Health and access to care for undocumented migrants living in the European Union: a scoping review.

BACKGROUND: Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990-2012), thus clarifying what is known, key gaps, and potential next steps. METHODS: Authors used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights. RESULTS: Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005-2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees appeared most vulnerable. While EU policy supports health-care access for undocumented migrants, practices remain haphazard, with studies reporting differing interpretation and implementation of rights at regional, institutional and individual levels. CONCLUSIONS: This scoping review is an initial attempt to describe available primary evidence on health and access to care for undocumented migrants in the European Union. It underlines the need for more and better-quality research, increased co-operation between gatekeepers, providers, researchers and policy makers, and reduced ambiguities in health-care rights and obligations for undocumented migrants

Experiences of Personal and Professional Identities during Clinical Psychology Doctoral Training

This study explored newly qualified Clinical Psychologists’ (CPs) experiences of personal professional development (PPD) during doctoral training. In particular there was a focus on their experiences of their personal and professional identities. Within literature relevant to PPD in Clinical Psychology training, personal and professional development were largely conceptualised as separate processes. Yet models of reflective practice would suggest that an awareness of the personal self is necessary for effective clinical work. The research questions were ‘How do newly qualified CPs experience their personal and professional identities during doctoral training? and ‘How do they experience the boundary between their personal and professional development?’. To respond to these questions seven newly qualified CPs were interviewed regarding their experiences of their personal and professional identities during training. A qualitative research design was employed and Interpretative Phenomenological Analysis was used to analyse the data. Three superordinate themes were identified within the data: Developing self-acceptance; Enhancing awareness of self and others; Taking risks and managing uncertainty. Within these results there was a strong message of an inextricable link between personal and professional identities. It seemed that participants started from a position of being themselves, and during training negotiated the dilemmas of learning a professional role. In order to do this they would often look to others for how to negotiate this process. Yet this process could create challenges, as bringing one’s personal self into the professional arena was not always seen as acceptable. If participants were able to show personal aspects of themselves this could make them feel vulnerable and, therefore, these processes held an element of uncertainty. Where participants were able to show their personal selves and felt validated, this allowed for developing self-acceptance. The implications for clinical training and the clients with whom CPs work are discussed

The buds and shoots of who I’ve grown to become: the development of reflective practice in Trainee Clinical Psychologists.

This is an Accepted Manuscript of an article published by Taylor & Francis in Reflective Practice on 16 November 2015, available online: http://www.tandfonline.com/doi/full/10.1080/14623943.2015.1095728.Within literature regarding Personal Professional Development (PPD) in Clinical Psychology training, personal and professional development are largely conceptualised as separate processes. Yet models of reflective practice would suggest that an awareness of the personal self is necessary for effective clinical work. This study explored newly qualified Clinical Psychologists’ (CPs) experiences of PPD, and in particular their identities, during their clinical psychology doctoral training. The main research question was ‘How do newly qualified CPs experience their personal and professional identities during doctoral training?’ Seven newly qualified CPs were interviewed regarding their experiences of their personal and professional identities during training. A qualitative research design was employed and Interpretative Phenomenological Analysis was used to analyse the data. Three superordinate themes were identified: Enhancing awareness of self and others; Taking risks and managing uncertainty; Developing self-acceptance. Within these results there was a strong message of an inextricable link between personal and professional identities. Enhancing awareness of self was understood as a personal process within PPD and an important aspect of reflective practice, thus it is proposed that PPD is an effective tool for training reflective practitioners. Within PPD, learning to manage uncertainty and take risks within relationships was seen to contribute to reflective practice, as CPs may be more able to attend to process issues within the therapeutic context. Furthermore, greater self-awareness seemed to help trainees find a balance between self-development and self-acceptance. Maintaining a stable and accepting sense of self may contribute to a CP’s professional development and personal wellbeing.Peer reviewe

HIV knowledge, risk perception and avoidant behaviour change among Sierra Leonean refugees in Guinea.

A common assumption underpinning health communications design in humanitarian settings is that increasing knowledge and risk perception will lead to appropriate behaviour change. This study compares associations of HIV knowledge and perceived risk with reported HIV-avoidant behaviour changes and sexual health choices from a community survey of 698 sexually experienced male and female Sierra Leonean refugees in Guinea. HIV knowledge was not significantly associated with reported HIV-avoidant changes (OR 1.25; adjusted for gender; 95%CI 0.76-2.04), while perceived HIV risk was negatively associated (OR 0.38, adjusted for age at sexual debut; 95%CI 0.22-0.66). Trying to conceive was the main reason reported for not using condoms or other contraception (28%; 138/498), followed by current pregnancy/lactation (19%; 93/498). Results suggest contextual factors (e.g. desire for children) can be as important as knowledge and risk-perception, and HIV prevention initiatives in stable and chronic humanitarian settings should account for these

Reproductive health for refugees by refugees in Guinea IV: Peer education and HIV knowledge, attitudes, and reported practices

BACKGROUND: Both conflict and HIV affect sub-Saharan Africa, and supportive approaches for HIV prevention among refugees are crucial. Peer education has been associated with improved HIV outcomes, though relatively little research has been published on refugee settings. The primary objective of this study was to assess whether exposure to refugee peer education was associated with improved HIV knowledge, attitudes, or practice outcomes among refugees in Guinea. Secondary objectives were to assess whether gender, age, or formal education were more strongly associated than peer education with improved HIV outcomes. METHODS: Data was collected by cross-sectional survey from 889 reproductive-age men and women in 23 camps in the Forest Region of Guinea. Selected exposures (i.e. peer education, gender, formal education, age) were analysed for associations with HIV outcomes using logistic regression odds ratios (OR). RESULTS: Most participants (88%) had heard of HIV, particularly those exposed to peer or formal education. Most correctly identified ways to protect themselves, while maintaining misconceptions about HIV transmission. Women and those exposed to either peer or formal education had significantly fewer misconceptions. Half of participants considered themselves at risk of HIV, women with 52% higher odds than men (adjusted OR 1.52, 95%CI 1.01-2.29). Participants exposed to peer education had more than twice the odds of reporting having made HIV-avoidant behavioural changes than unexposed participants (72% versus 58%; adjusted OR 2.49, 95%CI 1.52-4.08). While women had 57% lower odds than men of reporting HIV-avoidant behavioural changes (OR 0.43, 95%CI 0.31-0.60), women exposed to peer education had greater odds than exposed men of reporting HIV-avoidant changes (OR 2.70 versus OR 1.95). Staying faithful (66%) was the most frequent behavioural change reported. CONCLUSIONS: Peer education was most strongly associated with reported HIV-avoidant behaviour change. Gender was most associated with HIV knowledge and risk perception. Refugee women had fewer misconceptions than men had, but were more likely to report HIV risk and less likely to report making behavioural changes. Peer education appears promising for HIV interventions in chronic-emergency settings, if gender disparities and related barriers to condom usage are also addressed

Toxic optic neuropathy in the setting of docetaxel chemotherapy: a case report

Background: To describe the first reported case of toxic optic neuropathy secondary to docetaxel (Taxotere®) chemotherapy. Case presentation. A 53-year-old female presented with predominantly unilateral visual loss, but extensive bilateral visual field defects and bilateral optic nerve head swelling 2 weeks after first dose of docetaxel (Taxotere®) and trastuzumab (Herceptin®) chemotherapy for a left sided node-positive, HER2 positive breast cancer. Extensive investigation ruled out other causes of optic neuropathy. She was treated with high dose corticosteroids intravenously for 1 week then a tapering oral dose over 8 weeks. Visual field defects gradually resolved and visual acuity improved. Docetaxel chemotherapy was discontinued but targeted therapy with trastuzumab continued without further complication. Conclusion: Docetaxel can cause a toxic optic neuropathy possibly due to an ischemic or neurotoxic mechanism at the optic nerve head. With cessation of docetaxel therapy and treatment with systemic corticosteroids, visual recovery can occur without significant residual visual deficit

Management of aromatase inhibitor induced musculoskeletal symptoms in postmenopausal early breast cancer: a systematic review and meta-analysis

Aromatase Inhibitors (AI) are widely used for the adjuvant treatment of hormone receptor positive breast cancers in the post-menopausal population. AI are often associated with significant joint and muscular symptoms; symptoms that are commonly referred to as aromatase inhibitor-associated musculoskeletal syndrome (AIMSS). AIMSS adversely impacts health-related quality of life of many patients, and reduces AI compliance. Although there are informal practice recommendations, the limited current level of evidence for management of AIMSS for breast cancer patients on aromatase inhibitors has made development of formal guidelines challenging, and remains an unmet need. This is the first systematic review to consider the evidence for all pharmacological and non-pharmacological interventions in the treatment of AIMSS, including physical therapy, acupuncture and complementary therapies

Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study.

BACKGROUND: Contracting-out non-state providers to deliver a minimum package of essential health services is an increasingly common health service delivery mechanism in conflict-affected settings, where government capacity and resources are particularly constrained. Afghanistan, the longest-running example of Basic Package of Health Services (BPHS) contracting in a conflict-affected setting, enables study of how implementation of a national intervention influences access to prioritised health services. This study explores stakeholder perspectives of sexual and reproductive health (SRH) services delivered through the BPHS in Afghanistan, using Bamyan Province as a case study. METHODS: Twenty-six in-depth interviews were conducted with health-system practitioners (e.g. policy/regulatory, middle management, frontline providers) and four focus groups with service-users. Inductive thematic coding used the WHO Health System Framework categories (i.e. service delivery, workforce, medicines, information, financing, stewardship), while allowing for emergent themes. RESULTS: Improvements were noted by respondents in all health-system components discussed, with significant improvements identified in service coverage and workforce, particularly improved gender balance, numbers, training, and standardisation. Despite improvements, remaining weaknesses included service access and usage - especially in remote areas, staff retention, workload, and community accountability. CONCLUSIONS: By including perspectives on SRH service provision and BPHS contracting across health-system components and levels, this study contributes to broader debates on the effects of contracting on perceptions and experiences among practitioners and service-users in conflict-affected countries

Maintaining dose intensity of adjuvant chemotherapy in older patients with breast cancer

Maintaining the relative dose intensity (RDI) of adjuvant chemotherapy at\ua0≥ 85% has been associated with improved treatment outcomes in early-stage breast cancer (ESBC). Increasing evidence has suggested that patients aged\ua0≥ 65 years can maintain the optimal RDI for standard chemotherapy regimens. The present study investigated the RDI of newer adjuvant chemotherapy regimens in this demographic.We retrospectively analyzed the data from 281 patients aged\ua0≥ 65 years with a diagnosis of ESBC who had received adjuvant chemotherapy across 3 sites in Queensland, Australia from 2010 to 2015. The primary endpoint was the proportion of patients who had received an RDI of\ua0≥ 85%.The median age at diagnosis was 68 years (range, 65-85 years), with 36.3% aged > 70 years. The patient characteristics included tumor stage T3 or T4 in 17% and node-positive disease in 60%. The common chemotherapy regimens included docetaxel/cyclophosphamide (23%), 5-fluorouracil/epirubicin/cyclophosphamide plus docetaxel or paclitaxel (17%); Adriamycin/cyclophosphamide/weekly paclitaxel (38%); and docetaxel/carboplatin/trastuzumab (11%). Primary (15%) and secondary (54%) granulocyte colony-stimulating factor (G-CSF) was used. An RDI of\ua0≥ 85% was achieved in 63% of the patients. Significant associations were noted between a reduced RDI and age\ua0≥ 70 years (P\ua0< .001), Charlson comorbidity index\ua0≥ 1 (P\ua0= .043), initial dose reductions (P\ua0= .01), secondary G-CSF use (P\ua0= .45), hospital admission (P\ua0< .001), and febrile neutropenia (P\ua0= .007). Treatment-related toxicities were the most common reason for noncompletion, with high rates of hospital admissions (46%) and febrile neutropenia (22%).Our findings suggest that patients aged\ua0≥ 65 years with ESBC can maintain an optimal RDI with modern chemotherapy regimens. Appropriate geriatric assessment and the use of supportive measures such as G-CSF could better assist select groups to maintain an optimal dose intensity