[The Migration and Health Teaching Network: consolidating and developing education and training]. / Das Lehrnetzwerk Migration und Gesundheit: Aus- und Weiterbildung konsolidieren und weiterentwickeln.

Patients with migration history often encounter barriers to accessing healthcare in Germany, which lowers the quality of care available to them and can affect their overall health. These barriers in access to healthcare are due to both adverse health policies and a lack of migration-related - and diversity-sensitive - content in medical and other health profession teaching. Although most healthcare professionals regularly care for patients with individual or generational migration experience in Germany, teaching content relevant to the healthcare of these patients has not yet been anchored in the curriculum. At best, it is taught in the form of electives or other optional courses.To address this gap, the Teaching Network Migration and Health was created with the goal of promoting the development of human rights-based, diversity-sensitive, and equity-oriented curricula at medical and healthcare professions schools. It aims to (1) connect individuals active in teaching and promote the exchange and collaborative development of teaching materials, (2) use this collective knowledge and experience to develop a model course on migration and health, and (3) develop strategies for the longitudinal implementation of this course into the regular medical and other health professional school curricula. These efforts are flanked by evaluative accompanying research. Anyone interested in joining the network is invited to join and strengthen the network by contacting the authors.

Ética de los sentimientos, desarrollo de capacidades, memoria histórica y reconciliación: la fragilidad del personal de salud en el conflicto armado colombiano / Ètica dels sentiments, desenvolupament de capacitats, memòria històrica i reconciliació: la fragilitat del personal de salut al conflicte armat colombià / Ethics of feelings, capacity building, historical memory, and reconciliation: the fragility of health personnel in the Colombian armed conflict

Objetivo: analizar la forma en que los sentimientos y la recuperación de la memoria colectiva, posibilitan la disminución de la fragilidad social y política de los integrantes de la Misión Médica, haciendo factible nuevas maneras de participación, mediante el desarrollo de capacidades deliberativas desde la perspectiva bioética. Metodología: estudio exploratorio con enfoque cualitativo, que toma en cuenta la subjetividad e intersubjetividad de los participantes. Con fuentes de información heterogénea: grupos focales, entrevistas semiestructuradas y cartillas de campo, se constituyó un marco de factores relevantes, que permitieron procesar la información, mediante relaciones y categorizaciones conceptuales,para su posterior triangulación. Resultados: los sentimientos con mayor impacto ético en Misión Médica: incertidumbre, inseguridad ante el trabajo, ansiedad por los hechos de violencia, tristeza, temor, miedo e impotencia; producen efectos emocionales relacionados con el principio de maleficencia. La resiliencia, ha impedido realizar ejercicios de memoria colectiva, a causa del negacionismo y temor a recordar los hechos más significativos, esto les ha impedido el acceso a los mecanismos de Justicia Restaurativa. La ausencia de capacidades para afrontar la situación compromete la autonomía individual, la salud laboral y genera carencias legales no resueltas. Conclusiones: los sentimientos colectivos en el ámbito público del personal sanitario prevalecen sobre los sentimientos individuales basados en vivencias, que afectan la capacidad de deliberación, esto implica promover ejercicios de memoria colectiva, sobre los hechos del conflicto, mediante el desarrollo de capacidades que fortalezcan la legitima defensade su autonomía y el desarrollo de un ejercicio profesional beneficiente, ante situaciones limítrofes de confrontación.(AU)

Objectiu: analitzar la manera com els sentiments i la recuperació de la memòria col·lectiva, possibiliten la disminució de la fragilitat social i política dels integrants de la Missió Mèdica, fent factible noves maneres de participació, mitjançant el desenvolupament de capacitats deliberatives des de la perspectiva bioètica. Metodologia: estudi exploratori amb enfocament qualitatiu, que té en compte la subjectivitat i la intersubjectivitat dels participants. Amb fonts d'informació heterogènia: grups focals, entrevistes semiestructurades i cartilles de camp, es va constituir un marc de factors rellevants, que van permetre processar la informació, mitjançant relacions i categoritzacions conceptuals, per triangular-les posteriorment. Resultats: els sentiments amb més impacte ètic a Missió Mèdica: incertesa, inseguretat davant la feina, ansietat pels fets de violència, tristesa, temor, por i impotència; produeixen efectes emocionals relacionats amb el principi de maleficència. La resiliència, ha impedit fer exercicis de memòria col·lectiva, a causa del negacionisme i temor de recordar els fets més significatius, això els ha impedit l'accés als mecanismes de Justícia Restaurativa. L'absència de capacitats per fer fronta la situació compromet l'autonomia individual, la salut laboral i genera mancances legals no resoltes. Conclusions: els sentiments col·lectius en l'àmbit públic del personal sanitari prevalen sobre els sentiments individuals basats en vivències, que afecten la capacitat de deliberació, això implica promoure exercicis de memòria col·lectiva, sobre els fets del conflicte, mitjançant el desenvolupament de capacitats que enforteixin la legítima defensa de la seva autonomia i el desenvolupament d'un exercici professional beneficient, davant de situacions limítrofes de confrontació.(AU)

Objective: to analyze the way in which feelings and the recovery of collective memory make it possible to reduce the social and political fragility of the members of the Medical Mission, making new ways of participation feasible, through the development ofdeliberative capacities from a bioethical perspective. Methodology: exploratory study with qualitative approach, which considers the subjectivity and intersubjectivity of the participants. With heterogeneous sources of information: focus groups, semi-structured interviews and field primers, a framework of relevant factors was constituted, which allowed processing the information, through conceptual relationships and categorizations, for its subsequent triangulation. Results: the feelings with the greatest ethical impact in Mission Medical: uncertainty, insecurity at work, anxiety due to acts of violence, sadness, fear, fear, and impotence; produce emotional effects related to the principle of maleficence. Resilience has prevented them from carrying out collective memory exercises, due to denial and fear of remembering the most significant events, which has prevented them from accessing Restorative Justice mechanisms. The absence of capacities to face the situation compromises individual autonomy, occupational health and generates unresolved legal shortcomings. Conclusions: collective feelings in the public sphere of health personnel prevail over individual feelings based on experiences, which affect the capacity for deliberation, this implies promoting exercises of historical memory on the facts of the conflict, through the development of capacities that strengthen the legitimate defense of their autonomy and the development of a beneficial professional exercise, in the face of borderline situations of confrontation.(AU)

Visceral leishmaniasis in new foci areas of Nepal: Sources and extent of infection.

Background & objectives: The successful elimination program of visceral leishmaniasis (VL) in Nepal decreased the incidence to less than 1 per 10,000 population leading to the consolidation phase. However, new VL cases have been recorded from new districts, threatening the elimination goal. This study monitors the geographical spread of VL and identifies potential risk factors. Methods: VL data of 2017-2020 were obtained from the Epidemiology and Disease Control Division (EDCD) of Nepal and mapped. Telephonic interviews with 13 VL patients were conducted. Results: The incidence maps indicate that VL is spreading to new areas. The target incidence exceeded four times in hilly and twice in mountainous districts. VL cases occurred in 64 of 77 districts in all three regions (mountainous, hilly and Terai). Interviews showed a correlation between travel history (private, commercial and for studies) and the spread of VL cases to new foci. Interpretation & conclusion: One major challenge of VL elimination in the maintenance phase is the spread of infection through travelers to new foci areas, which needs to be under continuous surveillance accompanied by vector control activities. This should be confirmed by a large-scale analytical study.

Factors shaping the COVID-19 epidemic curve: a multi-country analysis.

BACKGROUND: Lockdown measures are the backbone of containment measures for the COVID-19 pandemic both in high-income countries (HICs) and low- and middle-income countries (LMICs). However, in view of the inevitably-occurring second and third global covid-19 wave, assessing the success and impact of containment measures on the epidemic curve of COVID-19 and people's compliance with such measures is crucial for more effective policies. To determine the containment measures influencing the COVID-19 epidemic curve in nine targeted countries across high-, middle-, and low-income nations. METHODS: Four HICs (Germany, Sweden, Italy, and South Korea) and five LMICs (Mexico, Colombia, India, Nigeria, and Nepal) were selected to assess the association using interrupted time series analysis of daily case numbers and deaths of COVID-19 considering the following factors: The "stringency index (SI)" indicating how tight the containment measures were implemented in each country; and the level of compliance with the prescribed measures using human mobility data. Additionally, a scoping review was conducted to contextualize the findings. RESULTS: Most countries implemented quite rigorous lockdown measures, particularly the LMICs (India, Nepal, and Colombia) following the model of HICs (Germany and Italy). Exceptions were Sweden and South Korea, which opted for different strategies. The compliance with the restrictions-measured as mobility related to home office, restraining from leisure activities, non-use of local transport and others-was generally good, except in Sweden and South Korea where the restrictions were limited. The endemic curves and time-series analysis showed that the containment measures were successful in HICs but not in LMICs. CONCLUSION: The imposed lockdown measures are alarming, particularly in resource-constrained settings where such measures are independent of the population segment, which drives the virus transmission. Methods for examining people's movements or hardships that are caused by covid- no work, no food situation are inequitable. Novel and context-adapted approach of dealing with the COVID-19 crisis are therefore crucial.

The use of mobile phones for the prevention and control of arboviral diseases: a scoping review.

BACKGROUND: The rapid expansion of dengue, Zika and chikungunya with large scale outbreaks are an increasing public health concern in many countries. Additionally, the recent coronavirus pandemic urged the need to get connected for fast information transfer and exchange. As response, health programmes have -among other interventions- incorporated digital tools such as mobile phones for supporting the control and prevention of infectious diseases. However, little is known about the benefits of mobile phone technology in terms of input, process and outcome dimensions. The purpose of this scoping review is to analyse the evidence of the use of mobile phones as an intervention tool regarding the performance, acceptance, usability, feasibility, cost and effectiveness in dengue, Zika and chikungunya control programmes. METHODS: We conducted a scoping review of studies and reports by systematically searching: i) electronic databases (PubMed, PLOS ONE, PLOS Neglected Tropical Disease, LILACS, WHOLIS, ScienceDirect and Google scholar), ii) grey literature, using Google web and iii) documents in the list of references of the selected papers. Selected studies were categorized using a pre-determined data extraction form. Finally, a narrative summary of the evidence related to general characteristics of available mobile health tools and outcomes was produced. RESULTS: The systematic literature search identified 1289 records, 32 of which met the inclusion criteria and 4 records from the reference lists. A total of 36 studies were included coming from twenty different countries. Five mobile phone services were identified in this review: mobile applications (n = 18), short message services (n=7), camera phone (n = 6), mobile phone tracking data (n = 4), and simple mobile communication (n = 1). Mobile phones were used for surveillance, prevention, diagnosis, and communication demonstrating good performance, acceptance and usability by users, as well as feasibility of mobile phone under real life conditions and effectiveness in terms of contributing to a reduction of vectors/ disease and improving users-oriented behaviour changes. It can be concluded that there are benefits for using mobile phones in the fight against arboviral diseases as well as other epidemic diseases. Further studies particularly on acceptance, cost and effectiveness at scale are recommended.

Exploring urban health in Cape Town, South Africa: an interdisciplinary analysis of secondary data.

BACKGROUND: With modern information technology, an overwhelming amount of data is available on different aspects of societies. Our research investigated the feasibility of using secondary data sources to get an overview of determinants of health and health outcomes in different population strata of Cape Town, a large city of South Africa. METHODS: The methodological approach of secondary-data analysis was similar in the different disciplines: Biological Anthropology, Public Health, Environmental Health, Mental Health, Palliative Care, Medical Psychology and Sociology at the University of Freiburg and Public Health at the University of Cape Town. The teams collected information on Cape Town through Internet searches and published articles. The information was extracted, analyzed, condensed, and jointly interpreted. RESULTS: Data show the typical picture of a population in epidemiological and demographic transition exposed to often difficult social, mental, and physical environmental conditions. Comparison between low and higher socioeconomic districts demonstrated that the former had higher air pollution, poorer water quality, and deficient sanitary conditions in addition to sub-optimal mental health services and palliative care. CONCLUSION: Although important information gaps were identified, the data draw attention to critical public health interventions required in poor health districts, and to motivate for pro-equity policies.

The impact of health-management training programs in Latin America on job performance.

A study was undertaken in Mexico, Colombia, and El Salvador to determine the impact of a management training program on health managers' job performance. A quasi-experimental design was used where in the baseline study an intervention group of 85 district health managers in the three countries was compared with a control group of 71 managers who did not receive the training program. After the implementation of an 18-month training program (which included 5-day training workshops and a series of tasks to be carried out between the workshops), the outcome in terms of improved job performance (i.e. use of predefined management techniques) was measured through twelve management performance indicators. The data collection tools were two questionnaires, participant observation in managers' workplaces, focus group discussions, staff interviews, and document analysis. In Mexico, the control group showed 8.3 times weaker management performance compared to the intervention group; in Colombia the value was 3.6 and in El Salvador 2.4. Factors associated with a successful training outcome were: (a) training techniques, (b) strengthening of enabling factors, and (c) reinforcement mechanisms.

The impact of health-management training programs in Latin America on job performance

Se desarrolló un estudio en México, Colombia y El Salvador para determinar el impacto de un programa de capacitación en el desempeño de trabajo de los gerentes de salud. El diseño del estudio fue quasi-experimental (no-randomizado) comparando dos grupos: el grupo de intervención con 85 gerentes en los tres países que recibieron la capacitación y, el grupo control con 71 gerentes que no recibieron la capacitación. Después de ejecutar el programa de enseñanza de 18 meses de duración (el cual incluyó talleres de cinco días de duración y compromisos), el mejoramiento en el desempeño fue medido utilizando 12 indicadores. Los resultados mostraron que, en México, el grupo control mostró 8.3 veces más debilidades en el desempeño que el grupo de intervención; en Colombia, el valor fue 3.6 y en El Salvador 2.4 veces mayor. Factores asociados con el éxito de los resultados del programa de capacitación fueron: (a) las técnicas de enseñanza utilizadas, (b) el fortalecimiento de factores asociados con el buen desempeño y, (c) mecanismos de refuerzo.