Health care seeking among detained undocumented migrants: a cross-sectional study

BACKGROUND: As in many European countries, access to care is decreased for undocumented migrants in the Netherlands due to legislation. Studies on the health of undocumented migrants in Europe are scarce and focus on care-seeking migrants. Not much is known on those who do not seek care. METHODS: This cross-sectional study includes both respondents who did and did not seek care, namely undocumented migrants who have been incarcerated in a detention centre while awaiting expulsion to their country of origin. A consecutive sample of all new arrivals was studied. Data were collected through structured interviews and reviews of medical records. RESULTS: Among the 224 male migrants who arrived at the detention centre between May and July 2008, 173 persons were interviewed. 122 respondents met inclusion criteria. Only half of the undocumented migrants in this study knew how to get access to medical care in the Netherlands if in need. Forty-six percent of respondents reported to have sought medical help during their stay in the Netherlands while having no health insurance (n = 57). Care was sought most frequently for injuries and dental problems. About 25% of these care seekers reported to have been denied care by a health care provider. Asian migrants were significantly less likely to seek care when compared to other ethnic groups, independent from age, chronic health problems and length of stay in the Netherlands. CONCLUSION: The study underlines the need for a better education of undocumented patients and providers concerning the opportunities for health care in the Netherlands. Moreover, there is a need to further clarify the reasons for the denial of care to undocumented patients, as well as the barriers to health care as perceived by undocumented migrants

Spatio-temporal mixed pixel analysis of savanna ecosystems : a review

Reliable estimates of savanna vegetation constituents (i.e., woody and herbaceous vegetation) are essential as they are both responders and drivers of global change. The savanna is a highly heterogenous biome with high variability in land cover types while also being very dynamic at both temporal and spatial scales. To understand the spatial-temporal dynamics of savannas, using Earth Observation (EO) data for mixed-pixel analysis is crucial. Mixed pixel analysis provides detailed land cover data at a sub-pixel level which are essential for conservation purposes, understanding food supply for herbivores, quantifying environmental change, such as bush encroachment, and fuel availability essential for understanding fire dynamics, and for accurate estimation of savanna biomass. This review paper consulted 197 studies employing mixed-pixel analysis in savanna ecosystems. The review indicates that studies have so far attempted to resolve the savanna mixed-pixel issues by using mainly coarse resolution data, such as Terra-Aqua MODIS and AVHRR and medium resolution Landsat, to provide fractional cover data. Hence, there is a lack of spatio-temporal mixed-pixel analysis for savannas at high spatial resolutions. Methods used for mixed-pixel analysis include parametric and non-parametric methods which range from pixel-unmixing models, such as linear spectral mixture analysis (SMA), time series decomposition, empirical methods to link the green vegetation parameters with Vegetation Indices (VIs), and machine learning methods, such as regression trees (RT) and random forests (RF). Most studies were undertaken at local and regional scale, highlighting a research gap for savanna mixed pixel studies at national, continental, and global level. Parametric methods for modeling spatio-temporal mixed pixel analysis were preferred for coarse to medium resolution remote sensing data, while non-parametric methods were preferred for very high to high spatial resolution data. The review indicates a gap for long time series spatio-temporal mixed-pixel analysis of savannas using high resolution data at various scales. There is potential to harmonize the available low resolution EO data with new high-resolution sensors to provide long time series of the savanna mixed pixel, which, according to this review, is missing.The Deutscher Akademischer Austauschdienst and the Federal Ministry of Education and Research (BMBF) within the framework of the Strategy “Research for Sustainability” (FONA).http://www.mdpi.com/journal/remotesensingpm2022Geography, Geoinformatics and Meteorolog

Using Sentinel-1 and Sentinel-2 Time Series for Slangbos Encroachment Mapping in the Free State Province, South Africa

Increasing woody cover and overgrazing in semi arid ecosystems are known to be major factors driving land degradation. During the last decades woody cover encroachment has increased over large areas in southern Africa inducing environmental, land cover as well as land use changes. The goal of this study is to synergistically combine SAR (Sentinel 1) and optical (Sentinel 2) earth observation information to monitor the slangbos encroachment on arable land in the Free State province, South Africa, between 2015 and 2020. Both, optical and radar satellite data are sensitive to different land surface and vegetation properties caused by sensor specific scattering or reflection mechanisms they rely on. This study focuses on mapping the slangbos aka bankrupt bush (Seriphium plumosum) encroachment in a selected test region in the Free State province of South Africa. Though being indigenous to South Africa, the slangbos has been documented to be the main encroacher on the grassvelds (South African grassland biomes) and thrive in poorly maintained cultivated lands. The shrub reaches a height and diameter of up to 0.6 m and the root system reaches a depth of up to 1.8 m. Slangbos has small light green leaves unpalatable to grazers due to their high oil content and is better adapted to long dry periods compared to grass communities. We used the random forest approach to predict slangbos encroachment for each individual crop year between 2015 and 2020. Training data were based on expert knowledge and field information from the Department of Agriculture, Forestry and Fisheries (DAFF). Several input variables have been tested according to their model performance, e.g. backscatter, backscatter ratio, interferometric coherence as well as optical indices (e.g. NDVI (Normalized Difference Vegetation Index), SAVI (Soil Adjusted Vegetation Index), EVI (Enhanced Vegetation Index), etc.). We found that the Sentine 1 VH backscatter (vertical horizontal/cross polarization) and the Sentinel 2 SAVI time series information have the highest importance for the random forest classifier among all input parameters. The estimation of the model accuracy was accomplished via spatial cross validation and resulted in an overall accuracy of above 80 % for each time step, with the slangbos class being close to or above 90 %. Currently we are developing a prototype application to be tested in cooperation with local stakeholders to bring this approach to the farmers level. Once field work in southern Africa is possible again, further ground truthing and interaction with farmers will be carried out

COVID-19 burden differed by city districts and ethnicities during the pre-vaccination era in Amsterdam, the Netherlands

BackgroundDuring the first wave of COVID-19 in Amsterdam, the Netherlands, a disproportional number of COVID-19 hospitalizations occurred in individuals with an ethnic minority background and in individuals living in city districts with a lower socioeconomic status (SES). In this study, we assessed whether these disparities continued throughout the second wave, when SARS-CoV-2 testing was available to anyone with symptoms but prior to the availability of COVID-19 vaccination.MethodsSurveillance data on all notified SARS-CoV-2 cases in Amsterdam between 15 June 2020 and 20 January 2021 were matched to municipal registration data to obtain the migration background of cases. Crude and directly age- and sex-standardized rates (DSR) of confirmed cases, hospitalizations, and deaths per 100,000 population were calculated overall, and by city districts, and migration backgrounds. Rate differences (RD) and rate ratios (RR) were calculated to compare DSR between city districts and migration backgrounds. We used multivariable Poisson regression to assess the association of city districts, migration backgrounds, age, and sex with rates of hospitalization.ResultsA total of 53,584 SARS-CoV-2 cases (median age 35 years [IQR = 25–74]) were notified, of whom 1,113 (2.1%) were hospitalized and 297 (0.6%) deceased. DSR of notified infections, hospitalization, and deaths per 100,000 population were higher in lower SES peripheral city districts (South-East/North/New-West) than higher SES central districts (Central/West/South/East), with almost a 2-fold higher hospitalization DSR in peripheral compared to central districts (RR = 1.86, 95%CI = 1.74–1.97). Individuals with a non-European migration background also had a higher COVID-19 burden, particularly with respect to hospitalization rates, with a 4.5-fold higher DSR for individuals with a non-European background compared to ethnic-Dutch (RR 4.51, 95%CI = 4.37–4.65). City districts, migration backgrounds, male gender, and older age were independently associated with COVID-19 hospitalization rates.DiscussionIndividuals with a non-European background and individuals living in city districts with lower SES continued to independently have the highest COVID-19 burden in the second wave of COVID-19 in Amsterdam, the Netherlands

Mortality among drug users: guidelines for carrying out, analysing and reporting key figures 2011–12.

Drug-related mortality is a complex phenomenon, which accounts for a considerable percentage of deaths among young people in many European countries. The EMCDDA, in collaboration with national experts, has defined an epidemiological indicator with two components at present: deaths directly caused by illegal drugs (drug-induced deaths) and mortality rates among problem drug users. These two components can fulfil several public health and methodological objectives, notably as an indicator of the overall health impact of drug use and the components of this impact. This standard protocol focuses on the second component (mortality). It provides national focal points and experts with a guide for carrying out,analysing and reporting to the EMCDDA the key figures on mortality among drug users. It describes the features of the Fonte web-based interface which allow the Member States to report their mortality data to the EMCDDA. Each centre must adopt specific and effective procedures to ensure the absolute confidentiality of the information gathered and that the appropriate legislation on data protection, ethical approval and consent are respected. Table of contents: • Introduction/objectives • Carrying out mortality studies among drug users • Data analysis: rates, confidence intervals and adjustment for differences in age distribution • Strengths and limitations • Reference

An increase in overdose mortality during the first 2 weeks after entering or re-entering methadone treatment in Amsterdam

AIMS: It has been suggested that starting and temporarily discontinuing methadone treatment is related to an increased risk in overdose mortality. This study describes the incidence of overdose mortality in relation to time after (re)entering or leaving treatment. DESIGN: A dynamic cohort of 5200 Amsterdam methadone clients was observed during treatment and (a maximum of 1 year) after treatment. FINDINGS: Between 1986 and 1998, 29,729 person-years (py) and 68 overdose deaths were recorded, leading to an overdose mortality rate of 2.3/1000 py (2.2 during and 2.4 after treatment). A modest increase was observed during the first 2 weeks after (re)entering treatment; 6.0/1000 py (rate ratio: 2.9; 95% confidence interval 1.4; 5.8). Directly after leaving treatment no increase was observed. CONCLUSIONS: Inhaling heroin, common among Amsterdam heroin users, is thought to account for low OD mortality rates both during and after treatment. Accumulation of methadone, inadequate assessment of tolerance of known clients re-entering treatment and concurrent periods of stress or extreme heroin use when entering treatment are mentioned as possible explanations of the increased risk within the first 2 weeks. An Australian study reported a much higher increase. The modest increase in Amsterdam is explained by low background risk of overdose mortality, low starting dosage and the low threshold to treatmen

Performance indicators for public mental healthcare: A systematic international inventory

Abstract Background The development and use of performance indicators (PI) in the field of public mental health care (PMHC) has increased rapidly in the last decade. To gain insight in the current state of PI for PMHC in nations and regions around the world, we conducted a structured review of publications in scientific peer-reviewed journals supplemented by a systematic inventory of PI published in policy documents by (non-) governmental organizations. Methods Publications on PI for PMHC were identified through database- and internet searches. Final selection was based on review of the full content of the publications. Publications were ordered by nation or region and chronologically. Individual PI were classified by development method, assessment level, care domain, performance dimension, diagnostic focus, and data source. Finally, the evidence on feasibility, data reliability, and content-, criterion-, and construct validity of the PI was evaluated. Results A total of 106 publications were included in the sample. The majority of the publications (n = 65) were peer-reviewed journal articles and 66 publications specifically dealt with performance of PMHC in the United States. The objectives of performance measurement vary widely from internal quality improvement to increasing transparency and accountability. The characteristics of 1480 unique PI were assessed. The majority of PI is based on stakeholder opinion, assesses care processes, is not specific to any diagnostic group, and utilizes administrative data sources. The targeted quality dimensions varied widely across and within nations depending on local professional or political definitions and interests. For all PI some evidence for the content validity and feasibility has been established. Data reliability, criterion- and construct validity have rarely been assessed. Only 18 publications on criterion validity were included. These show significant associations in the expected direction on the majority of PI, but mixed results on a noteworthy number of others. Conclusions PI have been developed for a broad range of care levels, domains, and quality dimensions of PMHC. To ensure their usefulness for the measurement of PMHC performance and advancement of transparency, accountability and quality improvement in PMHC, future research should focus on assessment of the psychometric properties of PI

The effect of hepatitis C treatment and human immunodeficiency virus (HIV) co-infection on the disease burden of hepatitis C among injecting drug users in Amsterdam

Aims The hepatitis C virus (HCV) disease burden among injecting drug users (IDUs) is determined by HCV incidence, the long latency period of HCV, competing mortality causes, presence of co-infection and HCV treatment uptake. We examined the effect of these factors and estimated the HCV disease burden in Amsterdam. Design A Markov model was developed, incorporating HCV and human immunodeficiency virus (HIV), and parameterized with data from the Amsterdam Cohort Studies, surveillance studies and literature. Setting IDU population of Amsterdam. Measurements HCV infection simulated from its acute phase to HCV-related liver disease (i. e. decompensated cirrhosis and hepatocellular carcinoma). Findings The HCV prevalence among IDUs in Amsterdam increased to approximately 80% in the 1980s. From 2011 to 2025, the HCV-related disease prevalence will accordingly rise by 36%, from 57 cases (95% range 33-94) to 78 (95% range 43-138), respectively. In total, 945 (95% range 617-1309) individuals will develop HCV-related liver disease. This burden would have been 33% higher in the absence of HIV, resulting in 1219 cases (95% range 796-1663). In Amsterdam, 25% of HIV-negative IDUs receive successful HCV treatment, reducing the cumulative disease burden by 14% to 810 (95% range 520-1120). Further reduction of 36% can be achieved by improving treatment, resulting in 603 cases (95% range 384-851). Conclusions The hepatitis C virus burden among injecting drug users in Amsterdam has been reduced by a high competing mortality rate, particularly caused by HIV infection, and to a smaller extent by hepatitis C virus treatment. Improved hepatitis C virus treatment is expected to contribute to reduce the future hepatitis C virus disease burde

Chasing the dragon, related to the impaired lung function among heroin users

AIM: To describe the pulmonary function and prevalence of dyspnoea among methadone patients and to study the relation with exposure to heroin by inhaling. STUDY POPULATION: A sample of 100 patients from methadone maintenance treatment (84% male, average age 42 years). MEASUREMENTS: Questionnaires were used to measure life-time exposure to heroin, cocaine, cannabis, tobacco, and symptoms of dyspnoea. Spirometry was performed and residual difference of measured FEV(1) from the age, sex, height and ethnicity predicted value (delta FEV(1)) was used as a main outcome parameter. FINDINGS: The median delta FEV(1) was -0.26 l (inter quartile range -0.70; +0.12). Twenty per cent experienced dyspnoea while 'walking at a normal pace with someone of their own age'. History of cigarette smoking was reported by 98%; heroin smoking by 88%. Multiple linear regression analysis showed a statistically significant association between heroin-smoking and delta FEV(1), logistic regression analysis showed an association between heroin-smoking and prevalence of dyspnoea. CONCLUSIONS: Chronic heroin smoking seems to be related to an impaired lung function and higher prevalence of dyspnoea. However, part of the observed lung function impairment will be caused by tobacco smoking. Further research is needed to quantify the effect of heroin smoking and disentangle the effect of smoking heroin and tobacc