Impact of Separation on Refugee Families: Syrian Refugees in Jordan

The ongoing conflict in Syria, now entering its eighth year, has resulted in the largest refugee crisis since World War II. Nearly 6.5 million Syrians have become internally displaced, with an additional 5.6 million forced to leave their country to seek asylum. In the face of this displacement, greater attention is being given to complementary and alternative solutions such as reunification of separated family members. However, serious legal and procedural obstacles are obstructing the reunification of Syrian families across the Middle East and Europe. This study outlines several ways in which family separation negatively impacts Syrian refugees in Jordan. These effects are significant, and include financial burdens, increased child labour, emotional distress, broken social networks, parenting challenges and changes to familial roles

Geo-demographics of gunshot wound injuries in Miami-Dade county, 2002–2012

Abstract Background We evaluated correlates of gunshot wound (GSW) injuries in Miami-Dade County, Florida. Firearm-related injury has previously been linked to socio- and geo-demographic indicators such as occupation, income, neighborhood and race in other metropolitan areas, but remains understudied in Miami. Methods We reviewed 4,547 cases from a Level I trauma center’s patient registry involving an intentional firearm-related injury occurring from 2002 to 2012. During this eleven-year study period, this trauma center was the only one in Miami-Dade County, and thus representative of countywide injuries. Results The crude morbidity rate of GSW injury over the 11-year period was 15 per 100,000 persons with a crude mortality rate of 0.27 per 100,000 persons. The case fatality rate of injured patients was 15.4%. Both morbidity and mortality increased modestly over the 11-year study period. The total number of GSW patients rose annually during the study period and patients were disproportionately young, black males, though we observed higher severity of injury in white populations. Geo-demographic analysis revealed that both GSW incident locations and patient home addresses are spatially clustered in predominantly poor, black neighborhoods near downtown Miami, and that these patterns persisted throughout the study period. Using spatial regression, we observed that census tract-level GSW incidence rates (coded by home address) were associated with a census tract’s proportion of black residents (P < .001), single-parent households (P < .001), and median age (P < .001) (R 2 = .42). Conclusions These findings represent the first representative geo-demographic analysis of GSW injuries in Miami-Dade County, and offer evidence to support urgent, targeted community engagement and prevention strategies to reduce local firearm violence

Association of Racial and Socioeconomic Diversity With Implicit Bias in Acute Care Surgery

This study assesses whether racial and socioeconomic diversity mitigates the existence of implicit bias in the field of trauma care among surgical health care professionals

Coagulation Changes following Combined Ablative and Reconstructive Breast Surgery

This study assessed hemostatic function in cancer patients at high risk for venous thromboembolism. Thirty-eight female patients (age, 53 ± 9 years) undergoing immediate postmastectomy reconstruction were prospectively studied with informed consent. Blood was sampled preoperatively, on postoperative day 1, and at 1 week follow-up. Rotational thromboelastography clotting time, α-angle (clot kinetics), clot formation time, and maximum clot firmness were studied with three different activating agents: intrinsically activated test using ellagic acid, extrinsically activated test with tissue factor, and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D. Thromboprophylaxis was unfractionated heparin plus sequential compression devices if not contraindicated. Hypercoagulability was defined by one or more parameters outside the reference range. Preoperatively, 29 percent of patients were hypercoagulable, increasing to 67 percent by week 1 (p = 0.017). Clotting time, clot formation time, and α-angle remained relatively constant over time, but maximum clot formation increased in intrinsically activated test using ellagic acid, extrinsically activated test with tissue factor, and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (all p < 0.05). Body mass index was 28 ± 5 kg/m, 23 percent received preoperative chemotherapy, and 15 percent had a history of tobacco use, but there was no association between these risk factors and hypercoagulability. Despite perioperative thromboprophylaxis, two-thirds of patients undergoing combined tumor resection and reconstructive surgery for breast cancer were hypercoagulable 1 week after surgery. Hypercoagulability was associated with increased clot strength mediated by changes in platelet and fibrin function. Therapeutic, IV

SEARCH STRATEGIES | Implementation science in migrant humanitarian health

A search of the literature was conducted by a health sciences informationist (GKR) in October 2022 and a search update was implemented in February 2023. Eight scholarly databases were searched: MEDLINE (via Ovid interface), EMBASE (via Embase.com), CINAHL (via EBSCOhost), Scopus, PsycINFO (via EBSCOhost), Web of Science Core Collection (via Thomson Reuters), CENTRAL (Cochrane Central Register of Controlled Trials) in Cochrane Library (via Wiley) and the Cochrane Covid-19 Study Register (via Wiley). Keywords and controlled vocabulary search terms were used to represent the three main search concepts: 1) displaced persons; 2) humanitarian settings: and 3) health care delivery or disease management. The three main search concepts were combined to develop the final search strategies. Test searching was used to determine variation in controlled vocabulary terminology and search syntax. A revised version of University of Alberta's refugee camps search hedge for Ovid MEDLINE was utilized in each database search [1]. Search results were limited to English or Spanish articles published from 2000 to February 2024 in six of the eight databases. Language limits were not used in the search of the CENTRAL; and language or year limits were not required for the search implemented in the Cochrane Covid-19 Study Register. A total number of 10,857 citations were exported to the citation manager EndNote (Clarivate Analytics) for processing and removal of duplicate articles. After removal of duplicates using a variation on the Bramer method [2], 7,795 citations were exported to the evidence synthesis screening tool Rayyan [3] for assessment and initial screening. Due to the comprehensive search strategies implemented, keywords needed in the search strategy, and complexity of displaced person status, it was not always possible to clearly differentiate between articles addressing displaced persons in humanitarian settings from those with resettlement experiences during the search process. As such, a higher proportion of literature not relevant to this review was retrieved. Articles addressing resettlement experiences were removed in the initial screening. __________________________________ 1. Campbell, SM. A Hedge to Retrieve Studies that Include Refugee Camps from the Ovid MEDLINE Database. John W. Scott Health Sciences Library, University of Alberta. Rev. March 30, 2022. Available: https://docs.google.com/document/d/1MfgnILnxqwYbzXZkGDFYY-Y6IoPJH2C-yNvk8-NVom4/edit [Accessed 10 December 2023] __________________________________ 2. Bramer WM, Giustini D, de Jonge GB, Holland L, Bekhuis T. De-duplication of database search results for systematic reviews in EndNote [published correction appears in J Med Libr Assoc. 2017 Jan;105(1):111]. J Med Libr Assoc. 2016;104(3):240-243. doi:10.3163/1536-5050.104.3.014 _________________________________ 3. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. Published 2016 Dec 5. doi:10.1186/s13643-016-0384-4 ________________________________http://deepblue.lib.umich.edu/bitstream/2027.42/192766/1/10072022_SEARCH_STRATEGIES_Humanitarian_Health_Delivery.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/192766/2/02232024 UPDATE_SEARCH STRATEGIES_Humanitarian_Health_Delivery.pdf-1Description of 10072022_SEARCH_STRATEGIES_Humanitarian_Health_Delivery.pdf : LITERATURE SEARCH STRATEGIES_7 OCT 2022Description of 02232024 UPDATE_SEARCH STRATEGIES_Humanitarian_Health_Delivery.pdf : LITERATURE SEARCH STRATEGIES_UPDATED_23 FEB 2024SEL

Perceptions of Equity and Inclusion in Acute Care Surgery: From the #EAST4ALL Survey

The aim of this study was to characterize equity and inclusion in acute care surgery (ACS) with a survey to examine the demographics of ACS surgeons, the exclusionary or biased behaviors they witnessed and experienced, and where those behaviors happen. A major initiative of the Equity, Quality, and Inclusion in Trauma Surgery Practice Ad Hoc Task Force of the Eastern Association for the Surgery of Trauma was to characterize equity and inclusion in ACS. To do so, a survey was created with the above objectives. A cross-sectional, mixed-methods anonymous online survey was sent to all EAST members. Closed-ended questions are reported as percentages with a cutoff of α = 0.05 for significance. Quantitative results were analyzed focusing on mistreatment and bias. Most respondents identified as white, non-Hispanic and male. In the past 12 months, 57.5% of females witnessed or experienced sexual harassment, whereas 48.6% of surgeons of color witnessed or experienced racial/ethnic discrimination. Sexual harassment, racial/ethnic prejudice, or discrimination based on sexual orientation/sex identity was more frequent in the workplace than at academic conferences or in ACS. Females were more likely than males to report unfair treatment due to age, appearance or sex in the workplace and ACS (P ≤ 0.002). Surgeons of color were more likely than white, non-Hispanics to report unfair treatment in the workplace and ACS due to race/ethnicity (P < 0.001). This is the first survey of ACS surgeons on equity and inclusion. Perceptions of bias are prevalent. Minorities reported more inequity than their white male counterparts. Behavior in the workplace was worse than at academic conferences or ACS. Ensuring equity and inclusion may help ACS attract and retain the best and brightest without fear of unfair treatment