Emergency care provided to refugee children in Europe: RefuNET: a cross-sectional survey study

Mental healthcare access among resettled Syrian refugees in Leipzig, Germany

Our aim was to examine mental health needs and access to mental healthcare services among Syrian refugees in the city of Leipzig, Germany. We conducted a cross-sectional survey with Syrian refugee adults in Leipzig, Germany in 2021/2022. Outcomes included PTSD (PCL-5), depression (PHQ-9), anxiety (GAD-7) and somatic symptom (SSS-8). Descriptive, regression and effect modification analyses assessed associations between selected predictor variables and mental health service access. The sampling strategy means findings are applicable only to Syrian refugees in Leipzig. Of the 513 respondents, 18.3% had moderate/severe anxiety symptoms, 28.7% had moderate/severe depression symptoms, and 25.3% had PTSD symptoms. A total of 52.8% reported past year mental health problems, and 48.9% of those participants sought care for these problems. The most common reasons for not accessing mental healthcare services were wanting to handle the problem themselves and uncertainty about where to access services. Adjusted Poisson regression models (n = 259) found significant associations between current mental health symptoms and mental healthcare service access (RR: 1.47, 95% CI: 1.02-2.15, p = 0.041) but significance levels were not reached between somatization and trust in physicians with mental healthcare service access. Syrian refugees in Leipzig likely experience high unmet mental health needs. Community-based interventions for refugee mental health and de-stigmatization activities are needed to address these unmet needs in Leipzig.

Lost in translation? Information quality in pediatric pre-hospital medical emergencies with a language barrier in Germany

BACKGROUND

In pediatric medical emergencies, paramedics and emergency physicians must often rely on the information of third parties, often caregivers, to gather information. Failing to obtain relevant information may lead to misinterpretation of symptoms and subsequent errors in decision making and clinical treatment. Thus, children and/or caregivers with limited proficiency of the locally spoken language may be at risk for medical errors. This study analyzes logs of rescue missions to determine whether paramedics could obtain essential information from German-speaking and foreign-language children and their caregivers.

METHODS

We conducted a secondary data analysis based on retrospective data on pediatric patients of four emergency medical services (EMS) stations in Northern Germany. We defined language discordance with communication difficulties as main exposure. We used documentation quality as outcome defined as existing information on (a) pre-existing conditions, (b) current medication, and (c) events prior to the medical emergency. Statistical analyses include descriptive statistics, simple regression and multivariable regression. As multivariable regression model, a logistic regression was applied with documentation quality as dependent variable and language discordance with communication difficulties as independent variable adjusted for age, sex and Glasgow Coma Scale (GCS).

RESULTS

Data from 1,430 pediatric rescue missions were analyzed with 3.1% (n = 45) having a language discordance with communication difficulties. Patients in the pediatric foreign-language group were younger compared to German-speaking patients. Thorough documentation was more frequent in German-speaking patients than in patients in the foreign-language group. Pre-existing conditions and events prior to the medical emergency were considerably more often documented in German-speaking than for foreign-language patients. Documentation of medication did not differ between these groups. The adjustment of sex, age and GCS in the multivariable analysis did not change the results.

CONCLUSION

Language barriers are hindering paramedics to obtain relevant information in pediatric pre-hospital emergencies. This jeopardizes the safe provision of paramedic care to children who themselves or their caregivers are not fluent in German language. Further research should focus on feasible ways to overcome language barriers in pre-hospital emergencies.

TRIAL REGISTRATION

This is a retrospective secondary data analysis of a study that was registered at the German Clinical Trials Register (No. DRKS00016719), 08/02/2019.

Infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine

Hintergrund

Bis Anfang Juni 2022 sind ca. 300.000 Kinder und Jugendliche aus der Ukraine im deutschen Ausländerzentralregister registriert worden.

Die vorliegenden Handlungsempfehlungen sollen die Grundlage für eine evidenzbasierte und zielgerichtete infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine schaffen.

Ziele

Die Handlungsempfehlungen sollen medizinisches Personal in der Versorgung minderjähriger Flüchtlinge aus der Ukraine unterstützen, um

1. einen unvollständigen Impfschutz frühzeitig zu erkennen und zu vervollständigen;

2. übliche Infektionskrankheiten zu diagnostizieren und zu behandeln;

3. in Deutschland seltene Infektionskrankheiten frühzeitig zu erkennen und zu therapieren.

Material und Methoden

Die Handlungsempfehlungen wurden als durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) koordinierte Leitlinie der Stufe 1 verfasst und an die Situation Flucht aus der Ukraine angepasst.

Die Empfehlungen wurden durch eine repräsentativ zusammengesetzte Expertengruppe der beteiligten Fachgesellschaften im informellen Konsens erarbeitet und final von den Vorständen der Fachgesellschaften offiziell verabschiedet.

Ergebnisse

Es werden Empfehlungen für den Umfang der Anamnese und der körperlichen Untersuchung minderjähriger Flüchtlinge, angepasst an die Situation Flucht aus der Ukraine, ausgesprochen. Für alle minderjährigen Flüchtlinge werden die Bestimmung eines Differenzialblutbilds sowie Untersuchungen auf Tuberkulose, Hepatitis B und C sowie eine Human-Immunodeficiency-Virus(HIV)-Infektion empfohlen.

Zur raschen Vervollständigung des Impfstatus wird eine alters- und Indikationsbezogene Priorisierung einzelner Impfungen vorgenommen.

Diskussion

Angesichts anhaltend hoher Flüchtlingszahlen nicht nur aus der Ukraine ist eine weitere Professionalisierung der medizinischen Versorgung minderjähriger Flüchtlinge notwendig. Hierzu sollten die notwendigen strukturellen und personellen Rahmenbedingungen geschaffen werden.

Cascading Risks for Preventable Infectious Diseases in Children and Adolescents during the 2022 Invasion of Ukraine

Russia’s military incursion into Ukraine triggered the mass displacement of two-thirds of Ukrainian children and adolescents, creating a cascade of population health consequences and producing extraordinary challenges for monitoring and controlling preventable pediatric infectious diseases. From the onset of the war, infectious disease surveillance and healthcare systems were severely disrupted. Prior to the reestablishment of dependable infectious disease surveillance systems, and during the early months of the conflict, our international team of pediatricians, infectious disease specialists, and population health scientists assessed the health implications for child and adolescent populations. The invasion occurred just as the COVID-19 Omicron surge was peaking throughout Europe and Ukrainian children had not received COVID-19 vaccines. In addition, vaccine coverage for multiple vaccine-preventable diseases, most notably measles, was alarmingly low as Ukrainian children and adolescents were forced to migrate from their home communities, living precariously as internally displaced persons inside Ukraine or streaming into European border nations as refugees. The incursion created immediate impediments in accessing HIV treatment services, aimed at preventing serial transmission from HIV-positive persons to adolescent sexual or drug-injection partners and to prevent vertical transmission from HIV-positive pregnant women to their newborns. The war also led to new-onset, conflict-associated, preventable infectious diseases in children and adolescents. First, children and adolescents were at risk of wound infections from medical trauma sustained during bombardment and other acts of war. Second, young people were at risk of sexually transmitted infections resulting from sexual assault perpetrated by invading Russian military personnel on youth trapped in occupied territories or from sexual assault perpetrated on vulnerable youth attempting to migrate to safety. Given the cascading risks that Ukrainian children and adolescents faced in the early months of the war—and will likely continue to face—infectious disease specialists and pediatricians are using their international networks to assist refugee-receiving host nations to improve infectious disease screening and interventions.

Aktualisierte Empfehlungen zur infektiologischen Versorgung von Flüchtlingen im Kindes- und Jugendalter in Deutschland (Stand 30. März 2022), angemeldet als S1-Leitlinie (AWMF-Register Nr. 048-017)

Hintergrund

Mit etwa 190.000 Asylanträgen im Jahr 2021 ist Deutschland das wichtigste Aufnahmeland von Asylsuchenden in Europa.

Die vorliegenden Handlungsempfehlungen sollen eine Grundlage für eine evidenzbasierte und zielgerichtete infektiologische Versorgung minderjähriger Flüchtlinge schaffen.

Ziele

Die Handlungsempfehlungen sollen medizinisches Personal in der Versorgung minderjähriger Flüchtlinge unterstützen, um

1. einen unvollständigen Impfschutz frühzeitig zu erkennen und zu vervollständigen;

2. übliche Infektionskrankheiten zu diagnostizieren und zu behandeln;

3. in Deutschland seltene Infektionskrankheiten frühzeitig zu erkennen und zu therapieren.

Material und Methoden

Die Handlungsempfehlungen wurden als AWMF-Leitlinie Stufe 1 verfasst.

Entsprechend wurden die Empfehlungen durch eine repräsentativ zusammengesetzte Expertengruppe der beteiligten Fachgesellschaften im informellen Konsens erarbeitet und final von den Vorständen der Fachgesellschaften offiziell verabschiedet.

Ergebnisse

Es werden Empfehlungen ausgesprochen, für den Umfang der Anamnese und der körperlichen Untersuchung minderjähriger Flüchtlinge. Für alle minderjährigen Flüchtlinge werden die Bestimmung eines Differenzialblutbildes sowie Untersuchungen auf Tuberkulose und Hepatitis B empfohlen.

Je nach Herkunft und Alter werden weitere gezielte Untersuchungen z. B. auf Hepatitis C, HIV oder Schistosomiasis empfohlen. Zur raschen Vervollständigung des Impfstatus wird eine alters- und indikationsbezogene Priorisierung einzelner Impfungen vorgenommen.

Diskussion

Angesichts anhaltend hoher Flüchtlingszahlen ist eine weitere Professionalisierung der medizinischen Versorgung minderjähriger Flüchtlinge notwendig. Hierzu sollten die notwendigen strukturellen und personellen Rahmenbedingungen geschaffen werden.

Update on the Coordinated Efforts of Looking After the Health Care Needs of Children and Young People Fleeing the Conflict Zone of Ukraine Presenting to European Emergency Departments-A Joint Statement of the European Society for Emergency Paediatrics and the European Academy of Paediatrics

This joint statement by the European Society for Emergency Paediatrics and European Academy of Paediatrics aims to highlight recommendations for dealing with refugee children and young people fleeing the Ukrainian war when presenting to emergency departments (EDs) across Europe. Children and young people might present, sometimes unaccompanied, with either ongoing complex health needs or illnesses, mental health issues, and injuries related to the war itself and the flight from it. Obstacles to providing urgent and emergency care include lack of clinical guidelines, language barriers, and lack of insight in previous medical history. Children with complex health needs are at high risk for complications and their continued access to specialist healthcare should be prioritized in resettlements programs. Ukraine has one of the lowest vaccination coverages in the Europe, and outbreaks of cholera, measles, diphtheria, poliomyelitis, and COVID-19 should be anticipated. In Ukraine, rates of multidrug resistant tuberculosis are high, making screening for this important. Urgent and emergency care facilities should also prepare for dealing with children with war-related injuries and mental health issues. Ukrainian refugee children and young people should be included in local educational systems and social activities at the earliest opportunity.