Spatiality of Social Stress Experienced by Refugee Women in Initial Reception Centers

This study takes an interdisciplinary approach to understanding the multi-dimensionality of social stress within the spatiality of initial refugee reception centers in Berlin. By focusing particularly on the experiences of women who fled from Syria and Afghanistan, it situates this humanitarian issue within an analytical framework of gender-sensitive and culturally sensitive research and policymaking. Through qualitative interviews with 11 refugee women, the connection between the spatiality of initial reception centers and social stress is explored. This is done by thematically coding the data collected in the context of nine different initial reception centers across various districts in the city of Berlin. The study shows that in terms of the intercultural needs and practices of these women, social stress is triggered by a lack of essential privacy within the spatiality of these structures. However, privacy is not limited to a physical enclosure-it is about having control/freedom over different aspects of everyday life. This article highlights intercultural gaps in gender-sensitive and protection considerations during humanitarian responses

Spatiality of Social Stress Experienced by Refugee Women in Initial Reception Centers

This study takes an interdisciplinary approach to understanding the multi-dimensionality of social stress within the spatiality of initial refugee reception centers in Berlin. By focusing particularly on the experiences of women who fled from Syria and Afghanistan, it situates this humanitarian issue within an analytical framework of gender-sensitive and culturally sensitive research and policymaking. Through qualitative interviews with 11 refugee women, the connection between the spatiality of initial reception centers and social stress is explored. This is done by thematically coding the data collected in the context of nine different initial reception centers across various districts in the city of Berlin. The study shows that in terms of the intercultural needs and practices of these women, social stress is triggered by a lack of essential privacy within the spatiality of these structures. However, privacy is not limited to a physical enclosure—it is about having control/freedom over different aspects of everyday life. This article highlights intercultural gaps in gender-sensitive and protection considerations during humanitarian responses.Charité - Universitätsmedizin Berlin (3093)Peer Reviewe

Shared sorrow, shared costs: cost-effectiveness analysis of the Empowerment group therapy approach to treat affective disorders in refugee populations

Background Refugees and asylum seekers (RAS) in Germany need tailored and resource-oriented mental healthcare interventions. Aims To evaluate the cost-effectiveness of group psychotherapy for RAS with moderate depressive symptoms. Method This is a post hoc cost-effectiveness analysis of Empowerment group psychotherapy that was embedded in a stratified stepped and collaborative care model (SCCM) from the multicentre randomised controlled MEHIRA trial. One hundred and forty-nine participants were randomly assigned to SCCM or treatment as usual (TAU) and underwent Empowerment (i.e. level 3 of the SCCM for adults) or TAU. Effects were measured with the nine-item Patient Health Questionnaire (PHQ-9) and quality adjusted life-years (QALY) post-intervention. Health service and intervention costs were measured. Incremental cost-effectiveness ratios (ICER) were estimated and net monetary benefit (NMB) regressions with 95% confidence intervals were performed. Cost-effectiveness was ascertained for different values of willingness to pay (WTP) using cost-effectiveness acceptability curves for probable scenarios. Trial registration number: NCT03109028 on ClinicalTrials.gov. Results Health service use costs were significantly lower for Empowerment than TAU after 1 year. Intervention costs were on average €409.6. Empowerment led to a significant change in PHQ-9 scores but not QALY. Bootstrapped mean ICER indicated cost-effectiveness according to PHQ-9 and varied considerably for QALY in the base case. NMB for a unit reduction in PHQ-9 score at WTP of €0 was €354.3 (€978.5 to −€269.9). Results were confirmed for different scenarios and varying WTP thresholds. Conclusions The Empowerment intervention was cost-effective in refugees with moderate depressive symptoms regarding the clinical outcome and led to a reduction in direct healthcare consumption. Concerning QALYs, there was a lack of confidence that Empowerment differed from TAU

Effectiveness and cost-effectiveness for the treatment of depressive symptoms in refugees and asylum seekers: a multi-centred randomized controlled trial

BACKGROUND: Current evidence points towards a high prevalence of psychological distress in refugee populations, contrasting with a scarcity of resources and amplified by linguistic, institutional, financial, and cultural barriers. The objective of the study is to investigate the overall effectiveness and cost-effectiveness of a Stepped Care and Collaborative Model (SCCM) at reducing depressive symptoms in refugees, compared with the overall routine care practices within Germany's mental healthcare system (treatment-as-usual, TAU). METHODS: A multicentre, clinician-blinded, randomised, controlled trial was conducted across seven university sites in Germany. Asylum seekers and refugees with relevant depressive symptoms with a Patient Health Questionnaires score of ≥ 5 and a Refugee Health Screener score of ≥ 12. Participants were randomly allocated to one of two treatment arms (SCCM or TAU) for an intervention period of three months between April 2018 and March 2020. In the SCCM, participants were allocated to interventions tailored to their symptom severity, including watchful waiting, peer-to-peer- or smartphone intervention, psychological group therapies or mental health expert treatment. The primary endpoint was defined as the change in depressive symptoms (Patient Health Questionnaire-9, PHQ-9) after 12 weeks. The secondary outcome was the change in Montgomery Åsberg Depression Rating Scale (MADRS) from baseline to post-intervention. FINDINGS: The intention-to-treat sample included 584 participants who were randomized to the SCCM (n= 294) or TAU (n=290). Using a mixed-effects general linear model with time, and the interaction of time by randomisation group as fixed effects and study site as random effect, we found significant effects for time (p < .001) and time by group interaction (p < .05) for intention-to-treat and per-protocol analysis. Estimated marginal means of the PHQ-9 scores after 12 weeks were significantly lower in SCCM than in TAU (for intention-to-treat: PHQ-9 mean difference at T(1) 1.30, 95% CI 1.12 to 1.48, p < .001; Cohen's d=.23; baseline-adjusted PHQ-9 mean difference at T(1) 0.57, 95% CI 0.40 to 0.74, p < .001). Cost-effectiveness and net monetary benefit analyses provided evidence of cost-effectiveness for the primary outcome and quality-adjusted life years. Robustness of results were confirmed by sensitivity analyses. INTERPRETATION: The SSCM resulted in a more effective and cost-effective reduction of depressive symptoms compared with TAU. Findings suggest a suitable model to provide mental health services in circumstances where resources are limited, particularly in the context of forced migration and pandemics. FUNDING: This project is funded by the Innovationsfond and German Ministry of Health [grant number 01VSF16061]. The present trial is registered under Clinical-Trials.gov under the registration number: NCT03109028. https://clinicaltrials.gov/ct2/show/NCT0310902

Empowerment group therapy for refugees with affective disorders: results of a multi-center randomized controlled trial

Background Against the background of missing culturally sensitive mental health care services for refugees, we developed a group intervention (Empowerment) for refugees at level 3 within the stratified Stepped and Collaborative Care Model of the project Mental Health in Refugees and Asylum Seekers (MEHIRA). We aim to evaluate the effectiveness of the Empowerment group intervention with its focus on psychoeducation, stress management, and emotion regulation strategies in a culturally sensitive context for refugees with affective disorders compared to treatment-as-usual (TAU). Method At level 3 of the MEHIRA project, 149 refugees and asylum seekers with clinically relevant depressive symptoms were randomized to the Empowerment group intervention or TAU. Treatment comprised 16 therapy sessions conducted over 12 weeks. Effects were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery–Åsberg Depression Rating Scale (MÅDRS). Further scales included assessed emotional distress, self-efficacy, resilience, and quality of life. Results Intention-to-treat analyses show significant cross-level interactions on both self-rated depressive symptoms (PHQ-9; F(1,147) = 13.32, p < 0.001) and clinician-rated depressive symptoms (MÅDRS; F(1,147) = 6.91, p = 0.01), indicating an improvement in depressive symptoms from baseline to post-intervention in the treatment group compared to the control group. The effect sizes for both scales were moderate (d = 0.68, 95% CI 0.21–1.15 for PHQ-9 and d = 0.51, 95% CI 0.04–0.99 for MÅDRS). Conclusion In the MEHIRA project comparing an SCCM approach versus TAU, the Empowerment group intervention at level 3 showed effectiveness for refugees with moderately severe depressive symptoms

Defining pathways to healthy sustainable urban development.

Goals and pathways to achieve sustainable urban development have multiple interlinkages with human health and wellbeing. However, these interlinkages have not been examined in depth in recent discussions on urban sustainability and global urban science. This paper fills that gap by elaborating in detail the multiple links between urban sustainability and human health and by mapping research gaps at the interface of health and urban sustainability sciences. As researchers from a broad range of disciplines, we aimed to: 1) define the process of urbanization, highlighting distinctions from related concepts to support improved conceptual rigour in health research; 2) review the evidence linking health with urbanization, urbanicity, and cities and identify cross-cutting issues; and 3) highlight new research approaches needed to study complex urban systems and their links with health. This novel, comprehensive knowledge synthesis addresses issue of interest across multiple disciplines. Our review of concepts of urban development should be of particular value to researchers and practitioners in the health sciences, while our review of the links between urban environments and health should be of particular interest to those outside of public health. We identify specific actions to promote health through sustainable urban development that leaves no one behind, including: integrated planning; evidence-informed policy-making; and monitoring the implementation of policies. We also highlight the critical role of effective governance and equity-driven planning in progress towards sustainable, healthy, and just urban development

Spaces of Urban Refuge and Social Stress

Die wachsende Zahl an Menschen, die aus ihren Herkunftsländern fliehen musste und nach 2015 in Berlin ankam, stellte städtische Einrichtungen und die Bereitstellung sozioökonomischer Dienstleistungen für Personen mit diversen soziokulturellem und politischen Hintergründen vor eine große Herausforderung. Es gilt anzunehmen, dass zusätzlich zu früheren traumatischen Erfahrungen, der mehrdimensionale und komplizierte Prozess der Verteilung von Geflüchteten in städtischen Räumen zu Belastungen führen und die Prävalenz psychischer Störungen erhöhen kann. Angesichts der Tatsache, dass geflüchtete Frauen verstärkt unter verschiedenen Formen stressbedingter Störungen leiden, zielt die Dissertation darauf ab, jene sozialen Stressoren in drei verschiedenen sozio-räumlichen Settings zu untersuchen, welchen sich geflüchtete Frauen bei ihrer Ankunft in Berlin ausgesetzt wahrnahmen.The growing number of forcibly displaced people arriving in Berlin after 2015 brought about an extensive challenge in providing urban socio-economic facilities and services for numerous individuals from different socio-cultural and political backgrounds. The multi-dimensional and complicated process of resettlement of refugees in urban spaces, in addition to their earlier traumatic experiences, might result in distress and intensify the prevalence of mental disorders. Considering that refugee women are more likely to suffer from various forms of stress-related disorders, the dissertation aimed to evaluate the perceived social stressors by refugee women in three different socio-spatial settings upon their arrival in Berlin

Du kan om du vill! : En diskursanalys av framgångslitteratur och dess framstående konstruktioner

Denna uppsats förser läsaren med en diskursanalys av böcker inom, vad som i arbetet kommer benämnas som, ”framgångslitteratur”. Med detta menas litteratur av rådgivande karaktär som riktar sig till människor som vill gå från att må bra till att må bättre, till att bli mer framgångsrika, mer nöjda, mer effektiva, lyckligare osv. Det finns idag flertalet diskursanalyser av självhjälpslitteratur; dvs. den typ av litteratur som vänder sig till personer som vill gå från att må dåligt till att må bra eller bättre. Jag har dock funnit diskursanalyser kring just framgångslitteratur vara näst intill obefintligt. Därav har förhoppningen varit att denna studie ska fylla ett viktigt tomrum i det analytiska fältet kring det moderna samhället och dess fokus på framgång och utveckling. Genom en selektion av tre böcker synliggörs och analyseras denna ”framgångsdiskurs”. I studien undersöks huvudsakligen vilka konstruktioner som är framstående inom den valda framgångslitteraturen och vilka uppmaningar läsaren får däri. Arbetet knyts an till teorier och tidigare forskning inom områden som bl.a. det moderna samhället, identitet, lycka och otillfredsställelse. Av studien framgår det att framgångslitteraturen fokuserar på individens eget ansvar över sitt liv och en synnerligen framstående konstruktion är att läsaren har mängder av möjligheter, möjligheter som proklameras bli tillgängliga genom individens vilja, fokusering samt att kontinuerligt och medvetet välja det ”rätta” sättet att tänka, sätta upp mål och agera. Vidare har individens framgång och ständiga utveckling en central plats i diskursen, och individens varande sammankopplas med vad denne gör vilket öppnat upp för att titta på hur identitet konstrueras. Genom diskursen, samt genom författarnas auktoritärt framställda position i relation till läsaren, konstrueras och rekonstrueras kort sagt föreställningarna att ”man är vad man gör” och att ”man kan om man vill”. Något som kan relateras till de värdegrunder som vårt moderna samhälle tycks generera

Effects of aqueous extract of turnip leaf (Brassica rapa) in alloxan-induced diabetic rats

Objectives: Turnip leaf has been used in folk medicine of Iran for the treatment of diabetes. However,so far no scientific study has been done to support its use in traditional medicine. The present study was carried out to evaluate the possible hypoglycemic efficacy of aqueous extract of turnip leaf (AETL) in diabetic rats. Materials and Methods: Alloxan-induced diabetic rats were orally treated with AETL at doses of 200 and 400 mg/kg body weight (bw) per day for 28 days. In order to evaluate the anti-diabetic activity, fasting blood glucose concentrations were determined on the 1st, 14th and 29th days. Moreover,at the end of the study, plasma concentrations of total cholesterol, triglyceride (TG), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c), aspartate amino transfarase (AST), and alanine amino transferase (ALT) were measured by the use of standard kits and auto-analyzer. Results:Both doses of AETL significantly decreased (