Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis

Context  The global refugee crisis requires that researchers, policymakers, and clinicians comprehend the magnitude of the psychological consequences of forced displacement and the factors that moderate them. To date, no empirical synthesis of research on these issues has been undertaken. Objective  To meta-analytically establish the extent of compromised mental health among refugees (including internally displaced persons, asylum seekers, and stateless persons) using a worldwide study sample. Potential moderators of mental health outcomes were examined, including enduring contextual variables (eg, postdisplacement accommodation and economic opportunity) and refugee characteristics. Data Sources  Published studies (1959-2002) were obtained using broad searches of computerized databases (PsycINFO and PILOTS), manual searches of reference lists, and interviews with prominent authors. Study Selection  Studies were selected if they investigated a refugee group and at least 1 nonrefugee comparison group and reported 1 or more quantitative group comparison on measures of psychopathology. Fifty-six reports met inclusion criteria (4.4% of identified reports), yielding 59 independent comparisons and including 67 294 participants (22 221 refugees and 45 073 nonrefugees). Data Extraction  Data on study and report characteristics, study participant characteristics, and statistical outcomes were extracted using a coding manual and subjected to blind recoding, which indicated high reliability. Methodological quality information was coded to assess potential sources of bias. Data Synthesis  Effect size estimates for the refugee-nonrefugee comparisons were averaged across psychopathology measures within studies and weighted by sample size. The weighted mean effect size was 0.41 (SD, 0.02; range, –1.36 to 2.91 [SE, 0.01]), indicating that refugees had moderately poorer outcomes. Postdisplacement conditions moderated mental health outcomes. Worse outcomes were observed for refugees living in institutional accommodation, experiencing restricted economic opportunity, displaced internally within their own country, repatriated to a country they had previously fled, or whose initiating conflict was unresolved. Refugees who were older, more educated, and female and who had higher predisplacement socioeconomic status and rural residence also had worse outcomes. Methodological differences between studies affected effect sizes. Conclusions  The sociopolitical context of the refugee experience is associated with refugee mental health. Humanitarian efforts that improve these conditions are likely to have positive impacts.      

Prevention of excess mortality in refugee and displaced populations in developing countries

More than 30 million refugees and internally displaced persons in developing countries are currently dependent on international relief assistance for their survival. Most of this assistance is provided by Western nations such as the United States. Mortality rates in these populations during the acute phase of displacement have been extremely high, up to 60 times the expected rates. Displaced populations in northern Ethiopia (1985) and southern Sudan (1988) have suffered the highest crude mortality rates. Although mortality rates have risen in all age groups, excess mortality has been the greatest in 1- through 14-year-old children. The major causes of death have been measles, diarrheal diseases, acute respiratory tract infections, and malaria. Case-fatality ratios for these diseases have risen due to the prevalence of both protein-energy malnutrition and certain micronutrient deficiencies. Despite current technical knowledge and resources, several recent relief programs have failed to promptly implement essential public health programs such as provision of adequate food rations, clean water and sanitation, measles immunization, and control of communicable diseases. Basic structural changes in the way international agencies implement and coordinate assistance to displaced populations are urgently needed.     

生殖健康与计划生育

生殖健康是近年来提出的新概念,得到国际社会的普遍接受和重视。生殖健康与计划生育关系密切,了解生殖健康对于计划生育事业的发展有重要意义。一、生殖健康（一）生殖健康的定义和内容１９９４年９月在开罗召开的国际人口与发展大会制订的《行动纲领》,对生殖健康作了...     

健康教育对孕妇产前检查及妊娠结局的影响

目的：观察健康教育对孕妇产前定期检查及妊娠结局的影响。方法：将2008年1月至2009年12月在我科进行产前检查的800名孕妇随机分为观察组和对照组各400名。对观察组孕妇采用文字宣传、开设孕妇学校、个体指导、示范式教育等方式进行健康教育,对照组未参加系统规范的健康教育,只接受口头宣教指导。对两组孕妇产前检查结果及妊娠结局进行比较。结果：观察组孕妇对产前检查的认知情况、发现高危妊娠情况、妊娠结局等各项观察指标均明显优于对照组（P〈0.05）。结论：健康教育有助于孕妇建立良好的遵医行为,配合定期产前检查,保障孕妇妊娠过程安全和结局良好,提高了产科工作的质量。     

Outcomes of Mayo Clinic reBoot camps for postimplementation training in the electronic health record

ObjectiveAfter a new electronic health record (EHR) was implemented at Mayo Clinic, a training program called reBoot Camp was created to enhance ongoing education in response to needs identified by physician leaders.Materials and MethodsA reBoot camp focused on EHR topics pertinent to ambulatory care was offered from April 2018 through June 2020. There were 37 2-day sessions and 43 1-day sessions, with 673 unique participants. To evaluate outcomes of the reBoot camp, we used survey data to study baseline, immediate, and long-term perceptions of program satisfaction and self-assessed skills with the EHR. The study was conducted among practitioners at a large ambulatory practice network based in several states. Data were collected from April 2018 through January 2021. We analyzed automatically collected metadata and scores that evaluated the amount of personalization and proficiency of use.ResultsConfidence in skills increased by 13.5 points for general EHR use and was significant in 5 subdomains of use (13–18 point improvement). This degree of user confidence was maintained at the 6-month reassessment. The outcomes of configuration and proficiency scores also improved significantly.DiscussionOngoing education regarding EHR tools is necessary to support continued use of technology. This study was novel because of the amount and breadth of data collected, diversity of user participation, and validation that improvements were maintained over time.ConclusionsParticipating in a reBoot camp significantly improved user confidence in each domain of the EHR and demonstrated use of best-practice tools. Users maintained gains at the 6-month evaluation phase.     

Epidemiological assessment of the health and nutrition of Ethiopian refugees in emergency camps in Sudan, 1985

The findings from epidemiological data that were collected from emergency camps for Ethiopian refugees during a mass influx of refugees into Eastern Sudan in 1985 are presented. An overall mortality of 8.9 per 10,000 a day was recorded during February 1985, and in children under 5 years of age the rate was 22 per 10,000 a day. The estimated prevalence of malnutrition (calculated as less than 80% of the reference weight for height) ranged from 32% to 52% among children of preschool age. The principal causes of morbidity and mortality were measles, diarrhoea and dysentery, respiratory infections, and malaria. The findings suggest that malnutrition and disease increased in these refugees after they arrived in the camps. Epidemiological assessment is essential to help to maintain the health and nutrition of refugees in emergency camps.     

End-of-life discussions and preferences among persons with HIV

CONTEXT: Deficits in advance care planning leave many patients and their physicians unprepared for decisions about end-of-life care. Even though the prognosis has improved for many persons with human immunodeficiency virus (HIV) infection, a need for planning remains. OBJECTIVE: To evaluate prevalence of end-of-life discussions, use of advance directives, and preferences concerning end-of-life care and their relationship with patient demographics, clinical status, psychosocial variables, and practitioner characteristics among HIV-infected persons. DESIGN, SETTING, AND PATIENTS: Cross-sectional survey of a US probability sample of 2864, which represents 231 400 adults receiving care for HIV, conducted from January 1996 to April 1997. MAIN OUTCOME MEASURES: Communication with physician regarding end-of-life issues, completion of an advance directive, preference for aggressiveness of care, and willingness to tolerate future permanent adverse health states. RESULTS: A total of 1432 patients (50%) discussed some aspect of end-of-life care with their practitioner and 1088 (38%) completed an advance directive. Patients were more likely to complete an advance directive after a physician discussion (odds ratio [OR], 5.82; 95% confidence interval [CI], 4.50-7.52). Practitioners discussed end-of-life care less with blacks (OR, 0.57; 95% CI, 0.39-0.83) and Latinos (OR, 0.74; 95% CI, 0.55-0.98) than with whites. Women (OR, 1.39; 95% CI, 1.05-1.84) and patients with children in the household (OR, 1.53; 95% CI, 1.12-2.10) communicated the most with practitioners about end-of-life issues. Patients infected with HIV via injection drug use (OR, 0.64; 95% CI, 0.45-0.89) and those with less education communicated the least with physicians about end-of-life issues. Less denial, greater trust in one's practitioner, and longer patient-practitioner relationship were associated with more advance care planning. CONCLUSIONS: Half of all persons infected with HIV are at risk of making end-of-life decisions without prior discussions with their health care practitioners. Blacks, Latinos, intravenous drug users, and less educated individuals need advance care planning interventions in clinical HIV programs.     

Reproductive health in Irish female renal transplant recipients

Objective

To report the pregnancy outcomes in Irish female renal transplant recipients on modern maintenance immunosuppression.

Methods

The Republic of Ireland transplant database was accessed to identify the patient cohort in question. All female renal transplant recipients whose transplantation was in Ireland before or during their reproductive years were included. A questionnaire was sent to the identified women. A chart review was performed for those women who reported a pregnancy following renal transplantation.

Results

Two hundred and ten women met the inclusion criteria. There was a response rate of 70% (n?=?148). Eighteen women reported 29 pregnancies. The live birth rate was 76%. The mean gestation of the live births was 36.2?weeks with a mean birth weight of 3.0?kg. There were six cases of pre-eclampsia. Twin pregnancies and those entering pregnancy with a creatinine greater than 135???mol/l had particularly complicated clinical courses. Four women had not conceived post transplant despite actively trying for over 1?year. Two women utilised assisted fertility methods (in vitro fertilisation), one of whom became pregnant.

Conclusions

A significant proportion of women who attempt to conceive following renal transplantation are successful, without the use of assisted fertility. Pregnancy in this setting warrants meticulous multidisciplinary care.     

延边地区脑卒中高危人群不同健康素养水平对健康产出的影响

[目的]分析延边地区脑卒中高危人群不同健康素养水平对健康产出的影响.[方法]利用整群便利抽样法选取延边地区330例脑卒中高危人群进行健康素养、自我效能及生活质量3个方面的问卷调查,同时测量血压、身高、体质量、空腹血糖及血脂等健康产出指标水平进行分析.[结果]延边地区330名脑卒中高危人群中健康素养缺乏者占17.6%,临界健康素养者占28.5%,健康素养充足者占53.9%.健康产出项目中的自我效能得分较低,为26.12±7.28,生活质量平均得分为83.40±11.54,临床相关指标中体质量指数平均值为24.65±3.39,属于超体质量状态,血糖平均值为(6.12±1.50)mmol/L,偏高.不同健康素养水平脑卒中高危人群的自我效能和血糖值间差异有统计学意义(P<0.05,P<0.01).脑卒中高危人群健康素养与自我效能和生活质量得分均呈正相关(r=0.185,P<0.01;r=0.130,P<0.05),而与血糖值呈负相关(r=-0.144,P<0.01).[结论]脑卒中高危人群健康素养水平对健康产出有影响,随着健康素养水平增高,自我效能得分随之增高,生活质量和血糖水平控制亦越好.