How do refugee children experience their new situation in England and Denmark? Implications for educational policy and practice

As the number of individuals who have been forced to flee their homes and country of origin has increased rapidly in recent years, the need to understand how best to support such individuals, especially the youngest of them, becomes pressing. This study presents findings from interviews with adults who had arrived as asylum-seekers in one of two countries, Denmark or England, when they were children. Qualitative findings based on Interpretative Phenomenological Analyses demonstrate the participants' focus on Language-based challenges that extend to further difficulties, Choosing to succeed, Gaining strength through social support, encouragement and guidance, Integrating two separate worlds into one and Seeing, hearing and understanding children's needs. The participants have had time to reflect on their early experiences of integration, and their voices can inform researchers, educators and other practitioners currently working with refugee children and families

Experiences of Arriving to Sweden as an Unaccompanied Asylum-seeking Minor from Afghanistan: An Interpretative Phenomenological Analysis

Objective: The number of individuals seeking refuge and safety in European and Western host-societies has increased in recent years and there is no evidence to suggest that this trend will reverse in the foreseeable future. Unaccompanied asylum-seeking children and youth are particularly vulnerable to risk. The detrimental influence of political conflicts, war and forced migration on asylum-seeking individuals’ mental health is well-documented; however, the stressors encountered after arrival to the host-country have been investigated less frequently. This study explored how a group of six male refugees from Afghanistan experienced arriving to the Swedish host-society as unaccompanied minors, and how they perceived the support available to them. Methods: Based on individual semi-structured interviews, an interpretative phenomenological analysis was carried out to explore the perceived risks and protective factors during the first months and years in the host-society. Results: The qualitative findings draw attention to the crucial importance of clarifying the complex asylum-seeking process, the protective influence of social support, the importance of educational guidance, and participant’s strong desire to fit in and move forward with their lives. Conclusion: The resulting information can inform the practice of supporting asylum-seeking youths’ adaptation in host-societies and in developing assessment measures and interventions for these groups. Specifically, the results indicate the protective role of social support and highlight the potential value of mentoring schemes

Voices rarely heard: personal construct assessments of Sub-Saharan unaccompanied asylum-seeking and refugee youth in England

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 importance of social support as a means for hope, as an escape from distress and as an opportunity to form relationships that resembled family bonds. They expressed their desire to move forward and to achieve their goals, as well as their fear of rejections and issues related to trust. The participants' voices illustrate areas where gaps remain to be filled in terms of providing sufficient support to unaccompanied minors and youth in England, with implications for future research, policy and practice. The importance of providing unaccompanied children and youth with an opportunity to engage in meaningful activities with peers and adults is demonstrated and the need to provide initiatives that seek to prevent discrimination is highlighted

Internalizing and externalizing symptoms among unaccompanied refugee and Italian adolescents

This study investigated the prevalence of emotional and behavioral symptoms in unaccompanied refugee adolescents living in Italy; an area which remains under-researched despite the relatively high number of asylum seekers registered in Italy compared to other industrialized countries. The Child Behavior Checklist (CBCL) for 6–18 year-olds was completed by a social worker or parent for each of the 120 participating adolescents; sixty male unaccompanied refugee adolescents and sixty male native Italian adolescents. The paper presents findings that illustrate high levels of emotional and behavioral problems in unaccompanied refugee youth living in Italy. On all components of the CBCL, unaccompanied refugee adolescents were found to present with significantly more problems, as reported by social workers, compared to the Italian group of adolescents. In the light of these results, the importance of interventions and culturally sensitive therapeutic programs for refugee youth is discussed

The effects of a dialogue-based intervention to promote psychosocial well-being after stroke: a randomized controlled trial

Objective: To evaluate the effect of a dialogue-based intervention targeting psychosocial well-being at 12 months post-stroke. Design: Multicenter, prospective, randomized, assessor-blinded, controlled trial with two parallel groups. Setting: Community. Subjects: Three-hundred and twenty-two adults (⩾18 years) with stroke within the last four weeks were randomly allocated into intervention group (n = 166) or control group (n = 156). Interventions: The intervention group received a dialogue-based intervention to promote psychosocial well-being, comprising eight individual 1–1½ hour sessions delivered during the first six months post-stroke. Main measures: The primary outcome measure was the General Health Questionnaire-28 (GHQ-28). Secondary outcome measures included the Stroke and Aphasia Quality of Life Scale-39g, the Sense of Coherence scale, and the Yale Brown single-item questionnaire. Results: The mean (SD) age of the participants was 66.8 (12.1) years in the intervention group and 65.7 (13.3) years in the control group. At 12 months post-stroke, the mean (SE) GHQ-28 score was 20.6 (0.84) in the intervention group and 19.9 (0.85) in the control group. There were no between-group differences in psychosocial well-being at 12 months post-stroke (mean difference: −0.74, 95% confidence interval (CI): −3.08, 1.60). The secondary outcomes showed no statistically significant between-group difference in health-related quality of life, sense of coherence, or depression at 12 months. Conclusion: The results of this trial did not demonstrate lower levels of emotional distress and anxiety or higher levels of health-related quality of life in the intervention group (dialogue-based intervention) as compared to the control group (usual care) at 12 months post-stroke

Caregiver education in Parkinson’s disease: formative evaluation of a standardized program in seven European countries

The formative evaluation of a standardized psychosocial education program for patients with Parkinson's disease (PD) and their caregivers. The results of the participation of the caregivers are presented next to the data of the patients. Caregivers (n = 137) and patients with PD (n = 151) participated in the 8-week program in separate groups. Measurements were performed on psychosocial problems (BELA-P/A-k), health state (EQ-5D VAS), quality of life (PDQ-39) and depression (SDS) 1 week before and 1 week after the program. Participants rated their mood on a visual analogue scale before and after each session, and they filled in an evaluation questionnaire after the last session. Scores on the BELA-P/A-k improved significantly on the 'bothered by scale' as well as the 'need for help scale'. No improvements were found on EQ-5D VAS, PDQ-39 and SDS. Mood ratings improved significantly after each session. Most participants evaluated the program as positive. Feedback led to improvements in the program, which are incorporated in a final manual. The program was feasible to run in the different countries. This exploratory study led to improvements in the program and recommendations for further research. A study on the effectiveness of the program is the next step.Pathophysiology of paroxysmal and chronic degenerative progressive disorder of the central and periferal nervous syste

Quality of life in couples living with Huntington’s disease: the role of patients’ and partners’ illness perceptions

Research suggests that chronically ill patients and their partners perceive illness differently, and that these differences have a negative impact on patients’ quality of life (QoL). This study assessed whether illness perceptions of patients with Huntington’s disease (HD) differ from those of their partners, and examined whether spousal illness perceptions are important for the QoL of the couples (n = 51 couples). Partners reported that their HD-patient spouses suffered more symptoms and experienced less control than the patients themselves reported. Illness perceptions of patients and partners correlated significantly with patient QoL. Partners’ beliefs in a long duration of the patients’ illness and less belief in cure, were associated with patient vitality scores. Suggestions for future research emphasize the importance of qualitative research approaches in combination with cognitive-behavioural approaches

Patient knowledge on stroke risk factors, symptoms and treatment options

Kashif Waqar Faiz,1,2 Antje Sundseth,1 Bente Thommessen,1 Ole Morten Rønning1,3 1Department of Neurology, Akershus University Hospital, Lørenskog, Norway; 2Health Services Research Center, Akershus University Hospital, Lørenskog, Norway; 3Institute of Clinical Medicine, University of Oslo, Oslo, Norway Background: Public campaigns focus primarily on stroke symptom and risk factor knowledge, but patients who correctly recognize stroke symptoms do not necessarily know the reason for urgent hospitalization. The aim of this study was to explore knowledge on stroke risk factors, symptoms and treatment options among acute stroke and transient ischemic attack patients. Methods: This prospective study included patients admitted to the stroke unit at the Department of Neurology, Akershus University Hospital, Norway. Patients with previous cerebrovascular disease, patients receiving thrombolytic treatment and patients who were not able to answer the questions in the questionnaire were excluded. Patients were asked two closed-ended questions: “Do you believe that stroke is a serious disorder?” and “Do you believe that time is of importance for stroke treatment?”. In addition, patients were asked three open-ended questions where they were asked to list as many stroke risk factors, stroke symptoms and stroke treatment options as they could. Results: A total of 173 patients were included, of whom 158 (91.3%) confirmed that they regarded stroke as a serious disorder and 148 patients (85.5%) considered time being of importance. In all, 102 patients (59.0%) could not name any treatment option. Forty-one patients (23.7%) named one or more adequate treatment options, and they were younger (p<0.001) and had higher educational level (p<0.001), but had a nonsignificant shorter prehospital delay time (p=0.292). Conclusion: The level of stroke treatment knowledge in stroke patients seems to be poor. Public campaigns should probably also focus on information on treatment options, which may contribute to reduce prehospital delay and onset-to-treatment-time. Keywords: stroke, thrombolytic therapy, endovascular treatment, prehospital delay, stroke knowledge, stroke treatment option

Blood pressure control to prevent decline in cognition after stroke

Hege Ihle-Hansen,1 Bente Thommessen,2 Morten W Fagerland,3 Anne R Øksengård,4 Torgeir B Wyller,5 Knut Engedal,6 Brynjar Fure7 1Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway; 2Department of Neurology, Akershus University Hospital, Lørenskog, Norway; 3Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Norway; 4Department of Internal medicine, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway; 5Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; 6Norwegian Centre for Dementia Research, Oslo University Hospital, Oslo, Norway; 7Norwegian Knowledge Centre for the Health Services, Oslo, Norway Background: Treatment of hypertension post-stroke preserves cognition through prevention of recurrent stroke, but it is not clear whether it prevents cognitive decline through other mechanisms. We aimed to describe changes in blood pressure from baseline to 1 year post-stroke and to evaluate the association between achieved blood pressure targets and cognitive function, mild cognitive impairment (MCI), and dementia.Methods: We included patients with first-ever stroke, and defined achieved blood pressure goals as systolic blood pressure (SBP) in the categories ≤125 mmHg, ≤140 mmHg, and ≤160 mmHg, SBP reduction of ≥10 mmHg, and diastolic blood pressure (DBP) reduction of ≥5 mmHg. The main outcome variables were cognitive assessments 1 year post stroke. Secondary outcomes were diagnoses of MCI or dementia.Results: Forty-one of 166 patients (25%) reached SBP ≤125 mmHg after 1 year, 92/166 (55%) reached SBP ≤140 mmHg, and 150/166 (90%) reached SBP ≤160 mmHg. SBP was reduced by ≥10 mmHg in 44/150 (29%) and DBP by ≥5 mmHg in 57/150 (38%). We did not find any statistically significant associations between cognitive test performances and different blood pressure goals (P=0.070–1.0). Nor was there any significant association between achieved goal blood pressure or blood pressure reduction after 1 year and the diagnoses of MCI or dementia (P=0.32–0.56).Conclusion: Treatment of hypertension is important for primary and secondary prevention of stroke. Showing a potential beneficial effect of blood pressure control on cognitive function, however, probably needs longer follow-up. Keywords: cognitive impairment, hypertension, cerebrovascular disease, risk factor management, secondary preventio