Emergency radiology in displaced populations: imaging and practical challenges

Since the outbreak of the Syrian civil war in 2011, the population of Arab refugees in Turkey has rapidly increased. While cystic fibrosis (CF) is believed to be rare among Arabs, recent studies suggest it is underdiagnosed. This study aims to present the demographic, clinical, and genetic characteristics of CF patients among Arab refugees in Turkey. Additionally, a comparison is made between the findings in the National CF Registry 2021 in Turkey (NCFRT) and the refugee CF patient group. The study included refugee patients between the ages of 0 and 18 years who were diagnosed with CF and received ongoing care at pediatric pulmonology centers from March 2011 to March 2021. The study examined demographic information, age at diagnosis, age of diagnosis of patients through CF newborn screening (NBS), presenting symptoms, CF transmembrane conductance regulator (CFTR) mutation test results, sputum culture results, weight, height, and body mass index (BMI) z score. Their results were compared with the NCFRT results. The study included 14 pediatric pulmonology centers and 87 patients, consisting of 46 (52.9%) boys and 41 (47.1%) girls. All of the patients were Arab refugees, with 80 (92%) being Syrian. All the patients were diagnosed in Turkey. The median age at diagnosis of patients was 22.33 (interquartile range, 1–258) months. The median age of diagnosis of patients through NBS was 4.2 (interquartile range, 1–12) months. The median age of older patients, who were unable to be included in the NBS program, was 32.3 (interquartile range, 3–258) months. Parental consanguinity was observed in 52 (59.7%) patients. The mutation that was most frequently found was F508del, which accounted for 22.2% of the cases. It was present in 20 patients, constituting 32 out of the total 144 alleles. There was a large number of genetic variations. CFTR genotyping could not be conducted for 12 patients. These patients had high sweat tests, and their genetic mutations could not be determined due to a lack of data. Compared to NCFRT, refugee patients were diagnosed later, and long-term follow-up of refugee CF patients had significantly worse nutritional status and pseudomonas colonization. Conclusion: Although refugee CF patients have equal access to NBS programs and CF medications as well as Turkish patients, the median age at diagnosis of patients, the median age of diagnosis of patients through NBS, their nutritional status, and Pseudomonas colonization were significantly worse than Turkish patients, which may be related to the difficulties of living in another country and poor living conditions. The high genetic heterogeneity and rare mutations detected in the refugee patient group compared to Turkish patients. Well-programmed NBS programs, thorough genetic studies, and the enhancement of living conditions for refugee patients in the countries they relocate to can have several advantages such as early detection and improved prognosis.What is Known:• Children who have chronic diseases are the group that is most affected by wars.• The outcome gets better with early diagnosis and treatment in patients with Cystic Fibrosis (CF).What is New:• Through the implementation of a newborn screening program, which has never been done in Syria previously, refugee patients, the majority of whom are Syrians were diagnosed with cystic fibrosis within a duration of 4 months.• Despite equal access to the newborn screening program and CF medications for both Turkish patients and refugee patients, the challenges of living in a foreign country have an impact on refugees.

Refugee and migrant communities carry histories wrought with trauma. These traumas and trauma-related responses often contribute to feelings of mistrust towards Western health care systems and can additionally foster negative clinician biases (conscious or unconscious) and attitudes towards these communities. Consequently, clinicians often fail to uncover underlying causes of poor health and distress for their refugee and migrant patients. To dismantle biases and cultivate empathy towards refugee and migrant patients, we developed a 1-hour simulation-based educational workshop to train clinicians to think critically about incorporating trauma-informed care (TIC) for these patients' unique needs. We introduced this tool to the GME curricula at Texas Tech University (n = 36) and to the UME curricula at Albany Medical College (n = 43). Using pre- and postquestionnaires, we analyzed the impact of this workshop on participants' knowledge, attitudes, and practices regarding TIC for migrant and refugee populations (n = 44). This tool positively influenced students' and residents' knowledge and attitudes regarding TIC and displaced peoples, and learners expressed greater willingness to incorporate TIC into clinical practice (p < .001). Additionally, residents self-reported percentage increases in behaviors that promote equitable care for refugee and migrant patients 6 months postintervention. This training enhanced clinicians' trauma-informed practices towards refugee and migrant patients, with learners qualitatively expressing a greater sense of empathy towards this community. While measuring the impact on learners' empathy requires further assessment, this educational innovation's preliminary success provides a foundation for the role of simulation-based learning in medical education.

Introduction: Increase in refugees’ population poses great political, socio-economic and health challenges to Africa. This study aims to discuss the trends and drivers of refugees in African countries based on their country of origin. Methods: This study utilized secondary data on the population of refugees in all African countries from 1990 to 2017 based on their countries of origin. The data utilized were compiled by United Nations High Commissioner for Refugee (UNHCR) and analysed using Microsoft Excel 2019, IBM SPSS 25 and Adobe Photoshop CS6. Results: Seven countries account for about 66.3% of the refugee population in Africa within 1990 to 2017, five of which are in East Africa. The trend in population of African refugees from 1990 to 2017 can be divided into four phases. Phase one, a sharp decline in refugee population from 1990 till 1992, 1994 till 1997; phase two, a sharp rise in population of refugees’ from 1992 till 1994; phase three, a relatively stable period from 1998 till 2011 and phase four, an acute rise from 2011 till 2017 where it peaks. The drivers of African refugee migration are climate change, natural disasters, economic hardship, and violence and tensions. Conclusion: The refugee population over three decades has been on the rise with occasional periods of decline. This poses great socio-economic and health challenges to the refugees as well as the host countries themselves. It is therefore necessary that the government and other concerned stakeholders create solutions to the causes of this increase in refugee population.

Medical preparedness and response to radiation emergency are challenged by the fast development of nuclear energy and nuclear technology, the rapid use of radiological source and devices,and terrorist threats involving radiological material. Against this background, hospitals play a vital role in medical response to radiation emergency. In this article, we discussed the hospital's responsibility in medical response to radiation emergency, and raised a series of requirements to the medical bases engaged in radiation emergency, which cover the planning, personnel, facilities, equipments and drugs stockpiling, and medical management technique of such bases. Adequate preparedness in advance makes the best guard for such bases, to effectively handle nuclear and radiological emergency, minimizing casualties and health damage and protecting people's health and safety. Key words: Nuclear accident; Radiological accident; Emergency preparedness; Medical response

PurposeThe study aims to evaluate the hospitalization diagnoses and nursing diagnoses of the refugee and local population hospitalized in internal medicine clinics, which are especially important in the early diagnosis, treatment, and rehabilitation of chronic diseases, and to emphasize their importance in nursing care.MethodsThe study was carried out in a descriptive retrospective design. The files of 3563 patients admitted to the internal medicine clinic of a training and research hospital in Türkiye in 2022 were evaluated. SPSS 26.0 program was used for data analysis.ResultsIn the study, 95.3% of hospitalizations were native and 4.7% were refugee patients. It was determined that refugee patients admitted to the internal medicine service had a lower mean age compared to the native population (p < 0.05), but there was no difference in the duration of hospitalization (p > 0.05). When the medical diagnoses of hospitalization were examined, it was determined that the highest number of hospitalizations in the native and refugee populations were for bacterial infections in both genders. In nursing diagnoses, it was determined that both populations and genders were diagnosed with infection risk by the medical diagnoses of the patients.ConclusionAs a result of the study, it was observed that the duration of hospitalization, reasons for hospitalization, and nursing diagnoses of local and refugee patients were similar. In addition, it was determined that the patients’ medical hospitalization diagnoses and nursing diagnoses were compatible.

The National Cancer Institute (NCI) recognizes ‘cancer health disparities’ as adverse differences in cancer incidence, mortality, and burden that exist among specific population groups. Refugee populations often lack access to primary care and health screening or preventive services, leading to late diagnosis, higher cancer burdens of cancer-related outcomes and mortality. The disproportionate burden of cancer in refugee populations, necessitates research on specific determinates and disparities influencing their cancer care. Ongoing conflicts across the Middle East and North Africa (MENA) region have caused an unprecedented displacement of individuals to host countries. Four countries in the region, Jordan, Lebanon, Palestinian territories, and Turkey, host more than an estimated 3 million refugees collectively. As the region experiences a shift in disease burden to non-communicable diseases, the health systems of these host countries are placed under increased pressure to manage chronic conditions of refugees, such as cancer.2 These large-scale displacements in the MENA region present a unique opportunity to better understand the drivers of health disparities with the aim of improving cancer health in refugee populations. Through a Social Determinates of Health (SDOH) framework, this study aims to understand the landscape of health seeking behaviors for cancer prevention among refugees in Jordan, Lebanon, Palestinian territories, and Turkey. This is a first step to inform future research and initiatives around refugee cancer services. A systematic literature review was completed according to PRISMA standards, with assistance from the NIH Library. A review protocol was developed, and all literature that met eligibility criteria was included. Thematic coding and analysis was then performed to describe observational associations between cancer prevention behaviors and SDOH among refugees. The results reveal patterns in which SDOH directly and indirectly influence the landscape of refugee health seeking behaviors for cancer prevention services in their host countries. The SDOH that most clearly influenced cancer prevention behaviors include health system capacity, navigating host country’s health system, delivery of cancer prevention services, acculturation, competing social, health, and financial priorities, and the built environment. These interrelated constructs impact refugees’ ability to access and participate in cancer prevention services, as both enabling and inhibit factors. The influence of SDOH on seeking cancer care are important for refugee populations around the world since they are faced with comparable contextual factors that both enable and inhibit health seeking behaviors. Understanding the interplay between the SDOH constructs is pivotal towards developing targeted interventions by host countries to improve cancer prevention behaviors and health outcomes among refugees. Citation Format: Jordan Freeman, Marie Ricciardone, Richard Sullivan, Vidya Vedham. The influence of social determinants of health on primary and secondary cancer prevention health-seeking behaviors among refugees in Middle East and North Africa host countries [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A059.

Background: The National Cancer Institute (NCI) recognizes 'cancer health disparities' as adverse differences in cancer incidence, mortality, and burden that exist among specific population groups. Refugee populations often lack access to primary care and health screening or preventive services, leading to late diagnosis, and higher cancer burdens of cancer-related outcomes and mortality. The disproportionate burden of cancer in refugee populations, necessitates research on specific determinants and disparities influencing their cancer care. Ongoing conflicts across the Middle East and North Africa (MENA) region have caused an unprecedented displacement of individuals to host countries. Four countries in the region, Jordan, Lebanon, Palestinian territories, and Turkey, host more than an estimated 3 million refugees collectively. As the region experiences a shift in disease burden to noncommunicable diseases, the health systems of these host countries are placed under increased pressure to manage chronic conditions of refugees, such as cancer. These large-scale displacements in the MENA region present a unique opportunity to better understand the drivers of health disparities with the aim of improving cancer health in refugee populations. Aim: Through application of a Social Determinants of Health (SDOH) framework, this study aims to understand the landscape of health seeking behaviors for cancer prevention among refugees in Jordan, Lebanon, Palestinian territories, and Turkey. This is a first step to inform future research and initiatives around refugee cancer services. Methods: A systematic literature review was completed according to PRISMA standards, with assistance from the NIH Library. A review protocol was developed, and all literature that met eligibility criteria was included. Thematic coding and analysis was then performed to describe observational associations between cancer prevention behaviors and SDOH among refugees. Results: The results reveal patterns in which SDOH directly and indirectly influence the landscape of refugee health seeking behaviors for cancer prevention services in their host countries. The SDOH that most clearly influenced cancer prevention behaviors include health system capacity, navigating host country's health system, delivery of cancer prevention services, acculturation, competing social, health, and financial priorities, and the built environment. These interrelated constructs impact refugees' ability to access and participate in cancer prevention services, as both enabling and inhibit factors. Conclusion: The influence of SDOH on seeking cancer care are important for refugee populations around the world since they are faced with comparable contextual factors that both enable and inhibit health seeking behaviors. Understanding the interplay between the SDOH constructs is pivotal toward developing targeted interventions by host countries to improve cancer prevention behaviors and health outcomes among refugees.

Industrialized dairy production in the U.S. relies on an immigrant, primarily Latino/a, workforce to meet greater production demands. Given the high rates of injuries and illnesses on U.S. dairies, there is pressing need to develop culturally appropriate training to promote safe practices among immigrant, Latino/a dairy workers. To date, there have been few published research articles or guidelines specific to developing effective occupational safety and health (OSH) training for immigrant, Latino/a workers in the dairy industry. Literature relevant to safety training for immigrant workers in agriculture and other high-risk industries (e.g., construction) was examined to identify promising approaches. The aim of this paper is to provide a practical guide for researchers and practitioners involved in the design and implementation of effective OSH training programs for immigrant, Latino/a workers in the dairy industry. The search was restricted to peer-reviewed academic journals and guidelines published between 1980 and 2015 by universities or extension programs, written in English, and related to health and safety training among immigrant, Latino/a workers within agriculture and other high-risk industries. Relevant recommendations regarding effective training transfer were also included from literature in the field of industrial–organizational psychology. A total of 97 articles were identified, of which 65 met the inclusion criteria and made a unique and significant contribution. The review revealed a number of promising strategies for how to effectively tailor health and safety training for immigrant, Latino/a workers in the dairy industry grouped under five main themes: (1) understanding and involving workers; (2) training content and materials; (3) training methods; (4) maximizing worker engagement; and (5) program evaluation. The identification of best practices in the design and implementation of training programs for immigrant, Latino/a workers within agriculture and other high-risk industries can inform the development of more effective and sustainable health and safety training for immigrant, Latino/a dairy workers in the U.S. and other countries.

The purpose of this study is to examine the future perspective of Bangladesh community in Korea (BCK). We analyze the formation, goals, purposes and activities of different types of community organizations. Bangladeshi migrants like to live in community in host country that plays an important role on their overseas life. Different types of Bangladeshi migrants have established different types of communities and all communities have specific goals. To achieve their goals, they have various activities. Bangladesh Community in Korea (BCK) known as common platform where all types of migrant communities work together as unity of will. It works asan umbrella organization upon all Bangladeshi migrants as well as migrant communities. BCK's aims are developing and raising the migrant community, achieving various facilities and opportunities from host country, making bridge between home and host country, and finally branding home country. The future perspective of BCK is very significant for Bangladeshi migrant society as well as home and host country. This study suggests that every community should have good strategy and increase network and activity to achieve their goals for target people and welfare of migrant society in Korea. BCK should promote Bangladeshi migrants as a member of the Korean society rather than excessive strengthening of ethnic national identity.

European oncologists face a communication gap with refugee patients who have recently immigrated from Middle Eastern and northern African countries, with their different health belief models and affinity for traditional and herbal medicine. A culturally sensitive approach to care will foster doctor-refugee communication, through the integration of evidence-based medicine within a nonjudgmental, bio-psycho-social-cultural-spiritual agenda, addressing patients' expectation within a supportive and palliative care context. Integrative physicians, who are conventional doctors trained in traditional/complementary medicine, can mediate between conventional and traditional/herbal paradigms of care, facilitating doctor-patient communication through education and by providing clinical consultations within conventional oncology centers.

IntroductionUganda currently hosts an estimated 1.5 million refugees. The refugees have challenges in accessing family planning (FP) services in the host country. The study aimed to investigate factors associated with FP use among host and refugee populations in Adjumani district, Uganda.MethodsA comparative cross-sectional study was conducted in May 2021 in three refugee settlements and their host communities in Adjumani district. A total of 1,310 respondents, (664 refugees and 646 host) were randomly selected using multistage cluster sampling and interviewed. Quantitative data were collected using structured questionnaires and analyzed using STATA V.15. Descriptive and Multivariate analysis performed.ResultsWe found that modern Contraceptive Prevalence Rate (mCPR) was 30.2% (32.2% for host and 28.2% for refugees). Multivariate analysis showed that women who live singly (AOR = 2.25, 95%, CI: 1.56 -3.84), completed primary education [AOR = 1.65, 95% CI: 1.27–2.16], acquired skills [AOR = 2.28, 95% CI: 2.11–2.47], have the desire for another child [AOR = 3.73, 95% CI: 1.45- 9.60], have stayed in the study area between 3–5 years [AOR = 2.24, 95% CI: 1.46–3.42] were statistically significantly associated with FP use among both refugee and host populations. The key barrier to FP use by host was harassment of women and separation/divorce for not consulting the family members. Whereas amongst the refugees, they do not want to use FP methods.ConclusionOur findings revealed low FP use amongst both populations in Adjumani district. The main factors associated with FP use amongst refugee populations included marital status, level of education, type of occupation, and duration of stay in the study area whereas amongst the host is the marital status. Main reasons for not using FP methods included fear of side effects by hosts and not wanting to use FP by refugees. There is need to sensitize both communities about the benefits of FP at community level.

Due to external regulations and limited resources, micro and small enterprises’ (MSEs) work safety behavior in China’s high-risk industries is passive behavior under constraints. Based on stakeholder theory, this paper describes the attributes and behavior rules of MSEs, the government safety supervision department and work safety service agencies using the agent-based simulation methods. We construct an evolution model to study this behavior. The software platform Netlogo is used for simulation exercises. Under the four factors of enterprise work safety resource strength, government supervision, government subsidies, and organization service level, the evolution of MSEs’ work safety behavior in high-risk industries is simulated and the results are discussed. It further reveals internal and external drivers of work safety of MSEs in high-risk industries, strengthens the scientific supervision and effective support of government safety supervision departments, and improves work safety service quality of service agencies multi-dimensionally.

Despite advancements in occupational health and safety (OHS) management, high-risk industries in China continue to report a significant number of fatal accidents, underscoring systemic challenges in protecting the well-being of workers while supporting economic development. This study analyzed 22 years of historical data on OHS incidents, labor dynamics, and economic growth in China’s high-risk industries via multiple regression and network analysis methods. The findings reveal hierarchical influence relationships, with coal mine fatalities emerging as critical upstream factors and transportation fatalities and national labor force dynamics emerging as key downstream factors. Notably, the study reveals a negative correlation between GDP and fatal workplace incidents: for every 0.461 trillion CNY increase in GDP, production safety accident deaths decrease by one. Conversely, each safety accident resulted in 1.052 coal mine fatalities and 0.153 cases of occupational disease. These results offer a novel quantitative perspective on the interplay between economic growth and workplace safety. The study’s models provide practical guidance for enhancing the effectiveness of OHS prevention and control efforts, contributing to sustainable economic and public health outcomes.

This research explores the advancement of Artificial Intelligence (AI) in Occupational Health and Safety (OHS) across high-risk industries, highlighting its pivotal role in mitigating the global incidence of occupational incidents and diseases, which result in approximately 2.3 million fatalities annually. Traditional OHS practices often fall short in completely preventing workplace incidents, primarily due to limitations in human-operated risk assessments and management. The integration of AI technologies has been instrumental in automating hazardous tasks, enhancing real-time monitoring, and improving decision-making through comprehensive data analysis. Specific AI applications discussed include drones and robots for risky operations, computer vision for environmental monitoring, and predictive analytics to pre-empt potential hazards. Additionally, AI-driven simulations are enhancing training protocols, significantly improving both the safety and efficiency of workers. Various studies supporting the effectiveness of these AI applications indicate marked improvements in risk management and incident prevention. By transitioning from reactive to proactive safety measures, the implementation of AI in OHS represents a transformative approach, aiming to substantially reduce the global burden of occupational injuries and fatalities in high-risk sectors.

Occupational health and safety management in municipal waste companies: A note on the Italian sector