Vulnerabilities of Arab refugees in primary health care: a scoping review / Vulnerabilidades de refugiados árabes na atenção primária à saúde: uma revisão de escopo

ABSTRACT OBJECTIVE To map and analyze the vulnerabilities of Arab refugees in the context of primary health care. METHOD Scoping review in which studies published in English, Spanish and Portuguese languages from 2011 onwards were reviewed. The following databases were surveyed: Cochrane, Scopus, Health System Evidence, MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science, SciELO, NYAM Grey Literature, BVS, Capes Thesis and Dissertation Database, Refworld and Journal of Refugee Studies. Data were analyzed in light of the concept of vulnerability. RESULTS Of the 854 studies identified, 40 articles were held for analysis and extraction of vulnerability indicators in the individual, social and programmatic dimensions. Regarding the individual dimension, the main indicators identified were unemployment, unstable and overcrowded housing, lack of sanitation and access to water, mental disorders, communicable and chronic noncommunicable diseases, etc. In the programmatic dimension, were identified, mainly, health teams with work overload, lack of preparation to deal with cultural and linguistic barriers, and delays in providing care. In relation to the social dimension, lack of access to schools, to information about health programs in the host countries, and to rights, among others, were found. CONCLUSION Vulnerabilities found highlight the disadvantage of refugees regarding health programs, services and system in host countries, in addition to highlighting the deep inequalities that affect this group. It is pointed out the need for programs and policies that promote actions, within the scope of primary health care, which recognize and respond to the health needs of refugees.

RESUMO OBJETIVO Mapear e analisar as vulnerabilidades de refugiados árabes no contexto da atenção primária à saúde. MÉTODO Revisão de escopo em que foram analisados estudos publicados nos idiomas inglês, espanhol e português, a partir de 2011. As bases foram Cochrane, Scopus, Health System Evidence , MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science , SciELO, NYAM Grey Literature , BVS, Banco de teses e dissertações Capes, Refworld e Journal of Refugee Studies. A análise dos dados foi realizada à luz do conceito de vulnerabilidade. RESULTADOS Dos 854 estudos identificados, restaram 40 artigos para análise e extração dos indicadores de vulnerabilidade nas dimensões individual, social e programática. Em relação à dimensão individual, os principais indicadores identificados foram desemprego, moradias instáveis e superlotadas, falta de saneamento e de acesso à água, agravos mentais, doenças transmissíveis e crônicas não transmissíveis etc. Na dimensão programática foram identificadas, principalmente, equipes de saúde com sobrecarga de trabalho, falta de preparo para lidar com as barreiras culturais e linguísticas, demora para o atendimento. Em relação à dimensão social, constatou-se falta de acesso às escolas, à informação sobre os programas de saúde dos países de acolhida, aos direitos, entre outros. CONCLUSÃO As vulnerabilidades constatadas evidenciam desvantagem dos refugiados perante os programas, serviços e sistema de saúde nos países de acolhida, além de colocar em evidência as profundas desigualdades que incidem nesse grupo. Aponta-se a necessidade de programas e políticas que promovam ações, no âmbito da atenção primária à saúde, que reconheçam e respondam às necessidades de saúde de refugiados.

Assessment of the quality of life of Egyptian and Tunisian autoimmune bullous diseases' patients using an Arabic version of the autoimmune bullous disease quality of life and the treatment of autoimmune bullous disease quality of life questionnaires

Abstract: Background: The Autoimmune Bullous Disease Quality of Life (ABQOL) and the Treatment of Autoimmune Bullous Disease Quality of Life (TABQOL) questionnaires proved to be reliable tools that measure the disease and treatment burden. Objectives: We aimed to assess the ABQOL and TABQOL in the Arabic population. Methods: The English questionnaires were translated into the Arabic language by a certified translation agency. Eighty autoimmune bullous disease (AIBD) patients were included in this study. Patients were asked to answer 2 questionnaires. After 1 week the same patients were asked to answer the same questionnaires again. Results: The age of the patients ranged from 19 to 81 years (mean=46), 19 males, 61 females. The ABQOL ranged from 0-37 (mean=16.4±9.2). The TABQOL ranged from 2-43 (mean=21.5±9.4). Test-retest reliability was acceptable, Cronbach's alpha was 0.76 for ABQOL and 0.74 for TABQOL. There was no significant correlation between the age of the patients and ABQOL, r =-0.2, p value was 0.183. There was a significant negative correlation between the age of the patients and the TABQOL, r=-0.2, p value was 0.039. There was a significant negative correlation between the education of the patients and the TABQOL, r=-0.3, p value was 0.007. Study limitations: Small sample size of some AIBDs and patients with severe disease. Conclusion: Objective and valuable measurements such as ABQOL and TABQOL are now available to help physicians understand their patient's distress and should be used in every patient with AIBD. Younger and less educated patients appear to have more effects on their QOL from the treatments.

Y-chromosomal STR variation in Kurds and Arabs population in Iraqi Kurdistan

Background: The Iraqi Kurdistan local population involves more than eight gatherings of tenants. The Muslim Kurds make up most of the population and after that the Yezidi Kurds. Alternate gatherings incorporate Armenians, Assyrian, Chaldea, Syriacs, and little minority of Arab and Turkmen individuals.Methods: A total of 36 unrelated males from the two population groups in Iraqi Kurdistan: Kurds and Arabs were analyzed for eight Y-chromosome STRs (DYS19, DYS392, DYS437, DYS448, DYS456, DYS458, DYS635 and Y-GATA-H4). Total DNA from blood cells was extracted using DNA extraction Kit.Results: A number of genetic parameters such as mean number of alleles, allele frequency, gene diversity, polymorphic information content (PIC), and genetic distance were calculated using Power Marker V3.25 software. The DYS458 had the highest diversity (GD: 0.883), while loci DYS456 and Y-GATA-H4 had the lowest (GD: 0.574). The Dendrogram separated the populations into two main clades, the Kurd group and the Arab group except in one case only from the whole population.Conclusions: This study confirms the discriminating power of high-resolution Y-STR typing and provides first primary dataset on Iraqi Kurdistan samples. The comparison of Kurdish and Arab datasets reveals an interesting overall picture of isolation of Kurdish group. The primers DYS19, DYS448, DYS458, and DYS635 can be considered the best for their high PIC power.

Vulnerabilidades de refugiados árabes na atenção primária à saúde: uma revisão de escopo / Vulnerabilities of Arab Refugees in Primary Health Care: Scope Review

Introdução: A crise global do refúgio do final do século XX e início do século XXI constitui a pior crise nesse campo desde a Segunda Guerra Mundial. Há cerca de 244 milhões de migrantes internacionais no mundo, dos quais 25,9 milhões são refugiados. Devido aos conflitos ocorridos na Síria, o refúgio dos árabes tornou-se um dos epicentros do problema. A Síria hoje é o país que mais apresenta refugiados no mundo, com 6,7 milhões. A Síria, a Palestina, o Iraque e Líbano são os países de origem que mais solicitaram refúgio no Brasil entre os anos 2007 a 2017. A própria condição de refúgio e suas diferentes fases são condicionantes de vulnerabilidade que incidem sobre o processo saúde-doença. Objetivo: Mapear e analisar as vulnerabilidades de refugiados árabes no contexto da Atenção Primária à Saúde. Método: Trata-se de uma Revisão de Escopo. Foram analisados estudos publicados nos idiomas inglês, espanhol e português, no período de 2011 a 2019, nas bases de dados: COCHRANE, SCOPUS, Health System Evidence, MedLine-PubMed-, CINAHL, EMBASE, LILACS, Web of Science, SciELO, NYAM Grey Literature, Banco de teses e dissertações CAPES, Refworld e Journal of Refugee Studies. A análise dos dados foi realizada à luz do conceito de vulnerabilidade. Resultados e discussão: Após buscas realizadas com duas estratégias, foram encontrados 854 estudos. Com base nos critérios de inclusão e de exclusão restaram 40 artigos para análise e extração dos indicadores de vulnerabilidade. Em relação à dimensão individual foram constatadas altas taxas de desemprego, moradias instáveis e superlotadas, falta de saneamento e de acesso à água, agravos de saúde mental, gastrointestinais, nutricionais, dermatológicos, neurológicos, musculoesqueléticos, odontológicos, relacionados à gestação e à primeira infância, além de doenças transmissíveis e doenças crônicas não transmissíveis. Na dimensão programática foram identificadas equipes de saúde com sobrecarga de trabalho, com falta de preparo para lidar com as barreiras culturais e linguísticas. Também se verificou longas horas de espera para o atendimento, alto custo da Atenção Primária à Saúde, falhas na atualização do calendário vacinal e na busca ativa de pacientes em programas voltados às doenças crônicas, assim como políticas de saúde que revogam direito ao acesso a saúde. Em relação à dimensão social, constatou-se falta de acesso às escolas, à informação sobre os programas de saúde dos países de acolhida, aos direitos, e participação limitada na economia local. Conclusão: Todas as dimensões de vulnerabilidade se fizeram presentes, identificadas por meio dos indicadores estudados. Os elementos de vulnerabilidade evidenciam desigualdade e desvantagem dos refugiados perante os programas, serviços e sistema de saúde nos países de acolhida. Nesse sentido, aponta-se a necessidade de programas e políticas que considerem tais elementos de vulnerabilidade, e promovam ações, no âmbito da Atenção Primária à Saúde, que reconheçam e respondam às necessidades de saúde dos refugiados. Também se aponta a necessária abordagem em saúde na perspectiva do conceito de vulnerabilidade, sobretudo na dimensão social, o que implica em reconhecer que a situação desse grupo social decorre fundamentalmente, de processos estruturais que envolvem embate de poder entre países.

Introduction: The global crisis of the late twentieth and early twenty-first century refuge is the worst crisis in this field since World War II. There are about 244 million international migrants in the world of which 25.9 million are refugees. Due to the conflicts in Syria, the refuge of the Arabs has become one of the epicenters of the problem. Today, Syria is the world's largest refugee country with 6.7 million. Syria, Palestine, Iraq and Lebanon are the countries of origin that most sought asylum in Brazil between 2007 and 2017. The condition of refuge itself and its different phases are conditions of vulnerability that affect the health-disease process. Objective: To map and analyze the vulnerabilities of Arab refugees in the context of Primary Health Care. Methodology: This is a Scope Review. Studies published in English, Spanish and Portuguese from 2011 to 2019, have been analyzed in the following databases: COCHRANE, SCOPUS, Health System Evidence, MedLine-PubMed-, CINAHL, EMBASE, LILACS, Web of Science, SciELO, NYAM Grey Literature, Bank of theses and dissertations CAPES, Refworld e Journal of Refugee Studies. Data analysis was performed in light of the concept of vulnerability. Results and discussion: After researching with two strategies, 854 studies were found. Based on the inclusion and exclusion criteria 40 articles remained for analysis and extraction of vulnerability indicators. Regarding the individual dimension, high unemployment rates, unstable and overcrowded housing, poor sanitation and access to water, mental health, gastrointestinal, nutritional, dermatological, neurological, musculoskeletal, dental, pregnancy-related and early childhood problems were found as well as communicable diseases and non-communicable chronic diseases. In the programmatic dimension health teams were identified with work overload, lack of preparation to deal with cultural and language barriers. There were also long waiting hours for care, high cost of Primary Health Care, failures to update the vaccination schedule and the active search of patients in programs focused on chronic diseases besides health policies that revoke the right to access to health. Regarding the social dimension, there was a lack of access to schools, information about the health programs of the host countries, rights and limited participation in the local economy. Conclusion: All dimensions of vulnerability were presented, identified through the indicators studied. The elements of vulnerability highlight the inequality and disadvantage of refugees towards the program, services and health system in the host countries. In this sense, there is a need for programs and policies that consider such elements of vulnerability and promote actions within the scope of Primary Health Care that recognizes and responds to the health needs of refugees. It also points out the necessary approach to health from the perspective of the concept of vulnerability especially in the social dimension, which implies recognizing that the situation of this social group derives fundamentally from structural processes that involve a clash of power between countries.

A Comparison of Rheumatoid Arthritis Patients in Kuwait with Other Populations: Results from the KRRD Registry.

Objective: Data on rheumatoid arthritis (RA) in Kuwait and The Middle East is scarce. Available data from Western countries may not be representative of the region. We describe RA patients in Kuwait and compare them with other RA populations and with Kuwaiti general population. Methods: Adult RA patients from Kuwait Registry for Rheumatic Diseases (KRRD), the first RA registry in The Middle East, were studied from February 2013 through February 2015. Demographic, clinical and serologic data were compared with other RA populations and with Kuwaiti general population. Results: 835 patients were enrolled, 62.3% female. Mean age 50.6±12 years and disease duration 6.1±6 years. RA was diagnosed at a mean age of 44.9±12 years. 17.1% had family history of autoimmune rheumatic diseases. 3.1% had rheumatoid nodules. Rheumatoid factor (RF) and anti-citrullinated peptide (ACPA) were detected in 75.6% and 57.8%, respectively. Both were positive in 49% (r=0.287, p=0.001). ANA was positive in 19.1%. Both ACPA and a combination of positive RF and ACPA were more in males (p=0.017, 0.004 respectively), whereas ANA was more in females (p=0.01). One third of male patients were smokers versus 1.9% of females. Smoking was correlated to RF (p=0.009) and ACPA (p=0,002). Difference in ACPA between genders was statistically explained by the predominance of smoking in males. Comorbidities included diabetes mellitus (DM) (20.8%), hypertension (20.2%), hyperlipidemia (10.5%) and coronary artery disease (CAD) (3.1%). 4 cases of cancer were reported. Conclusion: RA population in Kuwait includes less women than other RA populations but more than Kuwaiti general population. Family history is more common. A higher positive ACPA in males was explained by smoking difference. Hypertension and hyperlipidemia were less reported than in both Kuwaiti general population and other RA populations. CAD was similar to other RA populations. DM was more reported, reflecting its high background prevalence in Kuwait.

Israeli Arabs develop diverticulitis at a younger age and are more likely to require surgery than Jews / Árabes israelitas desenvolvem diverticulite em idade mais jovem e estão mais sujeitos ao tratamento cirúrgico do que os judeus

BACKGROUND: Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis. AIM: To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is a predictor of age of onset, complications, and need for surgery. METHODS: Was conducted a retrospective review of the charts of all patients diagnosed with a first episode of diverticulitis in our hospital between 2005 and 2012. RESULTS: Were found 638 patients with a first episode of acute diverticulitis in the eight year interval. Israeli Arabs developed a first episode of diverticulitis at a younger age compared to Jews (51.2 vs 63.8 years, p<0.01). Arabs living in rural areas developed diverticulitis at a younger age than Arabs living in urban centers (49.4 vs 54.5 years, P=0.03). Jewish and Arabic men developed diverticulitis at younger age compared to their female counterparts (59.9 vs 66.09, p<0.01, and 47.31 vs 56.93, p<0.01, respectively). Arabs were more likely [odds ratio (OR)=1.81 ,95% confidence interval (CI)1.12-2.90, p=0.017] than Jews to require surgical treatment (urgent or elective) for diverticulitis. CONCLUSIONS: Israeli Arabs tend to develop diverticulitis at a younger age and are more likely to require surgical treatment for diverticulitis compared to Jews. Arabs living in rural areas develop diverticulitis at a younger age than Arabs living in urban centers. These findings highlight a need to address the root cause for ethnic differences in onset, course and outcome of acute diverticulitis. .

RACIONAL: Somente poucos estudos examinaram o impacto das diferenças raciais na idade de início, curso e os resultados da diverticulite. OBJETIVO: Fornecer dados sobre a epidemiologia da diverticulite no norte de Israel, e determinar se a etnia é preditor de idade de início, complicações e necessidade de tratamento cirúrgico. MÉTODOS: Foi realizado estudo retrospectivo dos prontuários de todos os pacientes diagnosticados com um primeiro episódio de diverticulite em nosso hospital entre 2005 e 2012. RESULTADOS: Foram encontrados 638 pacientes com um primeiro episódio de diverticulite aguda no intervalo de oito anos. Os árabes israelenses desenvolveram o primeiro episódio de diverticulite em idade mais jovem em comparação com os judeus (51,2 vs 63,8 anos, p<0,01). Árabes que vivem em áreas rurais a diverticulite foi desenvolvida em idade mais jovem do que os árabes que vivem em centros urbanos (49,4 vs 54,5 anos, p=0,03). Homens judeus e árabes desenvolveram diverticulite em idade mais jovem em comparação com os seus homólogos do sexo feminino (59,9 vs 66,09, p<0,01, e 47,31 vs 56,93, p<0,01, respectivamente). Os árabes eram mais prováveis ​​do que os judeus de necessitar de tratamento cirúrgico (urgência ou eletiva) para a diverticulite [odds ratio (OR)=1,81, intervalo de confiança de 95% (CI) 1,12-2,90, p=0,017]. CONCLUSÕES: Os árabes israelenses tendem a desenvolver diverticulite em idade mais jovem e são mais propensos a necessitar de tratamento cirúrgico para a diverticulite em comparação com os judeus. Árabes que vivem em áreas rurais desenvolvem diverticulite em idade mais jovem do que os árabes que vivem em centros urbanos. Estes resultados destacam a necessidade de abordar a causa raiz para diferenças étnicas em início, o curso e o resultado da diverticulite aguda. .

Manifestaciones nasales de la lepra / Nasal manifestations of leprosy

Introducción: la lepra es una enfermedad crónica infecciosa, causada por Mycobacterium leprae, que se manifiesta mediante el desarrollo de lesiones granulomatosas específicas y neurotróficas en piel, membranas mucosas, nervios, ojos y vísceras. Objetivo: destacar, casuísticamente, lo más relevante de la Lepra nasal que sea de utilidad para el diagnóstico precoz de esta enfermedad por los médicos de la Atención Primaria de Salud. Métodos : estudio descriptivo de corte transversal y retrospectivo realizado por el Servicio de Otorrinolaringología del Policlínico Docente "Carlos Manuel Portuondo", durante el periodo Enero de 2010 a Enero 2012. El Universo estuvo comprendido por 106 pacientes del área de Marianao diagnosticados de lepra por el Servicio de Dermatología del Hospital "Carlos Juan Finlay", la muestra quedó constituida por 90 casos que presentaron patología nasosinusal. Resultados: 90 casos presentaron patología nasosinusal. Fue muy frecuente el hallazgo de lesiones nasales en pacientes hansenianos. Conclusiones: el síntoma más comúnmente referido como antecedente fue la obstrucción nasal, seguida por el de epistaxis o sangramiento nasal. La única forma clínica en la que hemos encontrado la destrucción total del septum nasal fue la lepromatosa.

Introduction: leprosy is a chronic infectious disease caused by Mycobacterium leprae, which is manifested by the development of specific and neurotrophic granulomatous lesions in skin, mucous membranes, nerves, eyes and viscera. Objective: highlight casuistically is the most relevant knowledge of nasal leprosy for helping early diagnosis of this disease by doctors at Primary Health Care. Methods: adescriptive cross-sectional and retrospective study was conducted by the Department of Otorhinolaryngology at Carlos Manuel Portuondo Polyclinic, from January 2010 to January 2012. The universe was comprised of 106 patients from Marianao area diagnosed with leprosy by the dermatology service at Carlos Finlay Hospital. The sample was composed of 90 cases with sinonasal pathology. Results: 90 cases showed sinus pathology. Nasal lesions were very common finding in leprosy patients. Conclusions: The most commonly referred symptom as antecedent was nasal obstruction, followed by epistaxis or nasal bleeding. Lepromatous was only clinical way in which we found total destruction of the nasal septum

Magnetic Resonance Imaging of the Lumbar Spine in Young Arabs with Low Back Pain

STUDY DESIGN: A prospective study. PURPOSE: To Investigate the prevalence of magnetic resonance imaging (MRI) changes of the lumbar spine in low back pain (LBP) and the associated risk factors in young Arab population. OVERVIEW OF LITERATURE: Studies on the prevalence of MRI findings and their relationship with LBP have been conducted; these have occurred in adult populations in developed countries. The prevalence of MRI changes in the young Arab population with LBP is not known. METHODS: Two hundred and fourteen patients of Arab origin in the 16 to 29 year age group with LBP symptoms underwent MRI examinations. The prevalence of MRI changes in the lumbar spine and associated risk factors were determined and compared to age, race, and gender-matched controls. RESULTS: A majority (64%) of the patients with LBP (138 out of 214) were found to have MRI evidence of degenerative disc disease (DD) compared to 10% (22 out of 214) in the control group. The majority (61%) of patients had multiple level disease, most commonly involving the lowest 2 disc levels. Reduced signal of the disc followed by disc bulge was the most common MRI features seen in the symptomatic subjects. Obesity correlated with MRI prevalence of abnormalities, while activity demonstrated a positive trend. CONCLUSIONS: The MRI prevalence of DD among the young Arab patients with LBP is high when compared to other reports in literature. Obesity correlated with MRI prevalence of abnormalities while activity demonstrated a positive trend.

Sickle cell disease in Middle East Arab countries.

The sickle cell (HbS) gene occurs at a variable frequency in the Middle Eastern Arab countries, with characteristic distribution patterns and representing an overall picture of blood genetic disorders in the region. The origin of the gene has been debated, but studies using β-globin gene haplotypes have ascertained that there were multiple origins for HbS. In some regions the HbS gene is common and exhibits polymorphism, while the reverse is true in others. A common causative factor for the high prevalence and maintenance of HbS and thalassaemia genes is malaria endemicity. The HbS gene also co-exists with other haemoglobin variants and thalassaemia genes and the resulting clinical state is referred to as sickle cell disease (SCD). In the Middle Eastern Arab countries, the clinical picture of SCD expresses two distinct forms, the benign and the severe forms, which are related to two distinct β-globin gene haplotypes. These are referred to as the Saudi-Indian and the Benin haplotypes, respectively. In a majority of the Middle Eastern Arab countries the HbS is linked to the Saudi-Indian haplotype, while in others it is linked to the Benin haplotype. This review outlines the frequency, distribution, clinical feature, management and prevention as well as gene interactions of the HbS genes with other haemoglobin disorders in the Middle Eastern Arab countries.

Absence of mutations in GJB2 (Connexin-26) gene in an ethnic group of southwest Iran.

BACKGROUND: The common GJB2 gene mutation (35delG) has been previously reported from Iranian patients that were affected with nonsyndromic autosomal recessive deafness. We, therefore, for the first time, investigated the prevalence and frequency of the GJB2 gene mutation in the Iranian deaf population with Arabian origins. MATERIALS AND METHODs: We amplified and sequenced the entire coding sequence of the GJB2 gene from 61 deaf patients and 26 control subjects. RESULT: None of the analyzed samples revealed deafness-associated mutation. CONCLUSION: This finding differs from several reports from Iran as we have focused on the GJB2 gene that possesses various mutations as the cause of congenital recessive deafness.