Predictors of asylum seekers' mental health course in the early stages of resettlement: Results of a longitudinal study.

Kindermann D, Zeyher V, Nagy E, et al. Predictors of asylum seekers' mental health course in the early stages of resettlement: Results of a longitudinal study. Journal of psychosomatic research. 2020;132: 109977.OBJECTIVE: Asylum seekers who have experienced persecution, war and torture show high prevalence rates of stress-related mental disorders. After arrival in the host country, the early stages of resettlement seem to be a particularly vulnerable phase characterized by social instability. This longitudinal study aimed to explore predictors of the asylum seekers' course of mental health during the transition phase from a state registration and reception center to municipal shelters.; METHODS: We used hierarchical regression analysis to assess the symptom course of posttraumatic stress disorder (PTSD), depression, anxiety and panic disorders as well as well-being in n=84 asylum seekers. The follow-up assessment took place three to five months after baseline assessment. The following blocks of possible predictors were included in the statistical models: (1) sociodemographic variables, (2) cultural background related variables, (3) psychometric measures of emotion regulation and sense of coherence and (4) time range to follow-up.; RESULTS: Language proficiency, origin, religion and gender were stronger predictors of the asylum seekers' mental health course in the early stages of resettlement than emotion regulation and sense of coherence.; CONCLUSIONS: Sociodemographic and cultural background related variables, like language proficiency have a high psychosocial relevance for asylum seekers in the early phase of the asylum process. Therefore, language courses should be implemented progressively. Psychotherapy for asylum seekers should always be performed with awareness for cultural specific perspectives and acculturative adjustment processes. Copyright © 2020 Elsevier Inc. All rights reserved

Impact Assessment of the Partial Closure of the Ham Luong Estuary

The Mekong Delta in Vietnam is facing several challenges as a result of climate change. Among others, the effects include an increase in river discharge during the wet season, leading to river floods, and a decrease in river discharge during the dry season. The decrease in discharge results in a shortage of fresh water required for irrigation and drinking water. Besides that, the combination of sea-level rise, land subsidence, and decreased river discharge during the dry season results in saltwater intrusion. This threatens freshwater supply even more. Furthermore, there is an increasing risk of floods from the sea due to low land elevation and the rising sea level in combination with the occurrence of storm surges. The scope of this research is the area around the Ham Luong estuary, which is a branch of the Mekong River. The partial closure of this river branch is considered by the Vietnamese government as a measure to reduce the effect of the above-mentioned effects of climate change. However, not enough research has been conducted yet on the impact of a partial closure on the Ham Luong estuary. This has lead to the following research question: “What is the impact of various closure scenarios on the hydraulic characteristics and social activities in the Ham Luong estuary, considering a 75-year forecast?” The region of the Ham Luong estuary is characterised by its intensive agri- and aquaculture. More than 60% of the inhabitants is directly active within the agri- or aquaculture. As these activities are strongly dependent on the salinity of the estuary, they are highly affected by the effects of climate change. The region is densely populated with more than 125,000 inhabitants living near the Ham Luong estuary. It is clear that the effects of climate change are threatening the region in hydraulic aspects, as well as socio-economic aspects. A partial closure could reduce these effects, but will influence the region in several ways. In order to estimate the impact, a combination of hydraulic and socio-economic aspects is assessed based on a criteria set. This criteria set contains the criteria of freshwater supply, agricultural and aquaculture adaptation, biodiversity, stable riverbanks, and navigability. These criteria will be tested on a total of four alternative interventions in the Ham Luong estuary. Three alternatives with a storm surge barrier and one alternative without a storm surge barrier. All alternatives include heightening of the existing dyke system, as this seems to be inevitable when aiming for long-term development in the region. The extend of dyke heightening is subject to the choice of alternative. As a part of the impact analysis, a Delft3D model was built to analyse the hydrodynamic and morphodynamic processes in the Ham Luong estuary. The model was restricted to the chosen spatial scope, which only covers the Ham Luong estuary, without any upstream bifurcations. The model gave insights in processes like salt intrusion, sedimentation rates, and water levels. However, due to model simplifications and assumptions, the outcomes of the model where not useful for quantitative assessments. Still, the results are used to compare the impact of the different alternatives to each other. As expected, the alternatives that include a storm surge barrier will provide more possibilities to retain fresh water than the alternative without a barrier. From the results, it followed that the limited spatial scope excludes the redistribution of upstream discharge. It is recommended to look at a larger scale of the Mekong Delta when assessing hydro- and morphodynamic processes. Forming a flood protection system, the structural design of such a storm surge barrier, together with a quick estimation of a dyke system. The dyke system is different for each alternative, depending on the presence and the location of a barrier. The barrier design includes a thorough analysis on feasibility of gate types, technical requirements, load combinations, design of dimensions, and the operation. The load combinations take hydrostatic, hydrodynamic, wind, and soil loads into account. The design of the dimensions is done for the gates, sill, lifting structure, pier, foundation, and the bed protection. By assessing the above-mentioned criteria, a preferred solution is identified. This preference is based on a Multi-Criteria Analysis, which includes weighted scores for all alternatives. The outcome of the Multi-Criteria Analysis appears to be very sensitive to the rating and weights of the criteria, which makes it difficult to identify one of the alternatives as the preferred solution based on only the score on the different criteria. For this reason more research is needed. However, when including a cost estimation of the four alternatives, it can be stated that the alternative of no storm surge barrier and only the corresponding extensive dyke heightening could be considered as most cost-beneficial alternative and therefore as the preferred solution. It is expected that with or without closure of the Ham Luong estuary the system will change. The availability of fresh water will be improved by the presence of a closure, although more research is needed to specify this further. The increasing salt intrusion, as a result of Relative Sea-Level Rise (RSLR) will lead to agricultural and aquaculture adaptation in all alternatives. Either due to the construction of the barrier, or due to the gradual RSLR. A closure also has effect on the biodiversity, stability of the river banks, and navigability in the river. When implementing a closure these effects should be further investigated to assess the effect quantitatively.Civil EngineeringCivil Engineering | Hydraulic EngineeringCivil Engineering | Structural EngineeringCivil Engineering | Hydraulic Structure

Asylum seekers’ mental health and treatment utilization in a three months follow-up study after transfer from a state registration-and reception-center in Germany

Nikendei C, Kindermann D, Brandenburg-Ceynowa H, et al. Asylum seekers’ mental health and treatment utilization in a three months follow-up study after transfer from a state registration-and reception-center in Germany. Health Policy. 2019;123(9):864-872

Less Anti-infliximab Antibody Formation in Paediatric Crohn Patients on Concomitant Immunomodulators

Objectives: To evaluate the effect of immunomodulators on formation of antibodies to infliximab (ATI) in paediatric patients with Crohn disease (CD) and the association of ATI and loss of response. Methods: Retrospective multicentre observational study (January 2009-December 2014) among Dutch children with CD treated with infliximab (IFX). ATI formation was analysed with Chi-square test and time-to-ATI formation with Kaplan-Meier and log-rank test. Results: A total of 229 children were identified. ATIs were measured in 162 patients (70.7%) and 25 (15%) developed ATIs: 6 of 62 (10%) on continuous combined immunosuppression (CCI), 11 of 81 (14%) on early combined immunosuppression (ECI), and 8 of 19 (42%) on IFX monotherapy. ATI formation was higher in patients on IFX monotherapy compared to CCI (P = 0.003) and ECI (P = 0.008), whereas no significant difference was found between CCI and ECI. Sixteen out of 25 patients (64%) with ATIs had loss of response, compared with 32 of 137 patients (19%) without ATIs (P Conclusions: In children with CD combination therapy is associated with significant reduction of antibody formation and prolonged effectivity compared to IFX monotherapy. ECI for at least 12 months, followed by IFX monotherapy, may be an equally effective alternative to CCI

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31â127 anaesthetic procedures in 30â874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0â5·5) with an incidence of respiratory critical events of 3·1% (2·9â3·3). Cardiovascular instability occurred in 1·9% (1·7â2·1), with an immediate poor outcome in 5·4% (3·7â7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10â000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86â0·90; p<0·0001), medical history, and physical condition (1·60, 1·40â1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981â0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97â0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. Funding European Society of Anaesthesiology

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia