The prevalence of post-traumatic stress disorder in Syrian refugees increased after long-distance migration

Introduction

Refugees are forced migrants but there is a large variation in the distance that refugees cover and there is a knowledge gap on how this may affect refugees’ health and health care needs.

Objectives

Herein, we investigate the association between long-distance migration and post-traumatic stress disorder (PTSD), a serious psychiatric disorder associated with deteriorating mental and somatic health and highly prevalent in refugees.

Methods

Included were 712 adult Syrian refugees and asylum seekers in Lebanon and Denmark arriving no more than 12 months prior to inclusion. The Harvard Trauma Questionnaire was used to assess PTSD and the estimate of association was obtained by multiply imputing missing data and adjusting for confounding by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience, and WHO-5-score, reporting the bootstrap 95-percentile confidence interval (95% CI). Additionally, a number of sensitivity analysis were carried out.

Results

The prevalence of PTSD was high in both Lebanon (55%) and Denmark (60%) and long-distance migration was associated with a 9 percentage point (95% CI [-1; 19]) increase in the prevalence of PTSD among newly arrived Syrian refugees and asylum-seekers.

Conclusions

In the present study the prevalence of PTSD increased after long-distance migration which may support considering “long-distance migration” in refugee health screenings and in particular when assessing the risk of post-traumatic stress disorder. This is a first step in examining the health effects of migration on refugee health.

Disclosure

No significant relationships.

The prevalence of post-traumatic stress disorder increased in refugees after long-distance migration

Background

Refugees are forced migrants but there is a large variation in the distance that refugees cover. This may importantly affect their health needs. Previous studies suggest an inverse association between long-distance migration and self-rated health in the general population, possibly related to difficulty in acculturation but there is a knowledge gap in the health effects of migration in refugee populations. Here, we estimate the association between long-distance migration and post-traumatic stress disorder (PTSD), a severe mental health disorder associated with deteriorating psychiatric and somatic health and highly prevalent in refugees.

Methods

Included were 712 adult Syrian refugees and asylum seekers in Lebanon and Denmark arriving no more than 12 months prior to inclusion. The Harvard Trauma Questionnaire was used to assess PTSD and the estimate of association was obtained by multiply imputing missing data and adjusting for confounding by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience, and WHO-5-score, reporting the bootstrap 95-percentile confidence interval (CI). Additionally, a number of sensitivity analysis were carried out.

Results

The prevalence of PTSD was high in both Lebanon (55%) and Denmark (60%). After adjusting for biases the prevalence difference increased from 5 percentage point (95-percentile CI [-5; 15] percentage point) to 9 percentage point (95-percentile CI [-1; 19] percentage point). All sensitivity analysis produced estimates of the same direction and magnitude, except when grossly violating the assumption of multiple imputation which halved the magnitude of the association.

Conclusions

We found that long-distance migration was associated with an increase in the prevalence of PTSD among newly arrived Syrian refugees and asylum-seekers. This is a first step in examining the effects of migration in refugee health.

Key messages

Long-distance migration was positively associated with prevalence of post-traumatic stress disorder in Syrian refugees. This is a first step to investigate the impact of migration in refugee health.

Targeted next generation sequencing panel for HPV genotyping in cervical cancer

Cervical cancer are generally caused by a persistent infection with the oncogenic virus, HPV. Patients with HPV integration are more prone to develop cervical cancer than patients without integration. In this proof-of-concept study, we aimed to develop a sensitive method based on targeted amplicon based NGS for early and precise detection of high-risk HPV-genotypes that are highly associated with the development of cervical cancer. Furthermore, we aimed to investigate if amplicon based NGS allowed for HPV genotyping in cervical lesions and whether it could detect HPV integration. The cohort included a group of CIN3⁺ biopsies (n = 64), CIN2 samples that progressed (n = 5), CIN2 samples that regressed (n = 3), healthy controls (n = 10), and plasma samples (n = 10) from cervical cancer patients. Sequencing was performed using a custom targeted NGS panel designed to detect all 25 high-risk and probably high-risk and two low-risk HPV genotypes. The method was validated by the SPF₁₀ PCR-DEIA-LiPA₂₅ assay. In the cohort, the following HPV genotypes were identified: HPV-16, 18, 31, 33, 35, 45, 51, 52, 56, 58, and 59. When comparing the results from the SPF₁₀ PCR-DEIA-LiPA₂₅ analyses with the NGS analyses, there was close to a perfect agreement (K = 0.92) among the genotyped HPV types, while in the two cases with complete disagreement, a third assay was applied, and here the results of the NGS analyses were confirmed. Whereas multiple HPV types were detected by the SPF₁₀ PCR-DEIA-LiPA₂₅ assay, the NGS analysis clearly suggest that there is one predomentant HPV type. The NGS assay was capable of detecting HPV-16 in a previous false-negative sample classified by the INNO-LiPA assay, emphasizing the importance of including multiple regions of the HPV genome when genotyping. For the 10 plasma samples, our NGS analyses showed full agreement with the digital droplet PCR (ddPCR) analyses of HPV positive as well as negative plasma samples. Lastly, the custom panel was capable of detecting the integration of HPV-16 in the SiHa cell line. The HPV panel provides a highly cost-effective method for HPV detection and genotyping, as exemplified by a list price of around 75 € per sample. In conclusion, the current study demonstrates that targeted NGS is capable of detecting and genotyping HPV in both FFPE biopsies and plasma samples. This method provides for early diagnosis and prognosis of cervical cancer disease progression, thereby optimizing the potential of recovery and survival for these patients.

Middle fossa approach in vestibular schwannoma surgery. Postoperative hearing preservation and EEG changes

When the middle fossa (MF) approach was introduced in Denmark, we were concerned about the possible risk to the temporal lobe caused by the retraction of the lobe when exposing the internal acoustic meatus. EEG recordings were therefore obtained prospectively before (21 patients) and after MF tumor removal (all 23 patients operated from 1989 to 1997). Only three patients had normal EEG recordings before and after surgery, while 86% had induction, or worsening, of focal and paroxystic activity, even at the last follow-up (median 3.5 years). Sixteen patients operated prospectively via the translabyrinthine (TL) also had pre- and postoperative EEG and served as a control group. Only minor EEG changes were found in this group. In neither group did the patients display any clinical neurological signs (seizures). At the latest evaluation the facial function was reduced in 8 patients (35%) with 6 patients going 1 step up the scale, 1 patient 2 steps up and 1 patient 3 steps up (from HB-1 to HB-4). The integrity of the facial nerve was maintained in all patients. Postoperatively, 10 patients (44%) had useful hearing (hearing class A and B) on the operated side. Four patients had anacusis and an additional 4 patients were reduced to hearing class D with very low PTA and SDS. In total, 9 patients (39%) retained their preoperative hearing class, while 14 patients (61%) had impairment in their hearing class. In conclusion, EEG changes (low frequency activity and IEA) may be provoked or worsened as part of the middle cranial fossa procedure. The mechanism is not fully known, but may reflect peroperative pressure on the temporal lobe. EEG changes are fewer and lighter in translabyrinthine-operated patients. The practical clinical implications of the possibility of developing EEG changes, even without clinical signs, are potentially serious, and must be included in the information given to the patients before surgery.

Less radical drilling in surgery for exostoses of the external auditory canal

OBJECTIVE

To estimate the anatomical and functional long-term result of surgery for ear canal exostosis.

METHODS

Case rapport review with extraction of data concerning pre- and postoperative anatomical conditions, symptoms and audiology and a clinical and audiological re-evaluation. In the 20-year-period from 1 January 1976 to 1 January 1996, 26 patients were operated on primarily for ear canal exostosis. 19 patients with in total 24 ears were re-evaluated. Control-period 7.2 years. Pre-operatively were found occluding ear-canal exostosis in all patients as well as hearing loss, otitis externa and pain.

RESULTS

At the re-evaluation all patient were completely free of their symptoms. 19 out of 24 ears still had some remnants of exostosis, but the ear canal was covered with completely normal skin and had normal migration properties. No signs of re-growth were found in this material. Postoperatively one patient had a sensorineural hearing loss of 85 dB at 6 kHz, one had a dehiscence of the temporomandibular joint and one patient had an anterior ear drum perforation.

CONCLUSION

To avoid the complications a less radical drilling of exostoses is proposed, in particular along the superior wall and near the short process of the malleus handle and along the anterior tympanomeatal angle. Removal of the bone from the posterior, inferior and anterior walls with preservation of the canal skin, creates enough lumen providing permanent cure.

Late effects of perivascular injection of Thorotrast in the neck

Two cases of late sequelae of accidental perivascular injection of Thorotrast (thorium dioxide) during carotid arteriography are presented. The complaints of the patients and the clinical findings are due to topical granulomatous and fibrous reactions with compression of the carotid artery and cranial nerves, and influence upon larynx and trachea. For future decades it will still be necessary to be aware of this possible cause of neck tumours with oto-laryngeal and neurological symptoms.