order to systematise the Italian studies, to compare the Italian situation with the international one and to define limits, resources and future directions of current Italian research. A literature review in the databases Scopus, PubMed and Web of Knowledge for documents published from 2012 to 2017 was conducted. From the analysis, twelve articles emerged principally following two main trajectories of investigation: a clinical and mental health-related trajectory and a psychosocial and community-based one. Compared with the wider international field of research, a general underdevelopment of Italian research emerged. Research into protective factors with regard to the development of psychopathological outcomes and on interventions is highly recommended. Results highlighted support for future research on the theme of asylum seekers and refugees. Some cause for reflection as regards levels of criticality, the direction of future research and specific links between research and Italian social policies were given.
Anderson, Joel R
Implicit and explicit attitudes correlate under certain conditions and researchers are interested in the moderating factors of this relationship. This paper explored the role of socially desirable responding in this relationship by testing the hypothesis that impression management (IM; i.e., deliberate response modification) and self-deceptive enhancement (SDE; i.e., positive self-bias) play moderating roles in the relationship of implicit-explicit attitudes toward asylum seekers in Australia. Seventy-four students responded to a battery of measures and the results revealed that IM (but not SDE) moderated this relationship to the extent that higher IM scores weakened the correspondence between implicit and explicit attitude scores. This suggests that attitudes toward asylum seekers might be susceptible to socially desirable response tendencies and in combination with the finding that IM was negatively related to explicit attitudes, it is argued that self-presentation concerns result in the deliberate attenuation of reported negative explicit attitudes. © 2017 International Union of Psychological Science.
The article describes the recent situation in the Mediterranean, where the number of asylum seekers arriving from countries south and east of the Mediterranean Sea is increasing significantly. The European Commission has suggested a plan, “A European Agenda on Migration”, which will redistribute ...... later on lead to a common EU migra-tion policy, which are beyond national control and would make it difficult to avoid responsibilities for internal crisis situations emerging in other parts of the Middle East or North Africa in the future.......The article describes the recent situation in the Mediterranean, where the number of asylum seekers arriving from countries south and east of the Mediterranean Sea is increasing significantly. The European Commission has suggested a plan, “A European Agenda on Migration”, which will redistribute...... the migrants arriving mainly in Italy and Greece, so that all 28 EU member states will take their part of the responsibility. The plan should – according to the EU-Commission – be mandatory and this has resulted in criticism from several member states, not least the UK. The article claims that the idea from...
Full Text Available Unaccompanied asylum-seeking children (UASC have experienced multiple traumas and are a high-risk group for posttraumatic stress disorder (PTSD. The effects of trauma are known to be associated with sleep problems; indeed sleeping problems are core features of PTSD. However, there has been no systematic research examining the sleep of this high risk group of children. This study presents the first evidence on the sleeping patterns of Afghan UASC living in the UK. A total of 222 male Afghan children, aged 13-18, were interviewed using validated self-report questionnaires measuring sleeping patterns and PTSD. Overall, UASC patterns for bed time and rise time appear acculturated to the country of asylum. Mean UASC sleep onset latency scores were approximately 20 minutes greater compared with normative scores, which may be a reflection of UASC pre-migration and post-migration experiences. As expected, UASC who screened above the clinical cut-off for PTSD reported significantly greater sleep onset latency, increased nightmares, and less total sleep time compared to the non-PTSD group. The results may be of particular interest to clinicians given that, compared to screening for PTSD, screening for sleep problems may be a less culturally disputed form of initial assessment indicating distress in UASC. Similarly, the field of UASC and refugee child interventions is largely focused on trauma, yet sleep may provide a novel avenue for equally or more effective treatment.
Hill, Micah J; DeCherney, Alan H
Physicians are involved in negotiations on a daily basis. Interactions with patients, support staff, nurses, fellow physicians, administrators, lawyers, and third parties all can occur within the context of negotiation. This article reviews the basic principles of negotiation and negotiation styles, models, and practical tools. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
This article discusses the first case law issued on the EU-Turkey deal from April to June 2016, which authoritatively answers the question whether Turkey constitutes a safe third country for refugees. In 390 out of 393 decisions, the Greek Asylum Appeals Committees ruled that Safe Third Country
The European Court of Human Rights' case law on judicial review in asylum cases is not entirely consistent. However, it can be interpreted as consistent if two presumptions are accepted. First, that, as the Court's role should be subsidiary to that of domestic courts, domestic judicial review should
This paper intends to address the challenges that the Italian education system is facing in terms of policies and practices relating to dis/abled asylum-seeking and refugee children, in order to make sense of the politics of daily life inside schools and the network of social services for forced migrants, and to pay renewed attention to the notion…
The period 1820–60 marked an era of transition and diversity in Ireland that rapidly transformed the face of Irish society. Inextricably linked with these processes was the expansion of Ireland's private asylum system. This system diverged from its British counterpart both in the socioeconomic cohort it served and in the role it played within the mental health-care system as a whole. The implementation of the 1842 Private Asylums (Ireland) Act, the first legislative measure geared exclusively toward the system, highlighted the growing importance of private care in Ireland as well as providing for the licensing and regulation of these institutions for the first time. To date, historians of Irish medicine have focused almost exclusively on the pauper insane. This article aims to shift this emphasis toward other categories of the Irish insane through exploration of the Irish private asylum system, its growth throughout the period, and the social profile of private patients. I shall also interrogate the trade in lunacy model through exploration of financial considerations, discharge and recovery rates, and conditions of care and argue that while Irish private institutions were a lucrative business venture, the quality of care upheld was apparently high. Finally, I shall argue that Irish private asylums catered primarily for the upper classes and briefly explore alternative provisional measures for other non-pauper sectors of society. PMID:21355010
Gerritsen, A.A.M.; Bramsen, I.; Devillé, W.; Willigen, L.H.M. van; Hovens, J.E.; Ploeg, H.M. van der
BACKGROUND: This article discusses the design of a study on the prevalence of health problems (both physical and mental) and the utilisation of health care services among asylum seekers and refugees in the Netherlands, including factors that may be related to their health and their utilisation of
Stellinga-Boelen, Annette A. M.; Wiegersma, P. Auke; Storm, Huub; Bijleveld, Charles M. A.; Verkade, Henkjan J.
Low dietary intake and limited sun exposure during Dutch winters, in particular when combined with highly pigmented skin, could compromise the vitamin D status of asylum seekers' children in The Netherlands. We determined the vitamin D status of children living in The Netherlands, but originating
The principle of non-discrimination in Article 2 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) holds that its rights are equally applicable to ‘everyone’. Nevertheless, evidence from the national context suggests that access to health care for asylum seekers and
Since 2005 around 60,000 asylum seekers, mostly from Eritrea and Sudan, have entered Israel by crossing the border from Egypt. Notwithstanding the Jewish history of persecution, and Israel being a signatory to the UN Convention for the protection of refugees, modern Israel systematically refuses to
Gerritsen, A.A.M.; Bramsen, I.; Devillé, W.; Willigen, L.H.M. van; Hovens, J.E.; Ploeg, H.M. van der
BACKGROUND: Although asylum seekers have been coming to The Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants, or on the refugees who have resettled in this country. The objective of this study is to estimate the use of health care services by
Full Text Available Housing is an important social determinant of health; however, little is known about the impact of housing experiences on health and wellbeing for people from refugee and asylum-seeking backgrounds. In this paper, we outline a qualitative component of a study in South Australia examining these links. Specifically, interviews were conducted with 50 refugees and asylum seekers who were purposively sampled according to gender, continent and visa status, from a broader survey. Interviews were analysed thematically. The results indicated that housing was of central importance to health and wellbeing and impacted on health through a range of pathways including affordability, the suitability of housing in relation to physical aspects such as condition and layout, and social aspects such as safety and belonging and issues around security of tenure. Asylum seekers in particular reported that living in housing in poor condition negatively affected their health. Our research reinforces the importance of housing for both the physical and mental health for asylum seekers and refugees living in resettlement countries. Improving housing quality, affordability and tenure security all have the potential to lead to more positive health outcomes.
Ziersch, Anna; Walsh, Moira; Due, Clemence; Duivesteyn, Emily
Housing is an important social determinant of health; however, little is known about the impact of housing experiences on health and wellbeing for people from refugee and asylum-seeking backgrounds. In this paper, we outline a qualitative component of a study in South Australia examining these links. Specifically, interviews were conducted with 50 refugees and asylum seekers who were purposively sampled according to gender, continent and visa status, from a broader survey. Interviews were analysed thematically. The results indicated that housing was of central importance to health and wellbeing and impacted on health through a range of pathways including affordability, the suitability of housing in relation to physical aspects such as condition and layout, and social aspects such as safety and belonging and issues around security of tenure. Asylum seekers in particular reported that living in housing in poor condition negatively affected their health. Our research reinforces the importance of housing for both the physical and mental health for asylum seekers and refugees living in resettlement countries. Improving housing quality, affordability and tenure security all have the potential to lead to more positive health outcomes.
Hughes, Nathan; Beirens, Hanne
The importance of early school experiences in the personal and social development of young refugees and asylum-seekers has been documented by researchers and enshrined in practice guidelines. The capacity of schools to implement these guidelines is, however, limited, in terms of the availability of appropriate knowledge and skills, financial…
Apostolidou, Zoe; Schweitzer, Robert
The present study is the first study undertaken in Australia that seeks to explore practitioners' perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugees. We used thematic analysis to analyse extracts of interviews that were conducted with nine professionals who worked therapeutically with…
Goosen, S.; Kunst, A.E.; Stronks, K.; van Oostrum, I.E.A.; Uitenbroek, D.G.; Kerkhof, A.J.F.M.
Several suicide and suicidal behaviour risk factors are highly prevalent in asylum seekers, but there is little insight into the suicide death rate and the suicidal behaviour incidence in this population. The main objective of this study is to assess the burden of suicide and hospital-treated
Schot, Suzanne; Bruijn, Larissa Michelle
During the 2015 refugee crisis border police officers engaged in violent behavior against asylum-seekers travelling through transit countries to reach the European Union. In Macedonia and Serbia, the violence included beatings, violent assaults, and the use of excessive force in form of stun
van Veldhuizen, Tanja S.; Horselenberg, Robert; Landström, Sara; Granhag, Pär Anders; van Koppen, Peter J.
The aim of the current vignette study is to map the style, type, and themes of questions that are asked when assessing the credibility of asylum seekers' claims. Sixty-five officials from the Swedish Migration Agency (Migrationsverket), were asked to respond to one out of four different vignettes
Recent scholarship has explored the dynamics between families and colonial lunatic asylums in the late nineteenth century, where families actively participated in the processes of custodial care, committal, treatment and release of their relatives. This paper works in this historical field, but with some methodological and theoretical differences. The Foucauldian study is anchored to a single case and family as an illness narrative that moves cross-referentially between bureaucratic state archival material, psychiatric case records, and intergenerational family-storytelling and family photographs. Following headaches and seizures, Harry Walter Wilbraham was medically boarded from his position as Postmaster in the Cape of Good Hope Colony of South Africa with a 'permanent disease of the brain', and was committed to the Grahamstown Asylum in 1910, where he died the following year, aged 40 years. In contrast to writings about colonial asylums that usually describe several patient cases and thematic patterns in archival material over time and place, this study's genealogical lens examines one white settler male patient's experiences within mental health care in South Africa between 1908 and 1911. The construction of Harry's 'case' interweaves archival sources and reminiscences inside and outside the asylum, and places it within psychiatric discourse of the time, and family dynamics in the years that followed. Thus, this case study maps the constitution of 'patient' and 'family' in colonial life, c.1888-1918, and considers the calamity, uncertainty, stigma and silences of mental illness.
National Institute of Adult Continuing Education, 2009
This briefing paper endeavours to highlight the challenges facing refugees and asylum seekers in the United Kingdom in accessing education, training and employment. It does not claim to cover all the issues but is intended as a starting point for providers of adult learning and/or advice. It initially sets out the facts about definitions and…
Reijneveld, S.A.; de Boer, J.B.; Bean, T.; Korfker, D.G.
We assessed the effects of a stringent reception policy on the mental health of unaccompanied adolescent asylum seekers by comparing the mental health of adolescents in a restricted campus reception setting and in a setting offering more autonomy (numbers [response rates]: 69 [93%] and 53 [69%],
Interest in the integration of refugees has grown with the increase in numbers of asylum seekers dispersed across the UK. The ability to communicate effectively in English is seen as the key priority in facilitating integration, while a lack of English language is seen as one of the major barriers to refugee employment. Some 267 million British…
McClendon, B J; Politzer, R M; Christian, E; Fernandez, E S
OBJECTIVE: To estimate the need for downsizing the physician workforce in a changing health care environment. METHODS: First assuming that 1993 physician-to-population ratios would be maintained, the authors derived downsizing estimates by determining the annual growth in the supply of specialists necessary to maintain these ratios (sum of losses from death and retirement plus increase necessary to parallel population growth) and compared them with an estimate of the number of new physicians being produced (average annual number of board certificates issued between 1990 and 1994). Then, assuming that workforce needs would change in a system increasingly dominated by managed care, the authors estimated specialty-specific downsizing needs for a managed care dominated environment using data from several sources. RESULTS: To maintain the 1993 199.6 active physicians per 100,000 population ratio, 14,644 new physicians would be needed each year. Given that an average of 20,655 physicians were certified each year between 1990 and 1994, at least 6011 fewer new physicians were needed annually to maintain 1993 levels. To maintain the 132.2 ratio of active non-primary care physicians per 100,000 population, the system needed to produce 9698 non-primary care physicians per year, because an average of 14,527 new non-primary care physicians entered the workforce between 1990 and 1994, downsizing by 4829, or 33%, was needed. To maintain the 66.8 active primary care physicians per 100,000 population ratio, 4946 new primary care physicians were needed per year, since primary care averaged 6128 new certifications per year, a downsizing of 1182, or 20% was indicated. Only family practice, neurosurgery, otolaryngology, and urology did not require downsizing. Seventeen medical and hospital-based specialties, including 7 of 10 internal medicine subspecialties, needed downsizing by at least 40%. Less downsizing in general was needed in the surgical specialties and in psychiatry. A
Bozorgmehr, Kayvan; Razum, Oliver; Saure, Daniel; Joggerst, Brigitte; Szecsenyi, Joachim; Stock, Christian
All asylum seekers in Germany undergo upon-entry screening for tuberculosis TB, but comprehensive evidence on the yield is lacking. We compared the national estimates with the international literature in a systematic review and meta-analysis of studies reporting the yield of TB, defined as the fraction of active TB cases detected among asylum seekers screened in Germany upon entry. We searched 11 national and international databases for empirical studies and the internet for grey literature published in English or German without restrictions on publication time. Among 1,253 screened articles, we identified six articles reporting the yield of active TB based on German data, ranging from 0.72 (95% confidence interval (CI): 0.45-1.10) to 6.41 (95% CI: 4.19-9.37) per 1,000 asylum seekers. The pooled estimate across all studies was 3.47 (95% CI: 1.78-5.73; I(2) = 94.9%; p < 0.0001) per 1,000 asylum seekers. This estimate was in line with international evidence (I(2) = 0%; p for heterogeneity 0.55). The meta-analysis of available international estimates resulted in a pooled yield of 3.04 (95% CI: 2.24-3.96) per 1,000. This study provides an estimate across several German federal states for the yield of TB screening in asylum seekers. Further research is needed to develop more targeted screening programmes. This article is copyright of The Authors, 2017.
Bachrach, D J
While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management; intramurally conducted courses in leadership skill development, management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. While part one of this series, which appeared in Volume 43, No. 6 of Medical Group Management Journal addressed, "The changing role of physician leaders at academic medical centers," part 2 will examine as a case study the faculty leadership development program at the University of Texas M.D. Anderson Cancer Center. These two articles were prepared by the author from his research into, and the presentation of a thesis entitled. "The importance of leadership training and development for physicians in academic medical centers in an increasingly complex health care environment," prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in this College.*
Snyder, L; Sulmasy, D P
Medical professional codes have long prohibited physician involvement in assisting a patient's suicide. However, despite ethical and legal prohibitions, calls for the liberalization of this ban have grown in recent years. The medical profession should articulate its views on the arguments for and against changes in public policy and decide whether changes are prudent. In addressing such a contentious issue, physicians, policymakers, and society must fully consider the needs of patients, the vulnerability of particular patient groups, issues of trust and professionalism, and the complexities of end-of-life health care. Physician-assisted suicide is prominent among the issues that define our professional norms and codes of ethics. The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) does not support the legalization of physician-assisted suicide. The routine practice of physician-assisted suicide raises serious ethical and other concerns. Legalization would undermine the patient-physician relationship and the trust necessary to sustain it; alter the medical profession's role in society; and endanger the value our society places on life, especially on the lives of disabled, incompetent, and vulnerable individuals. The ACP-ASIM remains thoroughly committed to improving care for patients at the end of life.
Full Text Available The article tackles the problem of models of communication in science. The formal division of communication processes into oral and written does not resolve the problem of attitude. The author defines successful communication as a win-win game, based on the respect and equality of the partners, regardless of their position in the world of science. The core characteristics of the process of scientific communication are indicated , such as openness, fairness, support, and creation. The task of creating the right atmosphere for science communication belongs to moderators, who should not allow privilege and differentiation of position to affect scientific communication processes.
The prominent Simonović family, from its earliest ancestors known for seeking and promoting education and holding key positions in the society, is known for several remarkable intellectuals, cultural and public workers, as well as physicians. They were all exceptional in their own way, contributing to national education and their professions, and not by accident. This paper presents personal lives and professional careers of three brothers, physicians from the Simonović family: Dr. Radivoj Simonović, a famous physician from Sombor who was also a historian, ethnographer, mountaineer, geomorphologist, photoamateur and a medical educator, Dr. Milan Simonović, for many years beloved and well-known physician in Petrovaradin, and Dr. Svetislav Simonović, esteemed physician in Belgrade who was the personal physician to King Petar Karadordević. Apart from their family heritage, their scientific and professional achievements are certainly a result of their talents, training and discipline.
Abbasi, Mahmoud; Pirouz, Amir Samavati
The physician's acquittal has obsessed Iranian legislator's mind to a large extent. This is exclusively observed in Iranian statuses and specifically in Shi’ite school of though. Muslim jurists’ opinions play a very important role in enacting legal articles related to it. After reviewing the literature, the authors tried to pick and collect common features of physician's responsibilities and duties to introduce Iranian Acts with respect to the subject. Also, Iranian Acts are analyzed and the challenging medical topics such as emergency situations and infectious diseases are discussed. Iranian legislator didn’t specify a kind of physician's acquittal which received from the patient knowingly and is based on his/her free will. There are also some medical and legal gaps. Patients are not often informed of all exact and scientific information and results of their treatments. Furthermore, the forms prepared to receive the patient's consent do not provide what Iranian legislator meant. PMID:22091234
Keygnaert, Ines; Vettenburg, Nicole; Roelens, Kristien; Temmerman, Marleen
.... Hence, this paper explores how refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands define sexual health, search for sexual health information and perceive sexual health determinants...
Weisz, George M
The mystery behind the behavior of infamous personalities leaves many open questions, particularly when related to the practice of medicine. This paper takes a brief look at two Jewish physicians who played memorable roles in the life of Adolf Hitler.
U.S. Department of Health & Human Services — This is the official dataset associated with the Medicare.gov Physician Compare Website provided by the Centers for Medicare and Medicaid Services (CMS). These data...
... classrooms, taking courses such as anatomy, biochemistry, pharmacology, psychology, medical ethics, and in the laws governing medicine. ... Surgeons, All Other Preventive Medicine Physicians Psychiatrists Radiologists Sports Medicine ... <- Similar Occupations Suggested citation: ...
U.S. Department of Health & Human Services — Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act to impose additional requirements for physician-owned hospitals to...
U.S. Department of Health & Human Services — The physician referral data was initially provided as a response to a Freedom of Information (FOIA) request. These files represent data from 2009 through June 2013...
U.S. Department of Health & Human Services — The physician referral data linked below was provided as a response to a Freedom of Information Act (FOIA) request. These files represent the number of encounters a...
Full Text Available This photographic essay presents images from the City of London Asylum archive as a example of how the visual can be used to expand our investigations of social histories of Victorian London, particularly the multi-cultural nature of the city. The essay argues that images are an essential part of the research process, but also discusses some of the disadvantages and ethical tensions encountered through the use of such portraits for historical recovery. Despite these caveats, the paper concludes that we have much to learn from the images that present images of the city that would otherwise be difficult, if not impossible, for twenty-first-century researchers to access.
Full Text Available Unaccompanied minor asylum seekers are vulnerable and thus, provided special international law protections. However, in reality, they are being mistreated as illegal immigrants and on thereceiving end of ethnic violence, discrimination, restrictions in enjoyment of their rights duly recognised by international human rights law. This article identifies legislative, policy and supportmechanisms which encompass the minimum UMAS guardianship standards at international law and which are evidence-based from best practice models for the provision of guardians for UMASinternationally. It presents situation of UMAS in relation to human rights violations with emphasis on the legal framework and practices in Australia and five ASEAN State Members. This article also highlights the various stands taken by various countries providing better legal framework and practices regarding the terms for protection and enforcement of human rights for UMAS. Finally, this article provides recommendations for Australia and ASEAN Member States to adopt in order to realise the international human rights of UMAS with respect to guardianship.
Australian asylum records (circa 1860 to circa 1945) demonstrate that medical staff went to great lengths to provide recreation to suitable patients. This article examines how the demarcation of Australian institutional spaces along gender divisions was also mirrored by the gender-specific recreational activities provided in purpose-built facilities. Using Australian examples I demonstrate how the main forms of recreation-that is divine service, music and dance, and sport-were justified to governments on medical grounds. Some designated recreational spaces even offered select female and male patients the opportunity to mix under medical supervision. Recreation was therapeutic because of its psychological, physical, social, and moral benefits, and government authorities funded the construction of costly chapels, recreation halls, and sports grounds expressly for this medical purpose.
Full Text Available How does the press in Hungary write about refugees, asylum-seekers and refugee affairs? We sought to answer this question. Articles appearing in 2005 and 2006 in two leading national Hungarian dailies were examined with quantitative content analysis. The results show that the articles analyzed often treat refugee affairs as an “official” political matter. The high proportion of legislation and political positions conveys the image that refugee affairs are a state or intergovernmental matter, an “official”, legal, political issue rather than for example a humanitarian question. Most of the articles published in both papers write about problems and conflicts in connection with refugee affairs. The negative media image has different significance for different topics. We argue that the question of refugee affairs is a topic where the image shown by the media is of great relevance: the media can be a more important source of information on this subject than personal contacts.
Bower, Nathan W. [Department of Chemistry, Colorado College, Colorado Springs, CO 80903-3294 (United States)]. E-mail: email@example.com; McCants, Sarah A. [Department of Chemistry, Colorado College, Colorado Springs, CO 80903-3294 (United States); Custodio, Joseph M. [Department of Chemistry, Colorado College, Colorado Springs, CO 80903-3294 (United States); Ketterer, Michael E. [Departments of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ 86011-5698 (United States); Getty, Stephen R. [Biological Sciences Curriculum Study, Colorado Springs, CO 80918 (United States); Hoffman, J. Michael [Department of Anthropology, Colorado College, Colorado Springs, CO 8090-3294 (United States)
Lead isotope ratios and lead (Pb) levels were analyzed in 33 individuals from a forgotten cemetery at the Colorado Mental Health Institute at Pueblo, Colorado dating to 1879-1899. Isotopic ratios from healing bone fractures, cortical bone, and tooth dentine provide information about sources of Pb exposures over a range of time that illuminates individual's life histories and migration patterns. Historical records and Pb production data from the 19th century were used to create a database for interpreting Pb exposures for these African, Hispanic and European Americans. The analysis of these individuals suggests that Pb exposure noticeably impacted the mental health of 5-10% of the asylum patients in this frontier population, a high number by standards today, and that differences exist in the three ancestral groups' exposure histories.
Kristensen, Kristina Langholz; Podlekareva, Daria; Ravn, Pernille
The still increasing global migration affects the epidemiology of tuberculosis (TB) in European countries. We present the case of an asylum seeker from a TB high-endemic country, who presented with severe TB spondylodiscitis and need for emergency surgery. The patient had a history of recurrent...... sterile axillary and perianal abscesses for years, but TB was never properly ruled out. The patient underwent surgery, responded well to antibiotics and regained the ability to walk. After 6 month of treatment the patient was lost to follow-up. In light of the increasing migration from TB high......-endemic countries to low-endemic countries, this case illustrates the paramount importance of minding TB as a differential diagnosis....
Montgomery, Edith; Foldspang, Anders
Aims: The aim of this study was to compare profiles of present mental health and previous exposure to violence among refugee children from the Middle East, whose asylum seeking families either did or did not obtain permission to stay in Denmark. Methods: Shortly after arrival in Denmark......, the parents of 311 Middle-Eastern children answered a structured interview on their children’s exposure to organized violence and their mental health. The families were followed-up as concerns receipt of a residence permit. Results: At arrival in Denmark, the children’s patterns of previous exposure...... to violence and present mental health was generally similar irrespective of the family getting a residence permit, as was the case for 90 families (60.4%) with 190 children (61.1%). In both groups an overwhelming majority, eight to nine out of 10 children, had been exposed to conditions of war and had stayed...
Hanewald, Bernd; Gieseking, Janina; Vogelbusch, Oliver; Markus, Inessa; Gallhofer, Bernd; Knipper, Michael
Interdisciplinary analysis of the consequences of laws and legal practice for mental health conditions of asylum seekers and psychiatric care. Based on the case study of a Kurdish woman with complex trauma-related psychiatric disorder, who had been in psychiatric hospital care for 25 months, the legal and medical facts are exposed, followed by a discussion referring to theoretical approaches from medical anthropology. Immigration laws and legal practice can have harmful consequences, which can be interpreted as "structural violence". In case of traumatized refugees, the coaction of legal and medical aspects has to be acknowledged seriously by the medical, legal and political parts involved. © Georg Thieme Verlag KG Stuttgart · New York.
Moore, John W.
These cases provide a good basis for discussions of scientific ethics, particularly with respect to the responsibilities of colleagues in collaborative projects. With increasing numbers of students working in cooperative or collaborative groups, there may be opportunities for more than just discussion—similar issues of responsibility apply to the members of such groups. Further, this is an area where, “no clear, widely accepted standards of behavior exist” (1). Thus there is an opportunity to point out to students that scientific ethics, like science itself, is incomplete and needs constant attention to issues that result from new paradigms such as collaborative research. Finally, each of us can resolve to pay more attention to the contributions we and our colleagues make to collaborative projects, applying to our own work no less critical an eye than we would cast on the work of those we don’t know at all.
Wångdahl, Josefin; Lytsy, Per; Mårtensson, Lena; Westerling, Ragnar
The purpose of the health examination for asylum seekers in most countries is to identify poor health in order to secure the well-being of seekers of asylum and to guarantee the safety of the population in the host country. Functional health literacy is an individual's ability to read information and instructions about health and to function effectively as a patient in the health system, and comprehensive health literacy is an individual's competence in accessing, understanding, appraising and applying health information. Little is known about refugees' health literacy and their experiences of the health examination for asylum seekers. The purposes of the study were to investigate refugees' experiences of communication during their health examination for asylum seekers and the usefulness of that examination, and whether health literacy is associated with those experiences. A cross-sectional study was made among 360 adult refugees speaking Arabic, Dari, Somali or English. Health literacy was measured using the Swedish Functional Health Literacy Scale and the short European Health Literacy Questionnaire. Experiences of communication and the usefulness of the health examination were measured in several questions. Associations were sought using univariate and multivariate statistical models. In the health examination for asylum seekers, a poor quality of communication was experienced by 36 %, receiving little information about health care by 55 %, and receiving little new knowledge by 41 % and/or help by 26 %. Having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of a poorer quality of communication (OR: 9.64, CI 95 %: 3.25-28.58) and the experience of receiving little valuable health care information (OR: 6.54, CI 95 %: 2.45-17.47). Furthermore, having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of not receiving new knowledge (OR: 7.94, CI 95 %: 3
Molto si è discusso sui quattro livelli progressivi secondo i quali Varrone struttura l’etimologia in ling. 5, 8; a ogni livello è associato un diverso tipo di analisi e si applica a una diversa categoria di parole. Una formulazione criptica ed ellittica, in un passo che nel manoscritto del testo è quasi certamente corrotto, avvolgono il quarto livello in una nube di incertezza e ambiguità. Se alcuni filologi hanno difeso il mantenimento del tradito Quartus, ubi est aditus et initia regis (“Il quarto livello è dove è l’ingresso e le origini del re”, la maggior parte delle interpretazioni moderne opta piuttosto per l’emendazione di aditus in adytum (“santuario” e legge il passo come un riferimento a vari tipi di culti misterici, collocando il quarto livello etimologico in un quadro di esoterismo. Nel presente contributo, si avanza la proposta che nel passo in questione non vi sia alcuna allusione ai misteri, ma un riferimento all’episodio storico-leggendario della fondazione, da parte di Romolo, di un “santuario” sul Campidoglio, destinato all’accoglienza di supplici provenienti da ogni popolo ed estrazione sociale. Questa istituzione portò alla formazione del primo nucleo abitativo di Roma e anche, di conseguenza, del sostrato vernacolare alle origini della lingua latina; come tale, tale episodio converge con gli interessi e le idee di Varrone. L’ipotesi che il quartus gradus etymologiae alluda al santuario di Romolo può essere difesa o dando una nuova interpretazione al termine adytum, o proponendo un’emendazione testuale (aditus > asylum, che produca il testo Quartus, ubi est asylum et initia regis.
Keboa, Mark Tambe; Hiles, Natalie; Macdonald, Mary Ellen
Improving the oral health of refugees and asylum seekers is a global priority, yet little is known about the overall burden of oral diseases and their causes for this population. To synthesize available evidence on the oral health of, and access to oral health care by this population. Using a scoping review methodology, we retrieved 3321 records from eight databases and grey literature; 44 publications met the following inclusion criteria: empirical research focused on refugees and/or asylum seekers' oral health, published between 1990 and 2014 in English, French, Italian, Portuguese, or Spanish. Analysis included descriptive and thematic analysis, as well as critical appraisal using the Critical Appraisal Skills Programme (CASP) criteria for quantitative and qualitative studies. The majority of publications (86 %) were from industrialized countries, while the majority of refugees are resettled in developing countries. The most common study designs were quantitative (75 %). Overall, the majority of studies (76 %) were of good quality. Studies mainly explored oral health status, knowledge and practices; a minority (9 %) included interventions. The refugee populations in the studies showed higher burden of oral diseases and limited access to oral health care compared to even the least privileged populations in the host countries. Minimal strategies to improve oral health have been implemented; however, some have impressive outcomes. Oral health disparities for this population remain a major concern. More research is needed on refugees in developing countries, refugees residing in refugee camps, and interventions to bridge oral health disparities. This review has utility for policymakers, practitioners, researchers, and other stakeholders working to improve the oral health of this population.
In the last few decades, the State of Israel has become a target for work migrants, refugees, asylum seekers and victims of human trafficking, as part of the trend of world immigration. Immigration is a process of loss and change with significant socio-psychological stress, with possible effects on the immigrants' mental health. The Physicians for Human Rights - Israel (PHR) Association operates a psychiatric clinic as part of the Open Clinic for Work Migrants and Refugees. This article will present major clinical issues regarding psychiatry and immigration in Israel according to the data collected at the clinic. Trauma and stress-related psychopathology was found to have a high prevalence in immigrant patients treated at the clinic; prevalence of PTSD (post-traumatic stress disorder) in immigrants was high (23%) and even higher in refugees (33%). Female immigrants are at higher risk for psychiatric hospitalization. The relative rate of African patients at the clinic is significantly higher than patients from other continents. A significant association was found between psychiatric hospitalization and suicide attempts. Immigrant patients present a combination of psychiatric, socio-economic and general medical conditions, which demands a holistic view of the patient. The evaluation of an immigrant patient must take into account the stress related to immigration, gender, culture of origin and the risk for suicide and hospitalization. Treatment recommendations include awareness of cultural diversities, acquiring information regarding the pre-immigration history, preferably using cultural consultants with background in the immigrants' culture and community. Decision-making about medication and diagnostic evaluation should be as inexpensive as possible. Basic human needs (food, shelter) and family support should be included in the decisions about treatment.
Nosè, M; Turrini, G; Barbui, C
In the populations of refugees and asylum seekers hosted in high-income countries, access to mental health care and psychotropic drugs, is a major challenge. A recent Swedish cross-sectional register study has explored this phenomenon in a national cohort of 43 403 young refugees and their families from Iraq, Iran, Eritrea, Ethiopia, Somalia and Afghanistan. This register study found lower rates of dispensed psychotropic drugs among recently settled refugees, as compared with Swedish-born residents, with an increase in the use with duration of residence. In this commentary, the results of this survey are discussed in view of their global policy implications for high-income countries hosting populations of refugees and asylum seekers.
de Micheli-Serra, A
The long way toward the Mexican Independence developed in various stages, each one characterized by the temperament of the leaders, the theater of war actions and the social instances. At the beginning of the movement, of popular and radical types, we find few physicians perhaps due to the small number of them in the cities and to their absence in the villages. The middle period shows a larger number of national and foreign physicians. They are present in a more important number during the last stage, of bourgeois and reformist characteristics. The comportment of these worthy members of the medical class, during the different stages of the national independence movement, is a clear example of the patriotism and honesty of the Mexican physicians.
Romani, Maya; Ashkar, Khalil
Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to cognitive-behavioral and patient-centered therapy have been found to be of utmost significance when it comes to preventing and treating burnout. However, evidence is insufficient to support that stress management programs can help reducing job-related stress beyond the intervention period, and similarly mindfulness-based stress reduction interventions efficiently reduce psychological distress and negative vibes, and encourage empathy while significantly enhancing physicians' quality of life. On the other hand, a few small studies have suggested that Balint sessions can have a promising positive effect in preventing burnout; moreover exercises can reduce anxiety levels and exhaustion symptoms while improving the mental and physical well-being of healthcare workers. Occupational interventions in the work settings can also improve the emotional and work-induced exhaustion. Combining both individual and organizational interventions can have a good impact in reducing burnout scores among physicians; therefore, multidisciplinary actions that include changes in the work environmental factors along with stress management programs that teach people how to cope better with stressful events showed promising solutions to manage burnout. However, until now there have been no rigorous studies to prove this. More interventional research targeting medical students, residents, and practicing physicians are needed in order to improve psychological well-being, professional careers, as well as the
Sundqvist, Johanna; Hansson, Jonas; Ghazinour, Mehdi; Ögren, Kenneth; Padyab, Mojgan
During the past ten years the number of unaccompanied asylum-seeking refugee children has dramatically increased in Sweden. Some of them are permitted to stay in the receiving country, but some are forced back to their country of origin. Social workers and police officers are involved in these forced repatriations, and such complex situations may cause stressful working conditions. This study aimed to bridge the gap in knowledge of the relationship between general mental health and working wi...
Mosinkie Phillip I
Full Text Available Abstract Background Refugees and asylum seekers experience language barriers in general practice. Qualitative studies have found that responses to language barriers in general practice are ad hoc with use of both professional interpreters and informal interpreters (patients' relatives or friends. However, the scale of the issues involved is unknown. This study quantifies the need for language assistance in general practice consultations and examines the experience of, and satisfaction with, methods of language assistance utilized. Methods Data were collected by telephone survey with general practitioners in a regional health authority in Ireland between July-August 2004. Each respondent was asked a series of questions about consulting with refugees and asylum seekers, the need for language assistance and the kind of language assistance used. Results There was a 70% (n = 56/80 response rate to the telephone survey. The majority of respondents (77% said that they had experienced consultations with refugees and asylum seekers in which language assistance was required. Despite this, general practitioners in the majority of cases managed without an interpreter or used informal methods of interpretation. In fact, when given a choice general practitioners would more often choose informal over professional methods of interpretation despite the fact that confidentiality was a significant concern. Conclusion The need for language assistance in consultations with refugees and asylum seekers in Irish general practice is high. General practitioners rely on informal responses. It is necessary to improve knowledge about the organisational contexts that shape general practitioners responses. We also recommend dialogue between general practitioners, patients and interpreters about the relative merits of informal and professional methods of interpretation so that general practitioners' choices are responsive to the needs of patients with limited English.
Pohl, Christian; Mack, Ines; Schmitz, Torsten; Ritz, Nicole
The aim of this retrospective study was to describe the epidemiology and spectrum of infections of admitted pediatric refugees and asylum seekers in a tertiary referral hospital in a high-income country in Europe. We identified recent refugees and asylum seekers < 18 years of age admitted to the University Children's Hospital in Basel, Switzerland, in 2015. A retrospective analysis was performed using electronic patient records. We identified 105 admissions in 93 patients with a median age of 5.7 (IQR 2.6-14.5) years. Eritrea, Syria, and Afghanistan were the most frequent countries of origin. The median duration of admission was 4 (IQR 2-6) days with infections and elective surgical interventions being the most common reason (54.8 and 16.1%, respectively). Most infections were airway, skin, and gastrointestinal in 46.4, 20.2, and 11.9%, respectively. The prevalence of tropical infections was 11.9%. The main pathogens identified were influenza A virus (13.8%), Staphylococcus aureus (10.3%), and rhino/enterovirus (10.3%). Previous medical non-infectious conditions were recorded in 13%. The study revealed a high burden of infections in admitted patients mostly caused by well-known pathogens prevalent also in the local population. Both tropical infections and pre-existing non-infectious conditions are also important in admitted patients. Better epidemiological data is required to optimize health care for this medically most vulnerable population in refugee crises. What is Known: • Pediatric refugees and asylum seekers are the most vulnerable population in refugee crises. • Data on health concerns and needs in this population is scarce. What is New: • This is one of the first studies on the epidemiology of pediatric refugees and asylum seekers treated as inpatients in a European high-income country. • The high burden of infections is mostly caused by well-known pathogens prevalent also in the local population.
Mellou, Kassiani; Chrisostomou, Anthi; Sideroglou, Theologia; Georgakopoulou, Theano; Kyritsi, Maria; Hadjichristodoulou, Christos; Tsiodras, Sotirios
An increased number of hepatitis A cases among refugees, asylum seekers and migrants residing in hosting facilities in Greece were recorded between April and December 2016. In total, 177 laboratory-confirmed symptomatic cases were reported; of these, 149 (84%) occurred in hosting camps mostly among Syrian children under 15 years. All cases reported symptom onset after their entry into the country. Public health interventions focused on hygiene measures and vaccination. This article is copyright of The Authors, 2017.
Full Text Available This paper aims to analyze the situation of the asylum seekers and the economic immigrants starting from an historic and legislative summary of the immigration in Italy. The case study concerns the situation in Calabria, Southern Italy. The comparison between the situation of the Calabrian jungles and the protection system called SPRAR, is used to explain the paradigm of the Italian migration policy that still considers immigration as some kind of permanent emergency.
MacFarlane, Anne; Glynn, Liam G; Mosinkie, Phillip I; Murphy, Andrew W
Refugees and asylum seekers experience language barriers in general practice. Qualitative studies have found that responses to language barriers in general practice are ad hoc with use of both professional interpreters and informal interpreters (patients' relatives or friends). However, the scale of the issues involved is unknown. This study quantifies the need for language assistance in general practice consultations and examines the experience of, and satisfaction with, methods of language assistance utilized. Data were collected by telephone survey with general practitioners in a regional health authority in Ireland between July-August 2004. Each respondent was asked a series of questions about consulting with refugees and asylum seekers, the need for language assistance and the kind of language assistance used. There was a 70% (n = 56/80) response rate to the telephone survey. The majority of respondents (77%) said that they had experienced consultations with refugees and asylum seekers in which language assistance was required. Despite this, general practitioners in the majority of cases managed without an interpreter or used informal methods of interpretation. In fact, when given a choice general practitioners would more often choose informal over professional methods of interpretation despite the fact that confidentiality was a significant concern. The need for language assistance in consultations with refugees and asylum seekers in Irish general practice is high. General practitioners rely on informal responses. It is necessary to improve knowledge about the organisational contexts that shape general practitioners responses. We also recommend dialogue between general practitioners, patients and interpreters about the relative merits of informal and professional methods of interpretation so that general practitioners' choices are responsive to the needs of patients with limited English.
Merry, Lisa; Pelaez, Sandra; Edwards, Nancy C
To synthesize the recent qualitative literature and identify the integrative themes describing the parenthood experiences of refugees, asylum-seekers and undocumented migrants. We searched seven online databases for the period January 2006 to February 2017. We included English and French published peer-reviewed articles and graduate-level dissertations, which qualitatively examined the parenthood experiences of refugees, asylum-seekers and undocumented migrants. We summarized study characteristics and performed a thematic analysis across the studies. One hundred thirty eight studies met inclusion criteria. All but three were conducted in high-income countries, mainly in the US. Migrants studied were mostly undocumented from Latin America and refugees from Sub-Saharan Africa. Almost all studies (93%) included mothers; about half (47%) included fathers; very few (5%) included extended family members. We identified three integrative themes: 1) experiencing hardship and/or loss in the context of precarious migration and past traumas; 2) building resilience and strength by bridging language, norms and expectations; and 3) living transnationally: obligations, challenges and resources. Each theme contributed to shaping the parenthood experience; the transnationalism theme intersected with the themes on hardship and loss and resilience and strength. More research is needed with fathers, extended family members, asylum-seekers and in the LMIC context. A transnational lens needs to be applied to programs, policies and future research for refugee, asylum-seeker and undocumented migrant parents. Addressing transnational concerns (family separation and reunification), acknowledging transnational resources, fostering a transnational family identity and conducting transnational and longitudinal studies are potentially pivotal approaches for this sub-population of parents.
Mellou, Kassiani; Chrisostomou, Anthi; Sideroglou, Theologia; Georgakopoulou, Theano; Kyritsi, Maria; Hadjichristodoulou, Christos; Tsiodras, Sotirios
An increased number of hepatitis A cases among refugees, asylum seekers and migrants residing in hosting facilities in Greece were recorded between April and December 2016. In total, 177 laboratory-confirmed symptomatic cases were reported; of these, 149 (84%) occurred in hosting camps mostly among Syrian children under 15 years. All cases reported symptom onset after their entry into the country. Public health interventions focused on hygiene measures and vaccination. PMID:28181904
Hartley, Lisa; Fleay, Caroline; Tye, Marian E
This paper explores the engagement in physical activity as a potential coping strategy for asylum seekers living in the Australian community without the right to work and with prolonged uncertainty, and benefits or barriers to undertaking such activity. Semi-structured in-depth interviews were held with 29 asylum seekers who had arrived to Australia by boat and were living in the community in the cities of Perth, Sydney or Melbourne in July-October 2013 after their release from immigration detention. The ratio of the numbers of men and women interviewed (23 men and 6 women) was comparable to the ratio of men and women who came by boat to Australia seeking asylum in 2012-2013. Nine participants reported that they participated in physical activity as a coping strategy. Seven other participants were so worried about their future and their families that they did not have the mental or physical energy to engage in physical activity. A further six wanted to participate in physical activity but faced a number of barriers to doing so. The seven remaining participants were either not asked about their physical activity engagement because they focused their discussion on other challenges or did not elaborate on why they were not engaging in physical activity. The findings suggest that physical activity, coupled with other coping strategies, are important for some asylum seekers in trying to manage the distress of being denied the right to work and living with prolonged uncertainty. In addition, these findings highlight the critical barrier that government policy plays in disabling engagement in physical activity, which further compounds social exclusion. This includes the lack of welfare support provided, which hinders people's financial ability to access activities and support in the community. © 2017 John Wiley & Sons Ltd.
BACKGROUND: Refugees and asylum seekers experience language barriers in general practice. Qualitative studies have found that responses to language barriers in general practice are ad hoc with use of both professional interpreters and informal interpreters (patients\\' relatives or friends). However, the scale of the issues involved is unknown. This study quantifies the need for language assistance in general practice consultations and examines the experience of, and satisfaction with, methods of language assistance utilized. METHODS: Data were collected by telephone survey with general practitioners in a regional health authority in Ireland between July-August 2004. Each respondent was asked a series of questions about consulting with refugees and asylum seekers, the need for language assistance and the kind of language assistance used. RESULTS: There was a 70% (n = 56\\/80) response rate to the telephone survey. The majority of respondents (77%) said that they had experienced consultations with refugees and asylum seekers in which language assistance was required. Despite this, general practitioners in the majority of cases managed without an interpreter or used informal methods of interpretation. In fact, when given a choice general practitioners would more often choose informal over professional methods of interpretation despite the fact that confidentiality was a significant concern. CONCLUSION: The need for language assistance in consultations with refugees and asylum seekers in Irish general practice is high. General practitioners rely on informal responses. It is necessary to improve knowledge about the organisational contexts that shape general practitioners responses. We also recommend dialogue between general practitioners, patients and interpreters about the relative merits of informal and professional methods of interpretation so that general practitioners\\' choices are responsive to the needs of patients with limited English.
Since 2004, a profound transformation of the asylum care model, characterized by overcrowding, lack of discharge and absence of rehabilitation programs, and social reinsertion, has been developed at National Colony "Dr. Manuel A. Montes de Oca". During this period, a plan that contemplates several programs and projects aimed at restoring the rights of institutionalized people with mental disabilities and promoting opportunities for social inclusion has been implemented.
Antinori, Spinello; Tonello, Cristina; Edouard, Sophie; Parravicini, Carlo; Gastaldi, Daniela; Grande, Romualdo; Milazzo, Laura; Ricaboni, Davide; Fenollar, Florence; Raoult, Didier; Corbellino, Mario; Mediannikov, Oleg
We report two cases of louse-borne relapsing fever observed at our Institution in June 2016. Both patients were young asylum seekers from Africa who had recently arrived in Milan, Italy. Notably, direct microscopic examination of peripheral blood smears was repeatedly negative for the presence of spirochetes and the diagnosis, supported by clinical and epidemiologic evidence, required molecular confirmation by polymerase chain reaction amplification of DNA extracted from blood and sequencing of the amplified products.
Sundqvist, Johanna; Hansson, Jonas; Ghazinour, Mehdi; Ögren, Kenneth; Padyab, Mojgan
During the past ten years the number of unaccompanied asylum-seeking refugee children has dramatically increased in Sweden. Some of them are permitted to stay in the receiving country, but some are forced back to their country of origin. Social workers and police officers are involved in these forced repatriations, and such complex situations may cause stressful working conditions. This study aimed to bridge the gap in knowledge of the relationship between general mental health and working with unaccompanied asylum-seeking refugee children who are due for forced repatriation. In addition, the role of psychosocial job characteristics in such relationships was investigated. A questionnaire including sociodemographic characteristics, the Swedish Demand-Control-Support Questionnaire, and the 12-item General Mental Health Questionnaire were distributed nationally. Univariate and multivariable regression models were used. Poorer mental health was associated with working with unaccompanied asylum-seeking refugee children among social workers but not among police officers. Psychological job demand was a significant predictor for general mental health among social workers, while psychological job demand, decision latitude, and marital status were predictors among police officers. Findings are discussed with special regard to the context of social work and police professions in Sweden.
Full Text Available Since the events of 9/11 in the US in 2001 and, four years later, the 7/7 London bombings in the UK, warnings of terrorist attacks are high on the public agenda in many western countries. Politicians and tabloid press in the UK have continued to make direct and indirect connections between asylum seekers, terrorism and crime. This has increasingly resulted in harsh policy responses to restrict the movement of ‘third-world’ nationals, criminalisation of immigration and asylum policy, and making the violation of immigration laws punishable through criminal courts. This paper largely highlights the narratives of five asylum seekers who committed ‘crime’ by breaching immigration laws and were consequently treated as ‘dangerous criminals’ by the state authorities. More importantly it shows how these individuals experienced this treatment. The aim of this paper is to give voice to the victims of state abuse, claim space for victim agency, gather victim testimonies, challenge official explanations and in the process confront criminal and racist state practices.
Full Text Available Object of this article is the destiny of psychiatric inmates in Wuerttemberg asylums, 1940-1945. These patients from Italian regions of Vicenza, Udine, Trento, Alto Adige and various locations more were delegated and, to a substantial number, illegally deported to the German asylums Zwiefalten, Schussenried and Weissenau, all in South Wuerttemberg, in 1940 and 1943. Attention is focused on the pioneering state pre-negotiations, and the so-called option treaties between the German Reich and Fascist Italy as part of the general aspect of National Socialist bio-Politics. The treatment of these South Tyrol patients in the asylums themselves, as well as their fate will be put into the context of the resettlement actions at the margins of the Third Reich, which started in 1939 and widely affected the European continent. It is referred to other sub-groups of migrating population from Italy to the German Reich as well, as a contrasting aspect of this contribution
Full Text Available Temporarity has a significant role in today’s urban spaces and peoples’ experiences of them. The city is often understood through stable material structures, while less attention is paid to such aspects of urban space that are there only for a limited time such as markets, events, manifestations and construction sites, for instance. Experiences of momentarity may be related to these kinds of elements of the city, but equally to personal feelings of not belonging to the city. In this paper we discuss, firstly, temporary geographies and their importance in today’s urban studies. Debates on relational spaces and moving geographies have directed attention towards the temporary aspects of urban spaces. Temporarity itself has mostly been discussed in relation to urban planning while less attention has been paid to other aspects of everyday life. Secondly, the theoretical aspects of temporary geographies in this paper will be illustrated with empirical material collected among young asylum seekers in the City of Turku in Finland in 2008–2009. The asylum seekers were interviewed and they kept photo diaries about their urban experiences. The material tells about the feelings of momentarity in urban space as the asylum seekers’ uses of the city were coloured by uncertainty while they were waiting for the decision about permission to stay in the country.
Full Text Available Abstract Background This article discusses the design of a study on the prevalence of health problems (both physical and mental and the utilisation of health care services among asylum seekers and refugees in the Netherlands, including factors that may be related to their health and their utilisation of these services. Methods/Design The study will include random samples of adult asylum seekers and refugees from Afghanistan, Iran and Somali (total planned sample of 600, as these are among the largest groups within the reception centres and municipalities in the Netherlands. The questionnaire that will be used will include questions on physical health (chronic and acute diseases and somatization, mental health (Hopkins Symptoms Checklist-25 and Harvard Trauma Questionnaire, utilisation of health care services, pre- and post-migratory traumatic experiences, life-style, acculturation, social support and socio-demographic background. The questionnaire has gone through a translation process (translation and back-translation, several checks and a pilot-study and cross-cultural adaptation. Respondents will be interviewed by bilingual and bicultural interviewers who will be specifically trained for this purpose. This article discusses the selection of the study population, the chosen outcome measures, the translation and cross-cultural adaptation of the measurement instrument, the training of the interviewers and the practical execution of the study. The information provided may be useful for other researchers in this relatively new field of epidemiological research among various groups of asylum seekers and refugees.
Marquardt, L; Krämer, A; Fischer, F; Prüfer-Krämer, L
This exploratory pilot study aimed to investigate the physical and mental disease burden of unaccompanied asylum-seeking adolescents arriving in Bielefeld, a medium-size city in Germany. A cross-sectional survey with purposive sampling of 102 unaccompanied asylum-seeking adolescents aged 12-18 years was performed. Information on general health status, selected infectious and non-communicable diseases, iron deficiency anaemia and mental illness was collected during routine check-up medical examinations upon arrival in Bielefeld, Germany. The data were analysed using descriptive statistics. The analysis revealed a complex disease burden with a high prevalence of infections (58.8%), mental illness (13.7%) and iron deficiency anaemia (17.6%) and a very low prevalence of non-communicable diseases (refugees were infected with parasites. Whilst sub-Saharan Africans showed the highest prevalence of infections (86.7%), including highest prevalences of parasites (46.7%), West Asians had the highest prevalence of mental disorders (20.0%). Overall, the disease burden in females was higher. A thorough medical and psychological screening after arrival is highly recommended to reduce the individual disease burden and the risk of infection for others. This promotes good physical and mental health, which is needed for successful integration into the receiving society. Barriers to health service access for unaccompanied asylum-seeking adolescents need to be lowered to allow need-specific health care and prevention. © 2015 John Wiley & Sons Ltd.
Keygnaert, Ines; Vettenburg, Nicole; Roelens, Kristien; Temmerman, Marleen
Although migrants constitute an important proportion of the European population, little is known about migrant sexual health. Existing research mainly focuses on migrants' sexual health risks and accessibility issues while recommendations on adequate sexual health promotion are rarely provided. Hence, this paper explores how refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands define sexual health, search for sexual health information and perceive sexual health determinants. Applying Community-based Participatory Research as the overarching research approach, we conducted 223 in-depth interviews with refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands. The Framework Analysis Technique was used to analyse qualitative data. We checked the extensiveness of the qualitative data and analysed the quantitative socio-demographic data with SPSS. Our results indicate that gender and age do not appear to be decisive determinants. However, incorporated cultural norms and education attainment are important to consider in desirable sexual health promotion in refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands. Furthermore, our results demonstrate that these migrants have a predominant internal health locus of control. Yet, most of them feel that this personal attitude is hugely challenged by the Belgian and Dutch asylum system and migration laws which force them into a structural dependent situation inducing sexual ill-health. Refugees, asylum seekers and undocumented migrants in Belgium and The Netherlands are at risk of sexual ill-health. Incorporated cultural norms and attained education are important determinants to address in desirable sexual health promotion. Yet, as their legal status demonstrates to be the key determinant, the prime concern is to alter organizational and societal factors linked to the Belgian and Dutch asylum system. Refugees, asylum seekers and undocumented migrants
Tay, Kuowei; Frommer, Naomi; Hunter, Jill; Silove, Derrick; Pearson, Linda; San Roque, Mehera; Redman, Ronnit; Bryant, Richard A; Manicavasagar, Vijaya; Steel, Zachary
The levels of exposure to conflict-related trauma and the high rates of mental health impairment amongst asylum seekers pose specific challenges for refugee decision makers who lack mental health training. We examined the use of psychological evidence amongst asylum decision makers in New South Wales, Australia, drawing on the archives of a representative cohort of 52 asylum seekers. A mixed-method approach was used to examine key mental health issues presented in psychological reports accompanying each asylum application, including key documents submitted for consideration of asylum at the primary and review levels. The findings indicated that the majority of decision makers at both levels did not refer to psychological evidence in their decision records. Those who did, particularly in the context of negative decisions, challenged the expert findings and rejected the value of such evidence. Asylum seekers exhibiting traumatic stress symptoms such as intrusive thoughts and avoidance, as well as memory impairment, experienced a lower acceptance rate than those who did not across the primary and review levels. The findings raise concern that trauma-affected asylum seekers may be consistently disadvantaged in the refugee decision-making process and underscore the need to improve the understanding and use of mental health evidence in the refugee decision-making setting. The study findings have been used to develop a set of guidelines to assist refugee decision makers, mental health professionals and legal advisers in improving the quality and use of psychological evidence within the refugee decision-making context. Copyright © 2013 Elsevier Ltd. All rights reserved.
Rahman, Sayeeda; Majumder, Md Anwarul Azim; Shaban, Sami F; Rahman, Nuzhat; Ahmed, Moslehuddin; Abdulrahman, Khalid Bin; D'Souza, Urban Ja
The rapid development of new drugs, therapies, and devices has created a dramatic increase in the number of clinical research studies that highlights the need for greater participation in research by physicians as well as patients. Furthermore, the potential of clinical research is unlikely to be reached without greater participation of physicians in research. Physicians face a variety of barriers with regard to participation in clinical research. These barriers are system-or organization-related as well as research-and physician-related. To encourage physician participation, appropriate organizational and operational infrastructures are needed in health care institutes to support research planning and management. All physicians should receive education and training in the fundamentals of research design and methodology, which need to be incorporated into undergraduate medical education and postgraduate training curricula and then reinforced through continuing medical education. Medical schools need to analyze current practices of teaching-learning and research, and reflect upon possible changes needed to develop a 'student-focused teaching-learning and research culture'. This article examines the barriers to and benefits of physician participation in clinical research as well as interventions needed to increase their participation, including the specific role of undergraduate medical education. The main challenge is the unwillingness of many physicians and patients to participate in clinical trials. Barriers to participation include lack of time, lack of resources, trial-specific issues, communication difficulties, conflicts between the role of clinician and scientist, inadequate research experience and training for physicians, lack of rewards and recognition for physicians, and sometimes a scientifically uninteresting research question, among others. Strategies to encourage physician participation in clinical research include financial and nonfinancial incentives
Radi, Joshua; Brisson, Michael; Line, Michael
The US Army aeromedical physician assistant (PA) serves aviation units in regards to crewmember medical readiness. All PAs are graduates of a 6-week flight surgeon course. They are responsible for conducting nearly 40% of the annual US Army flight physicals. This unique training and deployment illustrates the growing adaptability of PAs to assume a greater role in military medicine.
Kesselheim, Aaron S; Sinha, Michael S; Joffe, Steven
Although insider trading is illegal, recent high-profile cases have involved physicians and scientists who are part of corporate governance or who have access to information about clinical trials of investigational products. Insider trading occurs when a person in possession of information that might affect the share price of a company's stock uses that information to buy or sell securities--or supplies that information to others who buy or sell--when the person is expected to keep such information confidential. The input that physicians and scientists provide to business leaders can serve legitimate social functions, but insider trading threatens to undermine any positive outcomes of these relationships. We review insider-trading rules and consider approaches to securities fraud in the health care field. Given the magnitude of the potential financial rewards, the ease of concealing illegal conduct, and the absence of identifiable victims, the temptation for physicians and scientists to engage in insider trading will always be present. Minimizing the occurrence of insider trading will require robust education, strictly enforced contractual provisions, and selective prohibitions against high-risk conduct, such as participation in expert consulting networks and online physician forums, by those individuals with access to valuable inside information.
Merlo, Domenico Franco; Vahakangas, Kirsi; Knudsen, Lisbeth E.
consent was obtained.Integrity is central to environmental health research searching for causal relations. It requires open communication and trust and any violation (i.e., research misconduct, including fabrication or falsification of data, plagiarism, conflicting interests, etc.) may endanger......Environmental health research is a relatively new scientific area with much interdisciplinary collaboration. Regardless of which human population is included in field studies (e.g., general population, working population, children, elderly, vulnerable sub-groups, etc.) their conduct must guarantee...... well acknowledged ethical principles. These principles, along with codes of conduct, are aimed at protecting study participants from research-related undesired effects and guarantee research integrity. A central role is attributed to the need for informing potential participants (i.e., recruited...
The future evolution of the universe suggested by the cosmological model proposed earlier at this meeting by the authors is explored. The fundamental role played by the positive ''cosmological constant'' is emphasized. Dyson's 1979 paper entitled ''Time Without End'' is briefly reviewed. His most optimistic scenario requires that the universe be geometrically open and that biology is structural in the sense that the current complexity of human society can be reproduced by scaling up its (quantum mechanical) structure to arbitrary size. If the recently measured ''cosmological constant'' is indeed a fundamental constant of nature, then Dyson's scenario is, for various reasons, ruled out by the finite (De Sitter) horizon due to exponential expansion of the resulting space. However, the finite temperature of that horizon does open other interesting options. If, as is suggested by the cosmology under consideration, the current exponential expansion of the universe is due to a phase transition which fixes a physical boundary condition during the early radiation dominated era, the behavior of the universe after the relevant scale factor crosses the De Sitter radius opens up still other possibilities. The relevance of Martin Rees' apocalyptic eschatology recently presented in his book ''Our Final Hour'' is mentioned. It is concluded that even for the far future, whether or not cultural and scientific descendants of the current epoch will play a role in it, an understanding (sadly, currently lacking) of community and political evolution and control is essential for a preliminary treatment of what could be even vaguely called scientific eschatology.
Most physicians accept the general scientific discoveries about anthropogenic global warming and its dangers. Occasional denial by individual physicians of climate change can be readily answered by reference to the scientific consensus. But widespread, organized, political denial of climate change is hazardous to physicians' advocacy for an effective public health and health care response to climate change. This article assumes that physician climate advocacy is ethical and celebrates the many forms of health climate advocacy already under way. It concludes by drawing attention to measures that can scale up and strengthen the health care system's organized response to growing climate health hazards. © 2017 American Medical Association. All Rights Reserved.
Lawrence P. Casalino
Full Text Available We present a model of hypothesized relationships between physician satisfaction, physician well-being and the quality of care, in addition to a review of relevant literature. The model suggests that physicians who are stressed, burned out, depressed, and/or have poor self-care are more likely to be dissatisfied, and vice-versa. Both poor physician well-being and physician dissatisfaction are hypothesized to lead to diminished physician concentration, effort, empathy, and professionalism. This results in misdiagnoses and other medical errors, a higher rate of inappropriate referrals and prescriptions, lower patient satisfaction and adherence to physician recommendations, and worse physician performance in areas not observed by others. Research to date largely supports the model, but high quality studies are few. Research should include studies that are prospective, larger, and have a stronger analytic design, ideally including difference in differences analyses comparing quality of care for patients of physicians who become dissatisfied to those who remain satisfied, and vice versa.Keywords: physician satisfaction, physician dissatisfaction, quality of care, physician well-being, physician burnout
Crepet, Anna; Rita, Francesco; Reid, Anthony; Van den Boogaard, Wilma; Deiana, Pina; Quaranta, Gaia; Barbieri, Aurelia; Bongiorno, Francesco; Di Carlo, Stefano
In 2015, Italy was the second most common point of entry for asylum seekers into Europe after Greece. The vast majority embarked from war-torn Libya; 80,000 people claimed asylum that year. Their medical conditions were assessed on arrival but their mental health needs were not addressed in any way, despite the likelihood of serious trauma before and during migration. Médecins sans Frontières (MSF), in agreement with the Italian Ministry of Health, provided mental health (MH) assessment and care for recently-landed asylum seekers in Sicily. This study documents mental health conditions, potentially traumatic events and post-migratory living difficulties experienced by asylum seekers in the MSF programme in 2014-15. All asylum seekers transiting the 15 MSF-supported centres were invited to a psycho-educational session. A team of psychologists and cultural mediators then provided assessment and care for those identified with MH conditions. Potentially traumatic events experienced before and during the journey, as well as post-migratory living difficulties, were recorded. All those diagnosed with MH conditions from October 2014 to December 2015 were included in the study. Among 385 individuals who presented themselves for a MH screening during the study period, 193 (50%) were identified and diagnosed with MH conditions. Most were young, West African males who had left their home-countries more than a year prior to arrival. The most common MH conditions were post traumatic stress disorder (31%) and depression (20%). Potentially traumatic events were experienced frequently in the home country (60%) and during migration (89%). Being in a combat situation or at risk of death, having witnessed violence or death and having been in detention were the main traumas. Lack of activities, worries about home, loneliness and fear of being sent home were the main difficulties at the AS centres. MH conditions, potentially traumatic events and post-migratory living difficulties are
Full Text Available No abstract available. Article truncated at 150 words. “Life is like a boomerang. Our thoughts, deeds and words return to us sooner or later, with astounding accuracy.”-Brant M. Bright, former project leader with IBM A recent sounding board in the New England Journal of Medicine discussed legislative interference with the patient-physician relationship (1. The authors, the executive staff leadership of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American College of Surgeons believe that legislators should abide by principles that put patients’ best interests first. Critical to achieving this goal is respect for the importance of scientific evidence, patient autonomy, and the patient-physician relationship. According to the authors, lawmakers are increasingly intruding into the realm of medical practice, often to satisfy political agendas without regard to established, evidence-based guidelines for care. The article goes on to cite examples including: The Florida ….
Full Text Available Large-scale war-related migration to Switzerland and other European countries is currently challenging European health systems. Little is known about recent patterns and trends in Emergency Department (ED consultations by Asylum Seekers (AS.A retrospective single-centre analysis was performed of the data from all adult patients with the official status of "Asylum Seeker" or "Refugee" who consulted the ED of Bern University Hospital, Switzerland, between June 2012 and June 2015. Patient characteristics and clinical information, such as triage category, type of referral and discharge, violence-related injury and diagnostic group on discharge, were extracted from the computerised database or determined from the medical reports. Changes in categorical variables between the three studied years were described.A total of 1,653 eligible adult patients were identified in the 3-year period. Between the first (06/12-06/13 and third periods (06/14-06/15, the number of presentations per year increased by about 45%. The AS came from 62 different nations, the most common countries being Eritrea (13%, Somalia (13% and Syria (11%. The mean age was 33.3 years (SD 12.3 and two thirds (65.7% were male. The proportion of women increased over time. Moreover the relative proportions shifted from patients between 20 and 50 years to patients of under 20 or over 60 years. Nearly two thirds of the patients were walk-in emergencies and this proportion increased over time. The mean triage score was 2.9 (SD 0.7, with more than 90% presenting as "urgent consultation". About half of the patients were treated for trauma (17.2%, infections (16.8% or psychiatric problems (14.2%. Trauma was seen in a higher proportion of male than female patients. About 25% of the patients were admitted for in-hospital treatment.The recent rise in AS in the population has lead to an increase in AS presenting to EDs. This changes the composition of ED patients and should raise awareness that
Müller, Martin; Klingberg, Karsten; Srivastava, David; Exadaktylos, Aristomenis K
Large-scale war-related migration to Switzerland and other European countries is currently challenging European health systems. Little is known about recent patterns and trends in Emergency Department (ED) consultations by Asylum Seekers (AS). A retrospective single-centre analysis was performed of the data from all adult patients with the official status of "Asylum Seeker" or "Refugee" who consulted the ED of Bern University Hospital, Switzerland, between June 2012 and June 2015. Patient characteristics and clinical information, such as triage category, type of referral and discharge, violence-related injury and diagnostic group on discharge, were extracted from the computerised database or determined from the medical reports. Changes in categorical variables between the three studied years were described. A total of 1,653 eligible adult patients were identified in the 3-year period. Between the first (06/12-06/13) and third periods (06/14-06/15), the number of presentations per year increased by about 45%. The AS came from 62 different nations, the most common countries being Eritrea (13%), Somalia (13%) and Syria (11%). The mean age was 33.3 years (SD 12.3) and two thirds (65.7%) were male. The proportion of women increased over time. Moreover the relative proportions shifted from patients between 20 and 50 years to patients of under 20 or over 60 years. Nearly two thirds of the patients were walk-in emergencies and this proportion increased over time. The mean triage score was 2.9 (SD 0.7), with more than 90% presenting as "urgent consultation". About half of the patients were treated for trauma (17.2%), infections (16.8%) or psychiatric problems (14.2%). Trauma was seen in a higher proportion of male than female patients. About 25% of the patients were admitted for in-hospital treatment. The recent rise in AS in the population has lead to an increase in AS presenting to EDs. This changes the composition of ED patients and should raise awareness that changes in
Salla E. Toikkanen
Full Text Available The number of asylum seekers arriving in Germany has increased rapidly since 2014 and cases of vaccine-preventable diseases at reception centres were reported. Asylum seekers 12 years and older arriving in Lower Saxony were serologically screened for antibodies against measles, rubella and varicella between November 2014 and October 2015. We calculated the seroprevalence from the screening data by disease, country of origin and age group and compared them to literature-based herd immunity thresholds in order to identify immunisation gaps. In total, 23,647 specimens were included in our study. Although the vast majority of asylum seekers tested positive for antibodies against measles, rubella and varicella, the seroprevalences were not sufficient to ensure herd immunity. The seroprevalences varied substantially between countries of origin and increased with age. Immunisation of asylum seekers against measles, rubella and varicella is needed and the detailed information on seroprevalences among subgroups of asylum seekers can be used for targeted immunisations at reception centres.
Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research
Robertshaw, Luke; Dhesi, Surindar
Objectives To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries. Design Systematic review and qualitative thematic synthesis. Methods Searches of MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science. Search terms were combined for qualitative research, primary healthcare professionals, refugees and asylum seekers, and were supplemented by searches of reference lists and citations. Study selection was conducted by two researchers using prespecified selection criteria. Data extraction and quality assessment using the Critical Appraisal Skills Programme tool was conducted by the first author. A thematic synthesis was undertaken to develop descriptive themes and analytical constructs. Results Twenty-six articles reporting on 21 studies and involving 357 participants were included. Eleven descriptive themes were interpreted, embedded within three analytical constructs: healthcare encounter (trusting relationship, communication, cultural understanding, health and social conditions, time); healthcare system (training and guidance, professional support, connecting with other services, organisation, resources and capacity); asylum and resettlement. Challenges and facilitators were described within these themes. Conclusions A range of challenges and facilitators have been identified for health professionals providing primary healthcare for refugees and asylum seekers that are experienced in the dimensions of the healthcare encounter, the healthcare system and wider asylum and resettlement situation. Comprehensive understanding of these challenges and facilitators is important to shape policy, improve the quality of services and provide more equitable health services for this vulnerable group. PMID:28780549
Toikkanen, Salla E.; Baillot, Armin; Dreesman, Johannes; Mertens, Elke
The number of asylum seekers arriving in Germany has increased rapidly since 2014 and cases of vaccine-preventable diseases at reception centres were reported. Asylum seekers 12 years and older arriving in Lower Saxony were serologically screened for antibodies against measles, rubella and varicella between November 2014 and October 2015. We calculated the seroprevalence from the screening data by disease, country of origin and age group and compared them to literature-based herd immunity thresholds in order to identify immunisation gaps. In total, 23,647 specimens were included in our study. Although the vast majority of asylum seekers tested positive for antibodies against measles, rubella and varicella, the seroprevalences were not sufficient to ensure herd immunity. The seroprevalences varied substantially between countries of origin and increased with age. Immunisation of asylum seekers against measles, rubella and varicella is needed and the detailed information on seroprevalences among subgroups of asylum seekers can be used for targeted immunisations at reception centres. PMID:27376309
Full Text Available The death toll in Mexico due to drug-related violence has continued to rise since President Felipe Calderón initiated the Mexican Government's crackdown on drug trafficking organizations in 2006. Pervasive corruption among state and local government officials and alleged human rights violations by the Mexican military have added to the gravity of the endemic drug-related violence in Mexico. In response to the continuous violence in Mexico perpetrated by drug trafficking organiza- tions, a substantial number of Mexican citizens have fled to the United States seeking asylum. Due to the strict requirements for refugee status under international law and asylum protection under U.S. law, individuals seeking protection based on drug-related violence face several legal obstacles. This Article addresses the extent to which drug-related violence may con- stitute a basis for refugee status protection under international refugee law and U.S. asylum law. It seeks to provide insight into the potential viability of claims for refugee status brought by Mexican asylum-seekers fleeing drug-related violence. This Article concludes with a discussion on complementary protection under the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment for Mexican asylum-seekers.
Full Text Available The death toll in Mexico due to drug-related violence has continued to rise since President Felipe Calderón initiated the Mexican Government's crackdown on drug trafficking organizations in 2006. Pervasive corruption among state and local government officials and alleged human rights violations by the Mexican military have added to the gravity of the endemic drug-related violence in Mexico. In response to the continuous violence in Mexico perpetrated by drug trafficking organiza- tions, a substantial number of Mexican citizens have fled to the United States seeking asylum. Due to the strict requirements for refugee status under international law and asylum protection under U.S. law, individuals seeking protection based on drug-related violence face several legal obstacles. This Article addresses the extent to which drug-related violence may con- stitute a basis for refugee status protection under international refugee law and U.S. asylum law. It seeks to provide insight into the potential viability of claims for refugee status brought by Mexican asylum-seekers fleeing drug-related violence. This Article concludes with a discussion on complementary protection under the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment for Mexican asylum-seekers.
Arnold, R M; Martin, S C; Parker, R M
Researchers have recently begun to compare male and female physicians' attitudes toward patients, medical knowledge, and practice styles. Although women start medical school with more "humanistic views," the conservative effect of medical socialization on both male and female students attenuates these differences. While some studies suggested that men are more scientifically knowledgeable, recent studies showed no significant differences in physicians' medical knowledge. Male and female physicians also had comparable diagnostic and therapeutic behavior. In the intimate world of physicians and patients, however, there were notable differences. Women physicians seemed better able to communicate sensitivity and caring to patients, which may account for the common perception that women are more caring and empathic physicians. Medical educators may wish to study more closely female physicians' communication styles to identify these behaviors and inculcate them into all physicians.
A survey of Indian medical historiography will reveal no dearth of work on the systems of medicine and medical literature of ancient India. However, the people who were responsible for the healing have not received much attention. This article traces the evolution of the physician as a professional in ancient India. This article reviews the secondary literature on healing and medical practice in India, specifically pertaining to the individual medical practitioner, drawing from varied sources. The healers of ancient India hailed from different castes and classes. They were well-respected and enjoyed state patronage. They were held to the highest ethical standards of the day and were bound by a strict code of conduct. They underwent rigorous training in both medicine and surgery. Most physicians were multi-skilled generalists, and expected to be skilled in elocution and debate. They were reasonably well-off financially. The paper also briefly traces the evolution of medicinal ideas in ancient India.
Full Text Available A survey of Indian medical historiography will reveal no dearth of work on the systems of medicine and medical literature of ancient India. However, the people who were responsible for the healing have not received much attention. This article traces the evolution of the physician as a professional in ancient India. This article reviews the secondary literature on healing and medical practice in India, specifically pertaining to the individual medical practitioner, drawing from varied sources. The healers of ancient India hailed from different castes and classes. They were well-respected and enjoyed state patronage. They were held to the highest ethical standards of the day and were bound by a strict code of conduct. They underwent rigorous training in both medicine and surgery. Most physicians were multi-skilled generalists, and expected to be skilled in elocution and debate. They were reasonably well-off financially. The paper also briefly traces the evolution of medicinal ideas in ancient India.
Bavdekar, Sandeep B; Vyas, Shruti; Anand, Varun
A scientific poster is a summary of one's research that is presented in a visually engaging manner. Posters are presented as a means of short and quick scientific communications at conferences and scientific meetings. Presenting posters has advantages for the presenters and for conference attendees and organizers. It also plays a part in dissemination of research findings and furthering science. An effective poster is the one that focuses on a single message and conveys it through a concise and artistically attractive manner. This communication intends to provide tips on creating an effective poster to young scientists. © Journal of the Association of Physicians of India 2011.
This booklet has been developed for physicians by the U.S. Environmental Protection Agency in consultation with the American Medical Association (AMA). Its purpose is to enlist physicians in the national effort to inform the American public about radon.
Goldgar, Constance; Michaud, Ed; Park, Nguyen; Jenkins, Jean
Genomic discoveries are increasingly being applied to the clinical care of patients. All physician assistants (PAs) need to acquire competency in genomics to provide the best possible care for patients within the scope of their practice. In this article, we present an updated version of PA genomic competencies and learning outcomes in a framework that is consistent with the current medical education guidelines and the collaborative nature of PAs in interprofessional health care teams.
Full Text Available Members of Congress have introduced numerous pieces of legislation in recent years related to refugees, asylum seekers, and other populations of migrants seeking protection in the United States. These bills were drafted in reaction to dramatic events within the United States, at its borders, and around the world. For example, roughly 400,000 children traveling alone and mothers with children have arrived at the southern US border since 2013, many seeking protection from organized crime, gang violence, and threats of human trafficking. Similarly, more than a million refugees from the Middle East, North Africa, and Asia sought to reach safety on the European continent in 2015 alone. Terrorist attacks fueled attempts to curtail the US commitment to offer protection to those fleeing persecution, even when those attacks had no connection to refugees or only tenuous links. And yet existing US law has been left virtually unchanged throughout this tumultuous period. This article describes the significant attempts to enact legislation related to refugees and international migrants since 2013 and examines the reasons why those attempts have not succeeded. It also describes American attitudes toward refugees and assesses whether those attitudes affected the fate of legislation.
Morina, Naser; Ewers, Simon M; Passardi, Sandra; Schnyder, Ulrich; Knaevelsrud, Christine; Müller, Julia; Bryant, Richard A; Nickerson, Angela; Schick, Matthis
Mental health problems resulting from persecution and forced migration are very common among refugees and asylum seekers and evolve into a major public health challenge in hosting societies. Language barriers often prevent timely access to appropriate health care, leading to chronic trajectories and abortive social integration. Tools for multilingual screening and assessment could be of great benefit for this particularly vulnerable population as well as for policy makers. This study aimed at testing the reliability, feasibility and usability of the Multi-Adaptive Psychological Screening Software (MAPSS), a newly developed Audio Computer-Assisted Self-Interview Software (ACASI) for touchscreen devices, for screening purposes in a clinical setting. In a randomized cross-over design including both MAPSS and paper-pencil clinician-administered interviews, 30 treatment-seeking refugees completed clinical measures and a feasibility questionnaire to rate the user interface of MAPSS. Five professionals performed given tasks in MAPSS and completed usability questionnaires for the administration interface. Results showed no differences between the two assessment modalities with regard to symptom scores. The findings suggest good feasibility and usability of MAPSS in traumatized refugees. The administration via MAPSS was significantly shorter than the paper-pencil interview. MAPSS may be a cost-effective, flexible and valid alternative to interpreter-based psychometric screening and assessment.
Oppedal, Brit; Idsoe, Thormod
There is a lack of knowledge about psychosocial resources that may sustain post-resettlement psychological adjustment among unaccompanied minor asylum-seekers. The aim of this study is to investigate the impact of social support from family abroad and friends on acculturation, discrimination, and mental health among these vulnerable children and youth. Questionnaire data were collected from a population-based multi-ethnic sample involving 895 unaccompanied minors resettled in municipalities in all regions of the country. They met in groups in their local communities. The informants were on average 18.6 years, and had an average length of stay in Norway of 3.5 years. The findings showed that the participants suffered from high levels of ongoing war related intrusive symptoms and depression. Still, at the same time they engaged in adaptation processes that are normative to youth with immigrant backgrounds, in terms of constructing supportive networks and developing culture competence. In accordance with the main effect hypothesis, social support had direct effects on depression and indirect effects by increasing culture competence that may aid the young refugees in dealing with discrimination. However, there were no effects of social support on symptoms of PTSD. The findings give direction to areas of interventions, beyond dealing with the sequel of the traumas the unaccompanied minors have been exposed to, not only for clinicians, but also social workers and school personnel. © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd.
Full Text Available In 2006 Mexico’s then-president Felipe Calderón declared war on drug trafficking. The human toll was devastating with the loss of over 95,000 lives and the forced disappearance of more than 27,000 people. In addition, two percent of the Mexican population was displaced with families forced to flee their homes in the face of criminal violence. This article offers an explanation of how death, forced disappearances, persecution and exile are in essence the specific effects of governmentalization of the Mexican state. This governmentalization includes the shared use, by criminals and authorities, of techniques for dominating the population and controlling the conduct of citizens through the practices of death, that is, by employing the politics of death (necropolitics. The article goes on to discuss how the objectives, rationality and governmentalization of the State serve to dislocate human rights discourse in such a way that its truth politics excludes people suffering serious human rights violations, such as Mexican asylum seekers. This is accompanied by a new mode of subjectivity produced by Mexico's politics of death – the Endriago subject – which operates as a hybrid perpetrator of human rights violations.
Monica Sañé Schepisi
Full Text Available In Italy tuberculosis (TB is largely concentrated in vulnerable groups such as migrants and in urban settings. We analyzed three TB case finding interventions conducted at primary centers and mobile clinics for regular/ irregular immigrants and refugees/asylum seekers performed over a four-year period (November 2009-March 2014 at five different sites in Rome and one site in Milan, Italy. TB history and presence of symptoms suggestive of active TB were investigated by verbal screening through a structured questionnaire in migrants presenting for any medical condition to out-patient and mobile clinics. Individuals reporting TB history or symptoms were referred to a TB clinic for diagnostic workup. Among 6347 migrants enrolled, 891 (14.0% reported TB history or symptoms suggestive of active TB and 546 (61.3% were referred to the TB clinic. Of them, 254 (46.5% did not present for diagnostic evaluation. TB was diagnosed in 11 individuals representing 0.17% of those screened and 3.76% of those evaluated. The overall yield of this intervention was in the range reported for other TB screening programs for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population.
Schmid Mast, Marianne; Hall, Judith A; Cronauer, Christina Klöckner; Cousin, Gaëtan
This research aims at identifying how specific physician verbal and nonverbal behaviors are related to perceived dominance of female and male physicians. Analogue patients (163 students) watched videotaped excerpts of eight physicians and indicated how dominant they perceived each physician to be. Female physicians who spoke more, talked more while doing something else, spoke with louder voices, modulated their voices more, were oriented more toward the patients, sat at a smaller interpersonal distance, were more expansive, and had a more open arm position were perceived as more dominant. These relations were significantly more pronounced in female than in male physicians. With respect to verbal behavior, not agreeing with the patient, structuring the discussion, setting the agenda, and asking questions were related to being perceived as significantly more dominant in female than in male physicians. Patients interpret verbal and nonverbal female and male physicians' cues differently. If a behavior contradicts gender stereotypes regarding women, this behavior is perceived as particularly dominant in female physicians. To provide optimal care, physicians need to be aware of the expectations their patients harbor toward them--especially expected behavior related to the gender of the physician. Copyright © 2010. Published by Elsevier Ireland Ltd.
Morgan, Perri; Everett, Christine M; Humeniuk, Katherine M; Valentin, Virginia L
To describe trends in physician assistant (PA) specialty distribution, compare these trends with physicians, and quantify the relationship of PA specialty prevalence with both PA and physician salary. PA specialty and salary data were obtained from the 2013 American Academy of PAs' Annual Survey; physician specialty and salary data from the American Medical Association Physician Masterfile and the Medical Group Management Association. Analyses included descriptive statistics and linear regression. The proportion of PAs working in primary care decreased from 50% in 1997 to 30% in 2013. Substantial growth in PA proportions occurred in surgical and medical subspecialties. Regression models showed a higher prevalence of PAs in specialties with higher PA salary, higher physician salary, and higher physician-to-PA salary ratio (P<0.05). PAs are moving toward subspecialty practice. Our study suggests that demand for PAs may be an important factor driving the trend toward specialization.
Klimov, A S; Bulka, A P
Percent of graduates from civil medical universities among military physicians is 22%. Due to reforming of a system of military-medical education, percent of female soldiers in medical service has increased. Psychophysiological peculiarities of this military personnel class have an impact on a military service quality. It has been established that professional success of military physician is governed by mentality, social and psychological adaptation and military-professional motivation. For this reason, medical service recruiting should be realized on the basis of scientifically grounded series of measures of professionally psychological selection. It is shown that it is necessary to elaborate measures for selection and evaluation of professionally important qualities for female military physicians recruiting. Authors suggested the system of ranking of professional activity success, which can be a methodological basis for acceptance of scientifically grounded solutions about the administration of current medical personnel.
Sears, Nicholas J
Hospitals should take the following steps as they seek to engage physicians in an enterprisewide effort to effectively manage margins: Consider physicians' daily professional practice requirements and demands for time in balancing patient care and administrative duties. Share detailed transactional supply data with physicians to give them a behind-the-scenes look at the cost of products used for procedures. Institute physician-led management and monitoring of protocol compliance and shifts in utilization to promote clinical support for change. Select a physician champion to provide the framework for managing initiatives with targeted, efficient communication.
How Do Countries’ Health Information Systems Perform in Assessing Asylum Seekers’ Health Situation? Developing a Health Information Assessment Tool on Asylum Seekers (HIATUS) and Piloting It in Two European Countries
Bozorgmehr, Kayvan; Goosen, Simone; Mohsenpour, Amir; Kuehne, Anna; Razum, Oliver; Kunst, Anton E.
Background: Accurate data on the health status, health behaviour and access to health care of asylum seekers is essential, but such data is lacking in many European countries. We hence aimed to: (a) develop and pilot-test an instrument that can be used to compare and benchmark the country health information systems (HIS) with respect to the ability to assess the health status and health care situation of asylum seekers and (b) present the results of that pilot for The Netherlands (NL) and Germany (DE). Materials and Methods: Reviewing and adapting existing tools, we developed a Health Information Assessment Tool on Asylum Seekers (HIATUS) with 50 items to assess HIS performance across three dimensions: (1) availability and detail of data across potential data sources; (2) HIS resources and monitoring capacity; (3) general coverage and timeliness of publications on selected indicators. We piloted HIATUS by applying the tool to the HIS in DE and NL. Two raters per country independently assessed the performance of country HIS and the inter-rater reliability was analysed by Pearson’s rho and the intra-class correlation (ICC). We then applied a consensus-based group rating to obtain the final ratings which were transformed into a weighted summary score (range: 0–97). We assessed HIS performance by calculating total and domain-specific HIATUS scores by country as well as absolute and relative gaps in scores within and between countries. Results: In the independent rating, Pearson’s rho was 0.14 (NL) and 0.30 (DE), the ICC yielded an estimated reliability of 0.29 (NL) and 0.83 (DE) respectively. In the final consensus-based rating, the total HIATUS score was 47 in NL and 15 in DE, translating into a relative gap in HIS capacity of 52% (NL) and 85% (DE) respectively. Shortfalls in HIS capacity in both countries relate to the areas of HIS coordination, planning and policies, and to limited coverage of specific indicators such as self-reported health, mental health
How Do Countries' Health Information Systems Perform in Assessing Asylum Seekers' Health Situation? Developing a Health Information Assessment Tool on Asylum Seekers (HIATUS) and Piloting It in Two European Countries.
Bozorgmehr, Kayvan; Goosen, Simone; Mohsenpour, Amir; Kuehne, Anna; Razum, Oliver; Kunst, Anton E
Background: Accurate data on the health status, health behaviour and access to health care of asylum seekers is essential, but such data is lacking in many European countries. We hence aimed to: (a) develop and pilot-test an instrument that can be used to compare and benchmark the country health information systems (HIS) with respect to the ability to assess the health status and health care situation of asylum seekers and (b) present the results of that pilot for The Netherlands (NL) and Germany (DE). Materials and Methods : Reviewing and adapting existing tools, we developed a Health Information Assessment Tool on Asylum Seekers (HIATUS) with 50 items to assess HIS performance across three dimensions: (1) availability and detail of data across potential data sources; (2) HIS resources and monitoring capacity; (3) general coverage and timeliness of publications on selected indicators. We piloted HIATUS by applying the tool to the HIS in DE and NL. Two raters per country independently assessed the performance of country HIS and the inter-rater reliability was analysed by Pearson's rho and the intra-class correlation (ICC). We then applied a consensus-based group rating to obtain the final ratings which were transformed into a weighted summary score (range: 0-97). We assessed HIS performance by calculating total and domain-specific HIATUS scores by country as well as absolute and relative gaps in scores within and between countries. Results : In the independent rating, Pearson's rho was 0.14 (NL) and 0.30 (DE), the ICC yielded an estimated reliability of 0.29 (NL) and 0.83 (DE) respectively. In the final consensus-based rating, the total HIATUS score was 47 in NL and 15 in DE, translating into a relative gap in HIS capacity of 52% (NL) and 85% (DE) respectively. Shortfalls in HIS capacity in both countries relate to the areas of HIS coordination, planning and policies, and to limited coverage of specific indicators such as self-reported health, mental health, socio
Rosen, Michael R
The physician-scientist represents the medical-scientific version of the "triple threat" athlete. Yet, in medicine as in sports, specialization and business are ever more in the forefront. As the field of medicine evolves, it is likely that the role of the physician, the scientist, and the physician-scientist will continue to change. Whether this is for the good or bad will only be known in hindsight.
Rosen, Michael R.
The physician-scientist represents the medical-scientific version of the “triple threat” athlete. Yet, in medicine as in sports, specialization and business are ever more in the forefront. As the field of medicine evolves, it is likely that the role of the physician, the scientist, and the physician-scientist will continue to change. Whether this is for the good or bad will only be known in hindsight.
Jeffery, Colette; Morton-Rias, Dawn; Rittle, Mary; Cannon, James; Hooker, Roderick S
National health workforce supply and demand models help predict requirements built on individual annual productivity assumptions. Dual employment rarely is addressed, yet in 2015, about 13.5% of certified physician assistants (PAs) reported two or more clinical positions. Of PAs working two positions, 44% reported the main reason was to supplement earnings, followed by role variety. The mean number of hours worked by all certified PAs was 40.7 per week and the average number of patients was 75. Dual-employed PAs averaged more than 51 hours and 97 patients per week. This new finding reveals an added dimension to provider productivity statistics requiring refinements to annual output calculations.
Founded in 1910, by 1930 Mexico City's La Castañeda insane asylum was grappling with the problem of a massive number of chronic patients, a situation that earned it an image as a warehouse for the sick more than a place of treatment. Psychiatrists endeavored to restore the asylum's legitimacy by publicizing a nineteenth-century treatment which projected the public image that the mentally ill could be as productive as anyone else: work therapy. The government born of the Mexican revolution supported this proposal because the guiding objective behind public assistance for underprivileged groups was to make them part of the country's productive life via the market.
Langer, B; Wetter, T
Telemedical networks and services have received high attention in professional and scientific media in the recent past. In Germany some institutions and few physicians volunteer in experimenting with diverse telemedical service offerings. However, much is speculated but little is known about attitudes and expectations of the majority of physicians in local offices towards this new medium. Therefore we conducted an empirical survey using a random regional sample to poll the respective opinions. Encouraged by a high response rate to our paper questionnaire, we offer as conclusion: that physicians are surprisingly realistic about costs and benefits and can therefore be expected to subscribe as soon as benefits become obvious; that this trend increases with offices being taken over or newly established by younger physicians; and that the establishment of networks of comprehensive care offered by health care professionals from different disciplines is regarded as essential future advantage of telemedical networks.
In 1897 Hamburg was in search of an Oberarzt for the asylum Friedrichsberg who should function as the acting head of the head Wilhelm Reye (1833-1912). This search was part of the intended reformation of the outmoded psychiatric care in Hamburg. During this application procedure the Hamburg Physikus John Wahncau examined all possible candidates and applicants. The article explores the election process by using some sociological categories developed by Pierre Bourdieu (habitus, capital, field). The author argues that not only meritocratic attributes led to the choice of one candidate, but also his functional "fitting" into the field in Hamburg.
Georgiadou, Ekaterini; Morawa, Eva; Erim, Yesim
The number of asylum seekers in Germany has significantly increased in the last two years. Coming from regions of political conflict and war, the refugees have often experienced traumatic events which designate them as a high risk group for mental disorders. In a sample of Arabic speaking asylum seekers in collective accommodation centers in Erlangen, Germany, we estimated the extent of posttraumatic stress, depression, and anxiety. A further objective of the study was to test the comprehensibility and cultural appropriateness of the Arabic translations of the questionnaires in this sample. Between August and September 2016, 56 Arabic speaking asylum seekers placed among three collective accommodation centers in Erlangen completed self-report questionnaires assessing posttraumatic stress disorder (Essen Trauma-Inventory, ETI), and symptoms of depression (Patient Health Questionnaire-depression module, PHQ-9) and anxiety (Generalized Anxiety Disorder, GAD-7). The prevalence of participants with personally and/or witnessed traumatic events was 80.4% ( n = 45). About one-third of the examinees (35.7%, n = 20) endorsed symptoms of PTSD (posttraumatic stress disorder). The total score for depression in this sample was M = 11.9 (SD = 7.9, range: 0-27). Moderate to severe depression (PHQ-9 score ≥ 15) was found in 35.7% ( n = 20) of our sample and severe depression (PHQ-9 score ≥ 20) was found in 23.2% ( n = 13). The total score for anxiety was M = 8.8 (SD = 6.9, range: 0-21), with 26.8% ( n = 15) of the sample showing symptoms of severe anxiety (GAD-7 score ≥ 15). No significant difference between women and men with respect to frequency and symptom scores of PTSD, depression, and anxiety was found. Amongst asylum seekers of the presented sample, the rates of traumatic events as well as the prevalence of possible PTSD, depression, and anxiety were significantly higher than in the German population. This indicates that the refugee population is in need of culturally
Full Text Available The number of asylum seekers in Germany has significantly increased in the last two years. Coming from regions of political conflict and war, the refugees have often experienced traumatic events which designate them as a high risk group for mental disorders. In a sample of Arabic speaking asylum seekers in collective accommodation centers in Erlangen, Germany, we estimated the extent of posttraumatic stress, depression, and anxiety. A further objective of the study was to test the comprehensibility and cultural appropriateness of the Arabic translations of the questionnaires in this sample. Between August and September 2016, 56 Arabic speaking asylum seekers placed among three collective accommodation centers in Erlangen completed self-report questionnaires assessing posttraumatic stress disorder (Essen Trauma-Inventory, ETI, and symptoms of depression (Patient Health Questionnaire—depression module, PHQ-9 and anxiety (Generalized Anxiety Disorder, GAD-7. The prevalence of participants with personally and/or witnessed traumatic events was 80.4% (n = 45. About one-third of the examinees (35.7%, n = 20 endorsed symptoms of PTSD (posttraumatic stress disorder. The total score for depression in this sample was M = 11.9 (SD = 7.9, range: 0–27. Moderate to severe depression (PHQ-9 score ≥ 15 was found in 35.7% (n = 20 of our sample and severe depression (PHQ-9 score ≥ 20 was found in 23.2% (n = 13. The total score for anxiety was M = 8.8 (SD = 6.9, range: 0–21, with 26.8% (n = 15 of the sample showing symptoms of severe anxiety (GAD-7 score ≥ 15. No significant difference between women and men with respect to frequency and symptom scores of PTSD, depression, and anxiety was found. Amongst asylum seekers of the presented sample, the rates of traumatic events as well as the prevalence of possible PTSD, depression, and anxiety were significantly higher than in the German population. This indicates that the refugee population is in need of
Georgiadou, Ekaterini; Morawa, Eva; Erim, Yesim
The number of asylum seekers in Germany has significantly increased in the last two years. Coming from regions of political conflict and war, the refugees have often experienced traumatic events which designate them as a high risk group for mental disorders. In a sample of Arabic speaking asylum seekers in collective accommodation centers in Erlangen, Germany, we estimated the extent of posttraumatic stress, depression, and anxiety. A further objective of the study was to test the comprehensibility and cultural appropriateness of the Arabic translations of the questionnaires in this sample. Between August and September 2016, 56 Arabic speaking asylum seekers placed among three collective accommodation centers in Erlangen completed self-report questionnaires assessing posttraumatic stress disorder (Essen Trauma-Inventory, ETI), and symptoms of depression (Patient Health Questionnaire—depression module, PHQ-9) and anxiety (Generalized Anxiety Disorder, GAD-7). The prevalence of participants with personally and/or witnessed traumatic events was 80.4% (n = 45). About one-third of the examinees (35.7%, n = 20) endorsed symptoms of PTSD (posttraumatic stress disorder). The total score for depression in this sample was M = 11.9 (SD = 7.9, range: 0–27). Moderate to severe depression (PHQ-9 score ≥ 15) was found in 35.7% (n = 20) of our sample and severe depression (PHQ-9 score ≥ 20) was found in 23.2% (n = 13). The total score for anxiety was M = 8.8 (SD = 6.9, range: 0–21), with 26.8% (n = 15) of the sample showing symptoms of severe anxiety (GAD-7 score ≥ 15). No significant difference between women and men with respect to frequency and symptom scores of PTSD, depression, and anxiety was found. Amongst asylum seekers of the presented sample, the rates of traumatic events as well as the prevalence of possible PTSD, depression, and anxiety were significantly higher than in the German population. This indicates that the refugee population is in need of
Sataloff, Robert T; Hawkshaw, Mary; Kutinsky, Joshua; Maitz, Edward A
As the population of aging physicians increases, methods of assessing physicians' cognitive function and predicting clinically significant changes in clinical performance become increasingly important. Although several approaches have been suggested, no evaluation system is accepted or utilized widely. This article reviews literature using MEDLINE, PubMed, and other sources. Articles discussing the problems of geriatric physicians are summarized, stressing publications that proposed methods of evaluation. Selected literature on evaluating aging pilots also was reviewed, and potential applications for physician evaluation are proposed. Neuropsychological cognitive test protocols were summarized, and a reduced evaluation protocol is proposed for interdisciplinary longitudinal research. Although there are several articles evaluating cognitive function in aging physicians and aging pilots, and although a few institutions have instituted cognitive evaluation, there are no longitudinal data assessing cognitive function in physicians over time or correlating them with performance. Valid, reliable testing of cognitive function of physicians is needed. In order to understand its predictive value, physicians should be tested over time starting when they are young, and results should be correlated with physician performance. Early testing is needed to determine whether cognitive deficits are age-related or long-standing. A multi-institutional study over many years is proposed. Additional assessments of other factors such as manual dexterity (perhaps using simulators) and physician frailty are recommended.
Corda, R; Borchini, Rossana; Taborelli, S; Borsani, A; Ferrario, M M
With the introduction in Italy of the Law regarding alcohol abuse and addiction (Law No.125/01), new tasks and responsibilities were assigned to occupational physicians. This law establishes that in working activities with a high risk of industrial accidents, or which may cause a risk for the safety and health of others, workers are forbidden to consume alcoholic beverages during working hours. In addition, occupational physicians are asked to play a key role in testing workers for alcohol levels. In March 2006 a specific list of job titles was issued which makes the law effective. The application of this law gives rise to various consequences and ambiguities, in particular for occupational physicians, mainly concerning the identification of workers with alcohol problems, the subsequent control of such workers, including proposals for valid rehabilitation programmes, and assessment of residual work fitness. All these aspects can, to some extent, produce conflicts between privacy rights and the need to ensure the health and safety of workers and third parties. A specific screening package is proposed for the identification of alcohol abuse as well as methods to overcome some of the constraints. Specific and effective guidelines need to be issued by scientific societies and health authorities.
Full Text Available The period of British rule from 1757 to 1900 is marked by major sociopolitical changes and scientific breakthroughs that impacted medical systems, institutions, and practitioners in India. In addition, historians have debated whether the colonial regime used Western medicine as a tool to expand and legitimize its rule. This paper reviews the secondary literature on this subject with emphasis on the individual physicians. During this period, the practice of "Doctory" or Western medicine gained momentum in India, buoyed with the support of the British as well as Western-educated Indians. Many Indians were trained in Western medicine and employed by the administration as "native doctors" in the subordinate medical service, and the superior medical service by and large comprised Europeans. The colonial regime gradually withdrew most of its patronage to the indigenous systems of medicine. The practitioners of these systems, the vaidyas and the hakims, suffered significant loss of prestige against Western medicine′s claims of being a more rational "superior" system of medicine. Some of them became purists and defended and promoted their systems, while others adopted the methods and ideas of Western medicine into their education and practice. European doctors now rarely interacted with practitioners of Indian systems, but seriously pursued research into medicinal plants and tropical diseases. There is no mention of specialist physicians in this period, and all physicians and surgeons were generalists. Folk practitioners continued to be popular among the masses.
Morris, D B
Scientific expertise in the management of diabetes was an important factor in overcoming physician resistance to the education program. Nurses have expertise, and their expertise must be acknowledged for them to be viewed as leaders. Not only are nurses responsible for sharing their expertise with other nurses, it is equally important for them to share their expertise with the physicians, who may appreciate receiving any information that can help them improve their patients' outcomes. The components that are essential for success in pioneering a new program are good listening skills, a willingness to cooperate, self-confidence, scientific knowledge, vigilance, determination, and a clear vision. Patient outcomes will improve when nurses use their scientific knowledge base and leadership skills through patient-centered nursing practice, planned change strategies, and advanced practice nursing.
Bozorgmehr, Kayvan; Schneider, Christine; Joos, Stefanie
Research on inequities in access to health care among asylum-seekers has focused on disparities between asylum-seekers and resident populations, but little attention has been paid to potential inequities in access to care within the group of asylum-seekers. We aimed to analyse the principles of horizontal equity (i.e., equal access for equal need irrespective of socioeconomic status, SES) and vertical equity (higher allocation of resources to those with higher need) among asylum-seekers in Germany. We performed a secondary exploratory analysis on cross-sectional data obtained from a population-based questionnaire survey among all asylum-seekers (aged 18 or above) registered in three administrative districts in Germany during the three-month study period (N = 1017). Data were collected on health care access (health care utilisation of four types of services and unmet medical need), health care need (approximated by sex, age and self-rated health status), and SES (highest educational attainment and subjective social status, SSS). We calculated odds ratios and 95% confidence intervals (CI) in multiple logistic regression models to analyse associations between SES indicators and access to health care under control of need. We contacted 60.4% (614) of the total asylum-seekers population, of which 25.4% (N = 156) participated in the study. Educational attainment showed no significant effect on health care access in crude models, but was positively associated with utilisation of psychotherapists and hospital admissions in adjusted models. Higher SSS was positively associated with health care utilisation of all types of services. The odds of hospitals admissions for asylum-seekers in the medium and highest SSS category were 3.18 times [1.06, 9.59] and 1.6 times [0.49, 5.23] the odds of those in the lowest SSS category. After controlling for need variables none of the SES indicators were significantly associated with measures of access to care, but a positive
Kotsis, Sandra V; Chung, Kevin C
When considering the importance of scientific writing in disseminating new discoveries and ideas, it is quite remarkable that few physicians have received any formal instruction in this essential process. This article focuses on the fundamental principles of scientific writing that also include a "style and grace" component. The art of good scientific writing is to convey scientific materials in a clear and interesting way, while avoiding incomprehensible sentences that only serve to disguise marginal contents within the article. The goal of this article is to encourage authors and readers to critically examine the art of scientific writing to overcome the barrier to effective communication.
Washburn, E R
Today's physicians feel helpless and angry about changing conditions in the medical landscape. This is due, in large part, to our postmodernist world view and the influence of corporations on medical practice. The life and work of existentialist psychiatrist Viktor Frankl is proposed as a role model for physicians to take back control of their profession. Physician leaders are in the best position to bring the teachings and insight of Frankl's logotherapy to rank-and-file physicians in all practice settings, as well as into the board rooms of large medical corporations. This article considers the spiritual and moral troubles of American medicine, Frankl's answer to that affliction, and the implications of logotherapy for physician organizations and leadership. Physician executives are challenged to take up this task.
Over the span of their career, physicians experience changes to their professional role and professional identity. The process of continual adaptation in their work setting incurs losses. These losses can be ambiguous, cumulative, and may require grieving. Grief in the workplace is unsanctioned, and may contribute to physicians' experience of burnout (emotional exhaustion, depersonalization, low sense of achievement). Acknowledging loss, validating grief, and being prescient in dealing with physician burnout is essential. © 2017 Annals of Family Medicine, Inc.
Cooke, J; Molefe, C; Carew, S; Finucane, P; Clinch, D
Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1/17 of consultants described the experience as negative. 14/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17/17 GPs were satisfied with the arrangement. 1/86 nurses surveyed reported a negative experience. 1/48 patients were unhappy with the arrangement. An extra 2.2 (pposts can be broadly acceptable and cost efficient in Ireland.
Thamrin, Cindy; Stern, Georgette; Frey, Urs
There is increasing interest in the study of fractals in medicine. In this review, we provide an overview of fractals, of techniques available to describe fractals in physiological data, and we propose some reasons why a physician might benefit from an understanding of fractals and fractal analysis, with an emphasis on paediatric respiratory medicine where possible. Among these reasons are the ubiquity of fractal organisation in nature and in the body, and how changes in this organisation over the lifespan provide insight into development and senescence. Fractal properties have also been shown to be altered in disease and even to predict the risk of worsening of disease. Finally, implications of a fractal organisation include robustness to errors during development, ability to adapt to surroundings, and the restoration of such organisation as targets for intervention and treatment. Copyright 2010 Elsevier Ltd. All rights reserved.
Brown, M; Larson, S R; McCool, B P
Physician leadership extends beyond traditional clinical disciplines to hospital administration, group practice management, health policy making, management of managed care programs, and many business positions. What kind of person makes a good physician executive? What stands out as the most important motivations, attributes, and interests of high-performing physician executives? How does this compare with non-physician health care executives? Such questions have long been high on the agenda of executives in other industries. This article builds on existing formal assessments of leadership attributes of high-performing business, government, and educational executives and on closer examination of health care executives. Previous studies looked at the need for innovative, entrepreneurial, energetic, community-oriented leaders for positions throughout health care. Traits that distinguish excellence and leadership were described by Brown and McCool.* That study characterized successful leaders in terms of physical strengths (high energy, good health, and propensity for hard work), mental strengths (creativity, intuition, and innovation), and organizational strengths (mission orientation, vision, and entrepreneurial spirit). In this investigation, a subset of health care executives, including physician executives, was examined more closely. It was initially assumed that successful physician executives exhibit many of the same positive traits as do nonphysician executives. This assumption was tested with physician leaders in a range of administrative and managerial positions. We also set out to identify key differences between physician and nonphysician executives. Even with our limited exploration, it seems to us that physician executives probably do differ from nonphysician executives.
Chase, Liana E; Rousseau, Cécile
Clinical guidelines in refugee mental health increasingly advocate phased approaches to intervention that foreground the provision of pragmatic and social support in contexts of ongoing instability. However, the impact of such interventions has rarely been explored from the perspective of refugees themselves. We conducted ethnographic research on the experiences and perceptions of users of an intervention embodying this approach: a community Day Center for asylum seekers in Montreal. Data comprising 15 interviews and field notes from 50 participant observation visits were analyzed using an established theoretical framework to identify mechanisms supporting self-perceived wellbeing among users in the domains of safety, social networks, justice, identity/roles, and existential meaning. Results shed light on how this nonspecific buffering intervention responds to the threats and pressures asylum seekers themselves identify as most salient in the immediate postflight context. These findings are discussed in relation to emerging theoretical frameworks in refugee mental health that emphasize agency, justice, and the role of local ecologies. We conclude that the Day Center shows significant promise as an innovative early stage mental health intervention for precarious status migrants and merits further research and evaluation. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Full Text Available Abstract Background Screening and treatment of latent tuberculosis infection (LTBI in asylum seekers (AS may prevent future cases of tuberculosis. As the screening with Interferon Gamma Release Assay (IGRA is costly, the objective of this study was to assess which factors were associated with LTBI and to define a score allowing the selection of AS with the highest risk of LTBI. Methods In across-sectional study, AS seekers recently arrived in Vaud County, after screening for tuberculosis at the border were offered screening for LTBI with T-SPOT.TB and questionnaire on potentially risk factors. The factors associated with LTBI were analyzed by univariate and multivariate regression. Results Among 393 adult AS, 98 (24.93% had a positive IGRA response, five of them with active tuberculosis previously undetected. Six factors associated with LTBI were identified in multivariate analysis: origin, travel conditions, marital status, cough, age and prior TB exposure. Their combination leads to a robust LTBI predictive score. Conclusions The prevalence of LTBI and active tuberculosis in AS is high. A predictive score integrating six factors could identify the asylum seekers with the highest risk for LTBI.
Full Text Available Following a brief review of international asylum law (The Geneva Conventions, and the role of American mental health professionals in the asylum process, this paper attempts to understand the ways in which the often trauma-creating custom of machismo is transferred across generations in Central American families. Using as background the work of self psychologist Alan Roland (1989,1996, 2005, I have described families from these areas as so powerfully father-centric that children develop a sense of themselves based largely on their ability to sustain their father’s positive regard. In addition, without discussion, they present a positive image of him to the outside world, even when his behavior at home is brutal. To do otherwise would be humiliating. Having no place to reflect on these customs, often they are acted upon/acted out in the next generation. Note:We publish thi paper also tranlated in italian by Francesca Tessitore (Francesca Tessitore, Psychologist, PhD Student in Mind, Gender and Languages, her research fields are the processes of female immigration and motherhood at risk through a psychodynamic framework. firstname.lastname@example.org.
Yonekura, Cláudia Leiko; Certain, Lucas; Karen, Suen Ka Kee; Alcântara, Guilherme Augusto Sousa; Ribeiro, Lucas Gaspar; Rodrigues-Júnior, Antonio Luiz; Baddini-Martinez, José
To investigate the impressions made by different styles of dress and appearance adopted by physicians on patients, medical students and other physicians in Brazil. Two hundred fifty nine patients, 119 students, and 99 physicians answered questions related to a panel of male and female physicians' pictures covering the following styles: white clothing; white coat; formal, informal, and casual garments; and surgical scrubs. They also reported their level of discomfort with a list of 20 items for professional appearance of both genders. Most of the answers of the volunteers involved using white clothes or white coat, and in many situations the percentages of preference referred for these styles were close. Physicians and students preferred physicians wearing surgical scrubs for emergency visits, and doctors with informal style for discussing psychological problems with male professionals. Patients most often chose white clothing in response to questions. Regarding male professionals, all three groups reported high degree of discomfort for the use of shorts and bermuda shorts, multiple rings, facial piercing, sandals, extravagant hair color, long hair, and earrings. For females, high levels of discomfort were reported to shorts, blouses exposing the belly, facial piercing, multiple rings, extravagant hair color, and heavy makeup. Brazilian patients, physicians, and medical students form a better initial impression of physicians using clothing traditionally associated with the profession and exhibiting more conventional appearance. The use of entirely white garments appears to be a satisfactory option in this country. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.
Physician engagement has never been more important in this environment of healthcare reform--yet few healthcare organizations can define it or identify the elements of engagement that make increasing it possible. This may explain why a recent survey of physicians on the specifics regarding engagement from their perspective found, among other things, that levels of engagement over the past three years have increased at a lukewarm pace, at best. The survey confirmed that feeling engaged was very important to physicians' job satisfaction. It delved into what was important to them--and where there are gaps between what they want and what they are currently experiencing in their organizations--at a granular level, as well as measuring their current levels of engagement with their organizations and their work. It also explored the impact that feelings of engagement have on physicians' decisions around accepting or leaving a job or practice. A companion survey with administrators pointed out areas where there were gaps between their perceptions and those of physicians. The results point to actions that healthcare organizations can take to increase engagement--and, by extension, participation and buy-in--among their physician populations to reach critical goals and achieve greater success with key initiatives at a time of increasing physician shortages and competition between health systems for top physician talent.
Kasman, Deborah L.
An experienced physician-teacher shares her own experiences with loss in medicine and loss in her personal life. Through personal writings during her divorce, she exemplifies the healing effect writing can have during difficult transformations that occur in life. She shares her bias that physicians need to accept and own their emotions and can use…
Founded in 1910, by 1930 Mexico City's La Castañeda insane asylum was grappling with the problem of a massive number of chronic patients, a situation that earned it an image as a warehouse for the sick more than a place of treatment...
Enticott, Joanne; Buck, Kimberly; Shawyer, Frances
There is a lack of information on how to execute effective searches of the grey literature on refugee and asylum seeker groups for inclusion in systematic reviews. High-quality government reports and other grey literature relevant to refugees may not always be identified in conventional literature searches. During the process of conducting a recent systematic review, we developed a novel strategy for systematically searching international refugee and asylum seeker-related grey literature. The approach targets governmental health departments and statistical agencies, who have considerable access to refugee and asylum seeker populations for research purposes but typically do not publish findings in academic forums. Compared to a conventional grey literature search strategy, our novel technique yielded an eightfold increase in relevant high-quality grey sources that provided valuable content in informing our review. Incorporating a search of the grey literature into systematic reviews of refugee and asylum seeker research is essential to providing a more complete view of the evidence. Our novel strategy offers a practical and feasible method of conducting systematic grey literature searches that may be adaptable to a range of research questions, contexts, and resource constraints. Copyright © 2017 John Wiley & Sons, Ltd.
Werber, Dirk; Hoffmann, Alexandra; Santibanez, Sabine; Mankertz, Annette; Sagebiel, Daniel
The largest measles outbreak in Berlin since 2001 occurred from October 2014 to August 2015. Overall, 1,344 cases were ascertained, 86% (with available information) unvaccinated, including 146 (12%) asylum seekers. Median age was 17 years (interquartile range: 4-29 years), 26% were hospitalised and a 1-year-old child died. Measles virus genotyping uniformly revealed the variant 'D8-Rostov-Don' and descendants. The virus was likely introduced by and initially spread among asylum seekers before affecting Berlin's resident population. Among Berlin residents, the highest incidence was in children aged < 2 years, yet most cases (52%) were adults. Post-exposure vaccinations in homes for asylum seekers, not always conducted, occurred later (median: 7.5 days) than the recommended 72 hours after onset of the first case and reached only half of potential contacts. Asylum seekers should not only have non-discriminatory, equitable access to vaccination, they also need to be offered measles vaccination in a timely fashion, i.e. immediately upon arrival in the receiving country. Supplementary immunisation activities targeting the resident population, particularly adults, are urgently needed in Berlin. This article is copyright of The Authors, 2017.
Bartolomei, Javier; Baeriswyl-Cottin, Rachel; Framorando, David; Kasina, Filip; Premand, Natacha; Eytan, Ariel; Khazaal, Yasser
We aimed to assess the opinion of primary care workers, social workers, translators and mental health caregivers who work with asylum seekers about the latter's unmet needs and barriers to access to mental healthcare. We used a Likert scale to assess the opinion of 135 primary care workers (general practitioners, nurses, social workers and translators) and mental health caregivers about the proportion of asylum seekers with psychiatric disorders, their priority needs and their main barriers to mental health services. Insufficient access to adequate financial resources, poor housing and security conditions, access to employment, professional training and legal aid were considered as priority needs, as were access to dental and mental healthcare. The main barriers to access to mental healthcare for asylum seekers included a negative representation of psychiatry, fear of being stigmatized by their own community and poor information about existing psychiatric services. We found a good correlation between the needs reported by healthcare providers and those expressed by the asylum-seeking population in different studies. We discuss the need for greater mobility and accessibility to psychiatric services among this population.
Zijlstra, A Elianne; Kalverboer, Margrite E; Post, Wendy J; Knorth, Erik J; Ten Brummelaar, Mijntje D C
The Best Interest of the Child Questionnaire (BIC-Q) has been designed as an instrument for screening the quality of the rearing situation of asylum-seeking or refugee children. It is intended to aid legal decisions in asylum procedures. The aim of this study was to determine the reliability and the construct validity of the BIC-Q. Based on a study sample of refugee or asylum-seeking children in the Netherlands (N = 74), the psychometric quality of the BIC-Q was investigated using Cohen's kappa for the inter- and intrarater reliability and a nonparametric item response model for the construct validity. The interrater and intrarater reliabilities of the BIC-Q were good (kappa = .65 and .74 respectively). The results of the item response model revealed that the 14 pedagogical environmental conditions formed a strong and valid measurement scale for the quality of the childrearing environment (H = .55; rho = .94). Preliminary results indicate that the BIC-Q may be applied to support decisions on where the asylum-seeking or refugee child has the best opportunities for development. Copyright © 2012 John Wiley & Sons, Ltd.
Salvo, Tania; de C Williams, Amanda C
Lack of proficiency in the language of the host country predicts distress among refugees, but many refugees and asylum seekers in the United Kingdom have less than functional English. This study examined how learning English affected refugees' and asylum seekers' lives, particularly their emotional wellbeing, to explore what factors, particularly psychological ones, facilitated or impeded their learning English. We recruited 16 refugees and asylum seekers from an inner-city National Health Service trauma service and from a charity providing one-to-one English classes. All participants were interviewed in English. Interview data were analysed using thematic analysis from a critical realist perspective. Interviewees provided consistent accounts of their efforts to learn English, integrated into often unsettled and difficult lives. The analysis generated six themes in two domains. The impact of learning English was mainly positive, associated with autonomy, sense of achievement, and aspirations. Barriers to learning English consisted of other problems affecting refugees' capacity to learn, limited opportunities to speak English, and a sense of shame associated with perceived lack of English language competence. Findings highlight the need to provide adequate psychological support for refugees and asylum seekers learning English, recognising its importance in promoting both their integration in the UK and their individual psychological well-being.
Harris, Clodagh; Murphy, Philip
This paper assesses the relationship between community education and internal political efficacy. In particular it examines the association between voter/civic programmes run in advance of the 2009 local elections in Ireland and internal political efficacy amongst the asylum seeking community in Cork. A survey is used to test this relationship.…
Recent scholarship has explored the dynamics between families and colonial lunatic asylums in the late nineteenth century, where families actively participated in the processes of custodial care, committal, treatment and release of their relatives. This paper works in this historical field, but with some methodological and theoretical differences. The Foucauldian study is anchored to a single case and family as an illness narrative that moves cross-referentially between bureaucratic state archival material, psychiatric case records, and intergenerational family-storytelling and family photographs. Following headaches and seizures, Harry Walter Wilbraham was medically boarded from his position as Postmaster in the Cape of Good Hope Colony of South Africa with a ‘permanent disease of the brain’, and was committed to the Grahamstown Asylum in 1910, where he died the following year, aged 40 years. In contrast to writings about colonial asylums that usually describe several patient cases and thematic patterns in archival material over time and place, this study’s genealogical lens examines one white settler male patient’s experiences within mental health care in South Africa between 1908 and 1911. The construction of Harry’s ‘case’ interweaves archival sources and reminiscences inside and outside the asylum, and places it within psychiatric discourse of the time, and family dynamics in the years that followed. Thus, this case study maps the constitution of ‘patient’ and ‘family’ in colonial life, c.1888–1918, and considers the calamity, uncertainty, stigma and silences of mental illness. PMID:24775428
Busch, Johannes Rødbro; Hansen, Steen Holger; Hougen, Hans Petter
Using reports from 154 examinations of alleged torture victims among asylum applicants to Denmark conducted by the Department of Forensic Medicine, Univer- sity of Copenhagen, between 2001 and 2013, we have categorized the victims into four geographical regions, as well as according to the conflict...
Fehring, Keith A; De Martino, Ivan; McLawhorn, Alexander S; Sculco, Peter K
Physician to physician communication is essential for the transfer of ideas, surgical experience, and education. Social networks and online video educational contents have grown exponentially in recent years changing the interaction among physicians. Social media platforms can improve physician-to-physician communication mostly through video education and social networking. There are several online video platforms for orthopedic surgery with educational content on diagnosis, treatment, outcomes, and surgical technique. Social networking instead is mostly centered on sharing of data, discussion of confidential topics, and job seeking. Quality of educational contents and data confidentiality represent the major drawbacks of these platforms. Orthopedic surgeons must be aware that the quality of the videos should be better controlled and regulated to avoid inaccurate information that may have a significant impact especially on trainees that are more prone to use this type of resources. Sharing of data and discussion of confidential topics should be extremely secure according the HIPAA regulations in order to protect patients' confidentiality.
Murphy, Gregory P; Awad, Mohannad A; Osterberg, E Charles; Gaither, Thomas W; Chumnarnsongkhroh, Thanabhudee; Washington, Samuel L; Breyer, Benjamin N
Web-based physician ratings systems are a popular tool to help patients evaluate physicians. Websites help patients find information regarding physician licensure, office hours, and disciplinary records along with ratings and reviews. Whether higher patient ratings are associated with higher quality of care is unclear. The aim of this study was to characterize the impact of physician probation on consumer ratings by comparing website ratings between doctors on probation against matched controls. A retrospective review of data from the Medical Board of California for physicians placed on probation from December 1989 to September 2015 was performed. Violations were categorized into nine types. Nonprobation controls were matched by zip code and specialty with probation cases in a 2:1 ratio using the California Department of Consumer Affairs website. Web-based reviews were recorded from vitals.com, healthgrades.com, and ratemds.com (ratings range from 1-5). A total of 410 physicians were placed on probation for 866 violations. The mean (standard deviation [SD]) number of ratings per doctor was 5.2 (7.8) for cases and 4 (6.3) for controls (P=.003). The mean rating for physicians on probation was 3.7 (1.6) compared with 4.0 (1.0) for controls when all three rating websites were pooled (P1.0-2.2). This association was not significant in a multivariate model when we included age and gender. Web-based physician ratings were lower for doctors on probation indicating that patients may perceive a difference. Despite these statistical findings, the absolute difference was quite small. Physician rating websites have utility but are imperfect proxies for competence. Further research on physician Web-based ratings is warranted to understand what they measure and how they are associated with quality.
Herrick, Nicole Lilly; Fontanesi, John; Rush, Toni; Schatz, Richard A
To assess subjects' perception of healthcare costs and physician reimbursement. The lack of transparency in healthcare reimbursement leaves patients and physicians unaware of the distribution of health care dollars. Anonymous survey-based study by means of convenience sampling. Participants were asked to estimate the total hospital cost and physician fee for one of the six medical procedures (n = 250). On the average for all 6 procedures, patients estimated the total cost was $36,177, ∼1,540% more than the actual Medicare rate of $7,333. Similarly, patients estimated the physician fee was $7,694, 1,474% more the actual Medicare rate of $589. Patients' perception of the total cost and physician fee are significantly higher than Medicare rates for all 6 procedures. This lack of insight may have widespread negative implications on the patient-physician relationship, on political trends to reduce physician reimbursement, and on a physician's desire to continue practicing medicine. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.
Tracy, Octavious; Birchette-Pierce, Cheryl
Professional requirements for physicians specializing in cardiology were estimated to assist policymakers in developing guidelines for graduate medical education. The determination of physician requirements was based on an adjusted needs rather than a demand or utilization model. For each illness, manpower requirements were modified by the…
Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research.
Robertshaw, Luke; Dhesi, Surindar; Jones, Laura L
To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries. Systematic review and qualitative thematic synthesis. Searches of MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science. Search terms were combined for qualitative research, primary healthcare professionals, refugees and asylum seekers, and were supplemented by searches of reference lists and citations. Study selection was conducted by two researchers using prespecified selection criteria. Data extraction and quality assessment using the Critical Appraisal Skills Programme tool was conducted by the first author. A thematic synthesis was undertaken to develop descriptive themes and analytical constructs. Twenty-six articles reporting on 21 studies and involving 357 participants were included. Eleven descriptive themes were interpreted, embedded within three analytical constructs: healthcare encounter (trusting relationship, communication, cultural understanding, health and social conditions, time); healthcare system (training and guidance, professional support, connecting with other services, organisation, resources and capacity); asylum and resettlement. Challenges and facilitators were described within these themes. A range of challenges and facilitators have been identified for health professionals providing primary healthcare for refugees and asylum seekers that are experienced in the dimensions of the healthcare encounter, the healthcare system and wider asylum and resettlement situation. Comprehensive understanding of these challenges and facilitators is important to shape policy, improve the quality of services and provide more equitable health services for this vulnerable group. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly
Kortas, A Z; Polenz, J; von Hayek, J; Rüdiger, S; Rottbauer, W; Storr, U; Wibmer, T
During the migrant crisis in 2015, Germany was the largest single recipient of new asylum seekers in Europe. The German asylum law requires a screening examination for certain infectious diseases in asylum seekers upon arrival. The aim of this work was to analyse the rate of certain infectious diseases among asylum seekers screened at a reception centre in Southern Germany. Retrospective medical record review. Medical records of 2602 asylum seekers screened by a local public health authority in Germany in 2015 were systematically analysed. The majority of screened subjects came from Afghanistan and Syria. The mean age was 22.1 (±12.0) years. The majority of subjects were male (75.4%). Most individuals were of normal weight or overweight, more subjects were obese than underweight. A total of 78 (3.9%) individuals were infected with hepatitis B and eight (0.4%) with HIV. In 31 cases, chest radiographs suggested active tuberculosis (1.6%), which was confirmed in four cases (0.2%). The physical examination uncovered 44 (1.7%) cases of scabies, nine (0.3%) cases of lice, eight (0.3%) of upper respiratory tract infections, two (0.1%) of varicella and 13 (0.5%) of other skin infections. In the majority of subjects none of the screened infectious diseases were found. No evidence was found that the overall prevalence of certain infectious diseases screened for in the present analysis was considerably higher than in previous migration studies. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Despite a very successful process of professionalisation during the past 150 years, today's physicians face several challenges urging them to adapt their traditional professional role and the patient-physician relationship inherent in this role. Among these challenges, a growing economic influence on physicians' practices, new demands from particular groups of patients (consumerism, role of the Internet etc.), and increasing inter-professional competition deserve special attention. New evidence of an association between a stressful work environment and physician's increased health risks provides additional support in favour of this notion. This contribution suggests potential directions of change of the physician's role by pointing to (a) a growing 'feminisation' of medicine, (b) an even stronger emphasis on patient needs and (c) extended teamwork and inter-professional cooperation.
Cochran, Jack; Kaplan, Gary S; Nesse, Robert E
Today, hospitals and physicians are reorganizing themselves in novel ways to take advantage of payment incentives that reward shared accountability for the total health care experience. These delivery system changes will take place with our without physician leadership. To optimize change on behalf of patients, physicians must play a conscious role in shaping future health care delivery organizations. As physician leaders of three of the nation׳s largest integrated health care delivery systems - Kaiser Permanente, Virginia Mason Medical Center, and the Mayo Clinic Health System - we call on physicians to view leadership and the development of leaders as key aspects of their role as patient advocates. Copyright © 2014 Elsevier Inc. All rights reserved.
Rolf J. Kleber
Full Text Available Traumatised asylum seekers and refugees are clinically considered a complex population. Discussion exists on whether with this population treatment guidelines for post-traumatic stress disorder (PTSD should be followed and Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT or Eye Movement Desensitisation and Reprocessing (EMDR should be applied, or whether a phased model starting with stabilisation is preferable. Some clinicians fear that trauma-focused interventions may lead to unmanageable distress or may be ineffective. While cognitive-behavioural interventions have been found to be effective with traumatised refugees, no studies concerning the efficacy of EMDR with this population have been conducted as yet.In preparation for a randomised trial comparing EMDR and stabilisation with traumatised refugees, a pilot study with 20 participants was conducted. The objective was to examine feasibility of participation in a randomised trial for this complex population and to examine acceptability and preliminary efficacy of EMDR.Participants were randomly allocated to 11 sessions of either EMDR or stabilisation. Symptoms of PTSD (SCID-I, HTQ, depression and anxiety (HSCL-25, and quality of life (WHOQOL-BREF were assessed at pre- and post-treatment and 3-month follow-up.Participation of traumatised refugees in the study was found feasible, although issues associated with complex traumatisation led to a high pre-treatment attrition and challenges in assessments. Acceptability of EMDR was found equal to that of stabilisation with a high drop-out for both conditions. No participants dropped out of the EMDR condition because of unmanageable distress. While improvement for EMDR participants was small, EMDR was found to be no less efficacious than stabilisation. Different symptom courses between the two conditions, with EMDR showing some improvement and stabilisation showing some deterioration between pre-treatment and post-treatment, justify the conduct
Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1\\/17 of consultants described the experience as negative. 14\\/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17\\/17 GPs were satisfied with the arrangement. 1\\/86 nurses surveyed reported a negative experience. 1\\/48 patients were unhappy with the arrangement. An extra 2.2 (p<0.001) patients were seen per clinic. Length of stay was shortened by 2.49 days (p<0.001). A saving of 69,212 was made due to decreased locum requirements. We present data suggesting structured shared consultancy posts can be broadly acceptable and cost efficient in Ireland.
Swoboda, Debra A
In the absence of scientific consensus about contested illnesses such as Chronic Fatigue Syndrome (CFS), Multiple Chemical Sensitivities (MCS), and Gulf War Syndrome (GWS), physicians must make sense of competing accounts and develop practices for patient evaluation. A survey of 800 United States physicians examined physician propensity to diagnose CFS, MCS, and GWS, and the factors shaping clinical decision making. Results indicate that a substantial portion of physicians, including nonexperts, are diagnosing CFS, MCS, and GWS. Diagnosing physicians manage the uncertainty associated with these illnesses by using strategies that enhance bounded rationality and aid in thinking beyond current disease models. Strategies include consulting ancillary information sources, conducting analytically informed testing, and considering physiological explanations of causation. By relying on these practices and paradigms, physicians fit CFS, MCS, and GWS into an explanatory system that makes them credible and understandable to them, their patients, and the medical community. Findings suggest that physicians employ rational decision making for diagnosing contested illnesses, creating a blueprint of how illnesses lacking conclusive pathogenic and etiological explanations can be diagnosed. Findings also suggest that patients with contested illnesses might benefit from working with physicians who use these diagnostic strategies, since they help manage the complexity and ambiguity of the contested illness diagnostic process and aid in diagnosis. In addition, findings provide a window into how emerging illnesses get diagnosed in the absence of medical and scientific consensus, and suggest that diagnosing physicians advance the legitimacy of controversial illnesses by constructing the means for their diagnosis.
Tokyo Women's University has career support systems for a female physician. Basic career support is provided for a young female physician who has children. Our University runs the nursery school which takes care of children in day and night. It also helps mothers (female physician) when children are sick. The university also provides short time office hours system for doctors who take care of their children. Both men and women can take advantage of the system. These systems can assist for female physicians to keep their position in hospitals and universities. Then, the next step of a career support is a project for higher-ranking position. Publishing scientific papers and developing good reputation as excellent physicians are essential for promotion. How can we support female physicians for promotion? Our university establishes a scientific research grant and a one-year scholarship for female physicians. We just start the support, therefore, we expect out come in future. We have been developing support systems for female physicians, however effects have not been sufficient yet. We should take more active action to promote female physicians in our society.
Eichmiller, Judith Riley
This commentary compares the current physician practice acquisition frenzy to that of the mid-1990s and reflects on lessons learned. The bottom line: Physicians must understand that there were no "white knights" in the 1990s, and there really aren't any today. This article delineates five main factors that both physicians and hospital executives should thoroughly explore and agree on before an alignment or acquisition. Agreement on these issues is the glue that holds the deal together after the merger. These factors eliminate both buyer and seller remorse and delve into the true cultural alignment that must take place as the healthcare industry addresses the challenges of the future.
Interactions between physicians and detailers (even when legitimate ones) raise scientific and ethical questions. In Portugal little thinking and discussion has been done on the subject and the blames for bribery have monopolized the media. This work intended to review what has been said in medical literature about these interactions. How do physicians see themselves when interacting with pharmaceutical companies and their representatives? Do these companies in fact change their prescriptive behaviour, and, if so, how do they change it? How can physicians interact with detailers and still keep their best practice? A Medline research, from 1966 till 2002, was performed using the key-words as follows. A database similar to Medline but concerning medical journals published in Portugal, Index das Revistas Médicas Portuguesas, was also researched from 1992 to 2002. Pharmaceutical companies are profit bound and they allot promoting activities, and detailing in particular, huge amounts of money. Most physicians hold firmly to the belief that they are able to resist and not be influenced by drug companies promotion activities. Nevertheless, all previous works on literature tell us the opposite. Market research also indicates that detailers effectively promote drug sales. Various works also suggest that the information detailers provide to physicians may be largely incorrect, even comparing it to the written information provided by the pharmaceutical companies they work for. The frequency at which portuguese physicians (especially family physicians) contact with pharmaceutical sales representatives is higher than the frequency reported in countries where the available studies come from (namely, Canada and the United States of America). This may put portuguese physicians at a higher risk, making it imperative that work and wide debate are initiated among the class.
Sweileh, Waleed M
Wars and violent domestic conflicts have forced millions of people to move outside their homes. Meeting the basic health needs of those people requires an understanding of research activity and research output on this topic. The objective of this study was to shed light on the quantity and impact of medicine - related publications on refugees, asylum seekers and internally displaced people (IDP). Scopus database was used to retrieve required data. Specifically, the number of publications, top productive countries and institutions, highly cited articles, citation analysis, international collaboration, and journals involved in publishing articles on refugees, asylum seekers and IDP were reviewed and analyzed. The time span for the study was set from year 2000 to 2015. Two thousands five hundred and thirty publications were retrieved. The h-index of retrieved articles was 64. A steep rise in number of publications was noticed after 2011. Top productive countries were the United States of America, Australia and the United Kingdom. The American public health institute (Centers for Disease Control and Prevention) and the United Nations refugee agency were among the top active organizations on this topic. Active journals in publishing on health of refugees, asylum seekers and IDP were those on mental health, psychology, public health and general medicine. Publications on Somali, Afghani, Iraqi, and Syrian refugees received a significant share of medicine-related publications. Analysis of publications based on region showed that publications on refugees from Middle East is rising sharply and is approaching those on African refugees. Bibliometric analysis reveals that research publications on refugees have been increasing in a dramatic way and articles are being published in journals with high impact factor and international reputation, not only in general medicine and public health, but also mental health and psychology journals. Analysis of publications related to
Full Text Available Background: To deal with a physician shortage and reduce salary costs, nurse practitioners (NPs are seeing increasing numbers of patients especially in primary care. In Arizona, SB1473 has been introduced in the state legislature which would expand the scope of practice for NPs and nurse anesthetists to be fully independent practitioners. However, whether nurses provide equal quality of care at similar costs is unclear. Methods: Relevant literature was reviewed and physician and nurse practitioner education and care were compared. Included were study design and metrics, quality of care, and efficiency of care. Results: NP and physicians differ in the length of education. Most clinical studies comparing NP and physician care were poorly designed often comparing metrics such as patient satisfaction. While increased care provided by NPs has the potential to reduce direct healthcare costs, achieving such reductions depends on the particular context of care. In a minority of clinical situations, NPs appear to have increased costs compared to physicians. Savings in cost depend on the magnitude of the salary differential between doctors and NPs, and may be offset by lower productivity and more extensive testing by NPs compared to physicians. Conclusions: The findings suggest that in most primary care situations NPs can produce as high quality care as primary care physicians. However, this conclusion should be viewed with caution given that studies to assess equivalence of care were poor and many studies had methodological limitations.
An exploration of the connection between two meaning perspectives: an evidence-based approach to health information delivery to vulnerable groups of Arabic- and Somali-speaking asylum seekers in a Swedish context.
Ekblad, Solvig; Linander, Andrea; Asplund, Maria
The right to health care is significant for asylum seekers, particularly as many of them have experienced traumatic life events in their home country, during flight or in their host country. Post-migration living conditions have more impact than pre-migration conditions on ill health among asylum seekers, which underscores the importance of health care-related refugee reception policies. The purpose of this article is to explore the perceived meaning of comprehensive health information provided by a nurse to Arabic- and Somali-speaking adult asylum seekers, in a Swedish context, during its introduction at the Migration Board. In our study, the endpoint was whether asylum seekers found such health information relevant, understandable and respectful. Following an oral presentation, participants filled in a questionnaire consisting of three close-ended questions. A total of 39 groups of presentation attendees included 626 asylum seekers (415 Arabic- and 211 Somali-speaking). Data were analysed with descriptive statistics. Comments underwent content analysis. We also present some socio-demographic data on these asylum seekers. Independently of gender and language, the participants expressed their gratitude for and the meaningfulness of receiving professional, fact-based information, as well as being treated with concern and respect. They indicated a great need for this and felt relieved by being listened to. They liked the pedagogic group method, the opportunity for dialogue and to practice exercising their rights. These promising results indicate that exercising the asylum-seekers' right to receive such health information would improve future reception policies not only in Sweden, but throughout the EU. A renewed focus on communication and pedagogic skills, instead of just cultural training, should be considered for health care professionals assisting asylum seekers.
Terroso, Jazmin Sol
In Mexico the governmental authority in charge of refugees and asylum seekers is the Mexican Commission for Refugee Aid (hereafter COMAR). In 1980, Mexico was the host country for numerous populations that were fleeing dictatorships in Central America. Therefore, the Mexican federal government established COMAR as the agency in charge of analyzing asylum claims and responding to refugee needs. Since then, COMAR has been the governmental agency in charge of carrying out refugee status determin...
Craig, Alexa; Cronin, Beth; Eward, William; Metz, James; Murray, Logan; Rose, Gail; Suess, Eric; Vergara, Maria E
Legislation on physician-assisted suicide (PAS) is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians. To determine variables predictive of physicians' opinions on PAS in a rural state, Vermont, USA. Cross-sectional mailing survey. 1052 (48% response rate) physicians licensed by the state of Vermont. Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation (42% vs 34%). Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness (48% vs 33%). 30% of the respondents had experienced a request for assistance with suicide. Vermont physicians' opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor-patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management.
Full Text Available No abstract available. Article truncated at 150 words. Our fellowship held a discussion on physician burnout which was facilitated by Kris Cooper PhD, a psychologist who has long experience working with struggling physicians. We were joined by three physicians who volunteered to share their personal experiences regarding burnout. Each of these three physicians are exceptional in their devotion to their profession, high self-expectation, and level of professional achievement. Yet the commendable personal characteristics they share may have actually set them up to ultimately suffer burnout. Each of them responded to burnout in a different way. The first physician is an intensivist who left work suddenly 6 months ago, likely never to return. Over a long career, this physician had earned the respect of his colleagues and was beloved by the nurses for seeming to always knowing the right thing to do and dedicating himself fully to the care of the sickest patients and their families. For most of ...
Full Text Available This paper, based on broader discussions surrounding gender violence and immigration in the U.S., provides critical information on the historical context of extreme violence against women and femicide plaguing Central American societies today. Drawing on experiences of precedent setting cases of Guatemalan women, the authors offer suggestions for culturally specific treatment of and support for women who seek asylum in the U.S. out of justified fear for their and their family members’ lives should they return to their country of origin. The arguments presented are predicated on the belief that women worldwide share experiences of myriad forms of male domination and gender inequality which, however, play out differently on their bodies and lives in ways that must be accounted for in our attempt to offer them appropriate care and assist them in creating the tools they need to change their circumstances.
Nakash, Ora; Nagar, Maayan; Lurie, Ido
We examined the association between postnatal depression (PND), acculturation and mother-infant bond among 38 Eritrean asylum seekers in Israel, who were within 6 months of delivery. Participants completed a survey in their native language. A high rate of women (81.6 %) met the clinical threshold for PND on the Edinburgh Postnatal Depression Scale. Higher severity of PND (partial r = -.64, p < .001), higher identification with Israeli culture (partial r = -.45, p = .02), and lower quality of romantic relationship were associated with impaired mother-infant bond (partial r = .58, p = .002). Findings highlight the need to establish services to screen and treat PND among this vulnerable population in the receiving countries.
Robertson, Mary E A; Blumberg, Jocelyn M; Gratton, Jacqui L; Walsh, Eileen G; Kayal, Hamodi
Traumatised asylum seekers and refugees may present with significant and complex mental health problems as a result of prolonged, extreme, and multiple traumatic events. This is further complicated by ongoing complex social circumstances. In our work at the Traumatic Stress Clinic (TSC), the understanding afforded by the concept of complex posttraumatic stress disorder (PTSD) together with the related notion of a phased treatment model, provides a useful framework for organising our work with this population. An explication of complex PTSD as it applies to our client group is presented, followed by a description of our phased treatment model and an outline of the core principles, which guide our clinical approach. Our symptom management and stabilisation groups have been developed and refined over time and draw on techniques from a variety of cognitive behavioural therapies. These are described in some detail with illustrative clinical case vignettes. This paper concludes with some reflections on the challenges inherent to working with this complex client group.
Takla, A; Barth, A; Siedler, A; Stöcker, P; Wichmann, O; Deleré, Y
In order to contain a measles outbreak in a German asylum-seekers' shelter, serological testing of all residents was performed, followed by selective vaccination of those with negative test results/not tested. In this paper we describe the outbreak epidemiologically and then compare the implemented strategy with a hypothetical mass vaccination of all individuals unvaccinated or with unknown vaccination status born after 1970 as recommended by the German Standing Committee on Vaccination in terms of potentially avoided cases, logistics, and costs. Three hundred (70%) residents participated in the serological testing, of which 39 (13%) were seronegative. In total, 144 individuals were eligible for vaccination, while a mass vaccination would have targeted 359 persons. However, serological testing was time- and personnel consuming and revealed several logistical problems. Its costs amounted to €90 000, double that of mass vaccination that additionally might have avoided three of the eight cases. Mass vaccination seems the preferred measure for measles outbreak control in such settings.
Jacobson, P D; Pomfret, S D
The Employee Retirement Income Security Act (ERISA), enacted in 1974 to regulate pension and health benefit plans, is a complex statute that dominates the managed care environment. Physicians must understand ERISA's role in the relationship between themselves and managed care organizations (MCOs), including how it can influence clinical decision making and physician autonomy. This article describes ERISA's central provisions and how ERISA influences health care delivery in MCOs. We analyze ERISA litigation trends in 4 areas: professional liability, utilization management, state legislative initiatives, and compensation arrangements. This analysis demonstrates how courts have interpreted ERISA to limit physician autonomy and subordinate clinical decision making to MCOs' cost containment decisions. Physicians should support efforts to amend ERISA, thus allowing greater state regulatory oversight of MCOs and permitting courts to hold MCOs accountable for their role in medical decision making.
U.S. Department of Health & Human Services — The Physician Compare National Downloadable File is organized at the individual eligible professional level; each line is unique at the professional/enrollment...
The article presents the history of founding of the Organisation of Polish Physicians of Transcarpathian and their participation in presentation of the achievements of Polish Medical Sciences in Ukraine.
... monthly webinar series to protect your revenue, get benchmarking data, & complete your MOC Part-IV & clinical practice ... Read More More Than 850 Hours of Online Education Log In Now > Physicians Podcasts and Apps Reimbursement ...
Morgan-Haker, Veronica R.
Changes in the role of the physician in today's society have made their career choices risky. Career specialists have an opportunity to assist those who do not normally seek career advice outside their own profession. (JOW)
Rijkenberg, A M; van Sprundel, M; Stassijns, G
Collaboration between various stakeholders is essential for a well-operating vocational rehabilitation process. Researchers have mentioned, among other players, insurance physicians, the curative sector and employers. In 2011 the WHO organised the congress "Connecting Health and Labour: What role for occupational health in primary care". The congress was also attended by representatives of the WONCA (World Organisations of Family Medicine). In general, everyone agreed that occupational health aspects should continue to be seen as an integral part of primary health care. However, it is not easy to find literature on this subject. For this reason we conducted a review. We searched for literature relating to collaboration with occupational physicians in Dutch, English and German between 2001 and autumn 2011. Our attention focused on cooperation with specialists and insurance physicians. Therefore, we searched PUBMED using MeSH terms and made use of the database from the "Tijdschrift voor bedrijfs- en verzekeringsgeneeskunde (TBV) [Dutch Journal for Occupational - and Insurance Medicine]". We also checked the database from the "Deutsches Arzteblatt [German Medical Journal]" and made use of the online catalogue from THIEME - eJOURNALS. Last but not least, I used the online catalogue from the German paper "Arbeits -, Sozial -, Umweltmedizin [Occupational -, Social -, Milieu Medicine]". Additionally, we made use of the "snowball - method" to find relevant literature. We found many references to this subject. The Netherlands in particular has done a lot of research in this field. However, there is little research on the cooperation between occupational physicians and specialists; in particular insurance physicians. This is interesting, because several authors have mentioned its importance. However, cooperation with other specialists seems not to be the norm. Therefore, cooperation between curative physicians (specialists but also family doctors), insurance physicians and
Gottlieb, Nora; Weinstein, Tomer; Mink, Jonah; Ghebrezghiabher, Habtom M; Sultan, Zebib; Reichlin, Rachel
Israel hosts approximately 50,000 asylum seekers, most of them from Eritrea. Exclusive policies restrict their access to healthcare. In 2013, local activists partnered with Eritrean asylum seekers to assess health needs as well as willingness to pay for health insurance among the Eritrean communities. This initiative was meant as a step towards jointly advocating access to Israel's public healthcare system and towards strengthening collective efficacy among the asylum-seeking communities, as well as a first attempt to apply a community-based participatory research (CBPR) approach to migrant health research in Israel. Applying a CBPR approach, a 22-item survey was developed by a team of activists, academics and community members. It was administered by community members in four different cities. Cell weighting was applied to align sample estimates with the population distribution. The results were analyzed by means of a Generalized Linear Model. Six follow-up interviews and two focus group discussions helped interpret the quantitative findings and provided additional information. The results from 445 questionnaires show that most (95%) asylum seekers are interested in purchasing health insurance. To this end, more than half of the respondents are willing to invest up to 300 NIS monthly, which represents a significant part (5-7.5%) of their median monthly income. Willingness to pay for health coverage was independent from employment and income; it was significantly associated with city of residence - which translates into current healthcare options - understanding of health insurance, and health seeking motives. The study further highlights the role of labor policies in shaping not only asylum seekers' access to care but also psychosocial wellbeing. The study provides initial evidence for asylum seekers' willingness to pay monthly contributions into a public health insurance scheme, in spite of economic hardship, and it points to understanding of and trust in the
Experiencing 'pathologized presence and normalized absence'; understanding health related experiences and access to health care among Iraqi and Somali asylum seekers, refugees and persons without legal status.
Fang, Mei Lan; Sixsmith, Judith; Lawthom, Rebecca; Mountian, Ilana; Shahrin, Afifa
Asylum seekers, refugees and persons without legal status have been reported to experience a range of difficulties when accessing public services and supports in the UK. While research has identified health care barriers to equitable access such as language difficulties, it has not considered the broader social contexts of marginalization experienced through the dynamics of 'othering'. The current study explores health and health care experiences of Somali and Iraqi asylum seekers, refugees and persons without legal status, highlighting 'minoritization' processes and the 'pathologization' of difference as analytical lenses to understand the multiple layers of oppression that contribute to health inequities. For the study, qualitative methods were used to document the lived experiences of asylum seekers, refugees and persons without legal status. Thirty-five in-depth interviews and five focus groups were used to explore personal accounts, reveal shared understandings and enable social, cognitive and emotional understandings of on-going health problems and challenges when seeking treatment and care. A participatory framework was undertaken which inspired collaborative workings with local organizations that worked directly with asylum seekers, refugees and persons without legal status. The analysis revealed four key themes: 1) pre-departure histories and post-arrival challenges; 2) legal status; 3) health knowledges and procedural barriers as well as 4) language and cultural competence. Confidentiality, trust, wait times and short doctor-patient consultations were emphasized as being insufficient for culturally specific communications and often translating into inadequate treatment and care. Barriers to accessing health care was associated with social disadvantage and restrictions of the broader welfare system suggesting that a re-evaluation of the asylum seeking process is required to improve the situation. Macro- and micro-level intersections of accustomed societal
Lins, Liliane; Carvalho, Fernando Martins
This article focuses on scientific integrity and the identification of predisposing factors to scientific misconduct in Brazil. Brazilian scientific production has increased in the last ten years, but the quality of the articles has decreased. Pressure on researchers and students for increasing scientific production may contribute to scientific misconduct. Cases of misconduct in science have been recently denounced in the country. Brazil has important institutions for controlling ethical and safety aspects of human research, but there is a lack of specific offices to investigate suspected cases of misconduct and policies to deal with scientific dishonesty.
Shrank, William H; Liberman, Joshua N; Fischer, Michael A; Girdish, Charmaine; Brennan, Troyen A; Choudhry, Niteesh K
With constrained health-care resources, there is a need to understand barriers to cost-effective medication use. To study physician perceptions about generic medications. Physicians used 5-point Likert scales to report perceptions about cost-related medication nonadherence, the efficacy and quality of generic medications, preferences for generic use, and the implications of dispensing medication samples. Descriptive statistics were used to assess physician perceptions and logistic regression models were used to evaluate predictors of physician perceptions. Among the invited sample, 839 (30.4%) responded and 506 (18.3%) were eligible and included in the final study population. Over 23% of physicians surveyed expressed negative perceptions about efficacy of generic drugs, almost 50% reported negative perceptions about quality of generic medications, and more than one quarter do not prefer to use generics as first-line medications for themselves or for their family. Physicians over the age of 55 years were 3.3 times more likely to report negative perceptions about generic quality, 5.8 times more likely to report that they would not use generics themselves, and 7.5 times more likely to state that they would not recommend generics for family members (p generic medication. Almost half of the respondents expressed concern that free samples may adversely affect subsequent affordability, yet two thirds of respondents provide free samples. A meaningful proportion of physicians expressed negative perceptions about generic medications, representing a potential barrier to generic use. Payors and policymakers trying to encourage generic use may consider educational campaigns targeting older physicians.
Zimberg, S E; Clement, D G
Physicians are working harder today and enjoying it less. What has happened to create such dissatisfaction among those in one of the most autonomous professions? What can be done to address the anger, fear and unhappiness? This article is an analysis of the factors influencing human motivation. Maslow's hierarchy of needs--physiological, safety/security, social/affiliation, esteem and self-actualization--is used to suggest ways physicians can satisfy their needs in turbulent financial and professional times.
Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading. © 2015 American Society of Law, Medicine & Ethics, Inc.
Wilting, K R; Stienstra, Y; Sinha, B; Braks, M; Cornish, D; Grundmann, H
Two patients from Eritrea, recently arrived in the Netherlands, presented with fever and were investigated for malaria. Bloodfilms showed spirochetes but no blood parasites. Louse-borne relapsing fever caused by Borrelia recurrentis was diagnosed. Treatment was complicated by severe Jarisch-Herxheimer reactions in both patients. Physicians should be aware of the possibility of B. recurrentis infection in migrant populations who travel under crowded conditions, especially after passing through endemic areas such as Ethiopia and neighbouring countries.
U.S. Department of Health & Human Services — The Unique Physician Identification Number (UPIN) Directory contains selected information on physicians, doctors of Osteopathy, limited licensed practitioners and...
Hurst, Samia A; Hull, Sara Chandros; DuVal, Gordon; Danis, Marion
A common dilemma that confronts physicians in clinical practice is the allocation of scarce resources. Yet the strategies used by physicians in actual situations of resource constraint have not been studied. This study explores the strategies and rationales reported by physicians in situations of resource constraints encountered in practice. A national survey of US internists, oncologists, and intensive care specialists was performed by computer-assisted telephone interviews. As part of this survey, we asked physicians to tell us about a recent ethical dilemma encountered in practice. A subset of respondents reported difficulties regarding resource allocation. Transcripts of open-ended responses were coded for content based on consensus. Of the 600 physicians originally identified, 537 were eligible and 344 participated (response rate, 64%). Internists do not make allocation decisions alone but rather engage in negotiation in their resolution. Furthermore, these decisions are not made as dichotomous choices. Rather they often involve alternative solutions in the face of complexities of both the health care system and situations where limited resources must be allocated. Justice is not commonly the justification for rationing. Physicians' experiences in situations of resource constraints appear to be more complex than the normative literature on health care rationing assumes. In addition, reasoning about justice in health care seems to play only a small part in clinical decision making. Bridging this gap could be an important step in fostering fair allocation of resources in difficult cases.
Home; Journals; Resonance – Journal of Science Education; Volume 13; Issue 9. The Scientific Enterprise - Assumptions, Problems, and Goals in the Modern Scientific Framework. V V Raman. Reflections Volume 13 Issue 9 September 2008 pp 885-894 ...
Experts on the Federal Insecticide, Fungicide, and Rodenticide Act Scientific Advisory Panel provide independent scientific advice to the EPA on a wide range of health and safety issues related to pesticides.
Discusses the period of transition and self examination of the museology of science. Defines the main issues and limits of the museum as a means of transmitting a scientific culture and scientific ways. (Author/RT)
Starkiene, Liudvika; Macijauskiene, Jurate; Riklikiene, Olga; Stricka, Marius; Padaiga, Zilvinas
Many of the strategic planning studies worldwide have made recommendations to the policy makers on the steps to be taken in eliminating the perceived shortages of physician workforce or in improving their distribution and retention. Policy makers have also considered various policy interventions to ensure adequate numbers of physicians. This study reviewed the research evidence and health policy decisions taken from 2000 to 2010 in Lithuania and evaluated the chronological links over time between scientific recommendations and policy decisions. From the analysis it would seem that Lithuania's success in retaining physicians between 2000 and 2010 was influenced by the timely implementation of particular research recommendations, such as increased salaries and increased enrolment to physician training programmes. In addition were the health policy interventions such as health sector reform, change in the legal status of medical residents and establishment of professional re-entry programmes. Based on this evidence it is recommended that policy makers in Lithuania as well as in other countries should consider comprehensive and systematic health policy approaches that combine and address various aspects of physician training, retention, geographic mal-distribution and emigration. Implementation of such an inclusive policy however is impossible without the integration of research into strategic decision making in workforce planning and effective health policy interventions. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Extensional scientific realism is the view that each believable scientific theory is supported by the unique first-order evidence for it and that if we want to believe that it is true, we should rely on its unique first-order evidence. In contrast, intensional scientific realism is the view that all believable scientific theories have a common feature and that we should rely on it to determine whether a theory is believable or not. Fitzpatrick argues that extensional realism is immune, while intensional realism is not, to the pessimistic induction. I reply that if extensional realism overcomes the pessimistic induction at all, that is because it implicitly relies on the theoretical resource of intensional realism. I also argue that extensional realism, by nature, cannot embed a criterion for distinguishing between believable and unbelievable theories. Copyright © 2016 Elsevier Ltd. All rights reserved.