scholarly journals Asylum seekers health and wellbeing (TERTTU) survey: study protocol for a prospective total population health examination survey on the health and service needs of newly arrived asylum seekers in Finland

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027917 ◽  
Author(s):  
Natalia Skogberg ◽  
Päivikki Koponen ◽  
Paula Tiittala ◽  
Katri-Leena Mustonen ◽  
Eero Lilja ◽  
...  
Keyword(s):  
Health Service ◽  
Asylum Seekers ◽  
Total Population ◽  
Well Being ◽  
Evidence Base ◽  
Population Based ◽  
Baseline Data ◽  
Health Examination ◽  
Service Needs ◽  
Health And Wellbeing

IntroductionHealth, well-being and health service needs of asylum seekers have emerged as urgent topics following the arrival of 2.5 million asylum seekers to the European Union (EU) between 2015 and 2016. However, representative information on the health, well-being and service needs of asylum seekers is scarce. The Asylum Seekers Health and Wellbeing (TERTTU) Survey aims to: (1) gather population-based representative information; (2) identify key indicators for systematic monitoring; (3) produce the evidence base for development of systematic screening of asylum seekers’ health, well-being and health service needs.Methods and analysisTERTTU Survey is a population-based prospective study with a total population sample of newly arrived asylum seekers to Finland, including adults and children. Baseline data collection is carried out in reception centres in 2018 and consists of a face-to-face interview, self-administered questionnaire and a health examination following a standardised protocol. Altogether 1000 asylum seekers will be included into the study. Baseline data will be followed up with national electronic health record data encompassing the entire asylum process and later with national register data among persons who receive residency permits.Ethics and disseminationEthical approval has been granted by the Coordinating Ethics Committee of the Helsinki and Uusimaa Hospital District. Participation is voluntary and based on written informed consent. Results will be widely disseminated on a national and international level to inform health and welfare policy as well as development of services for asylum seekers. Results of the study will constitute the evidence base for development and implementation of the initial health assessment for asylum seekers on a national level.

scholarly journals The health of asylum seekers in Finland: a total population health examination survey (TERTTU)

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
N Skogberg ◽  
P Koponen ◽  
E Lilja ◽  
K-L Mustonen ◽  
F Garoff ◽  
...  
Keyword(s):  
Asylum Seekers ◽  
National Level ◽  
Circulatory System ◽  
Participation Rate ◽  
Evidence Base ◽  
Population Based ◽  
Health Examination ◽  
Assessment Protocol ◽  
Health And Wellbeing ◽  
Health Examination Survey

Abstract Background There is scarcity of representative population-based data on the health and wellbeing of asylum seekers in Europe. The Asylum Seekers Health and Wellbeing Survey (TERTTU) was launched to provide the evidence-base for developing services for asylum seekers as well as for planning and allocation of healthcare resources at a national level. Methods A sample of all first-time asylum applicants between 19.2-30.11.2018 was drawn from the Finnish Immigration Services electronic asylum database. Altogether 784 adults aged 18 years and older took part in the standardised health examination and face-to-face interview with participation rate of 79%. Interviewed health measures included the Minimum European Health Module, conditions previously diagnosed by a physician, permanent injury due to violence or accident and somatization. Results Self-rated health was good among 66% (95% CI 62,5-69,1) and 42% (95% CI 38,5-45,4) reported having some self-reported long-term illness or health problem. The most common previously diagnosed conditions were diseases of the circulatory system (19%, 95% CI 16,5-22,0), musculoskeletal system (18%, 95% CI 15,6-21,1), mental and behavioural disorders (13%, 95% CI 10,9-15,6) and diseases of the respiratory system (10%, 95% CI 8,0-12,2 ). Nearly half (47%, 95% CI 43,7-50,8) reported having a permanent injury due to violence or accident. Somatisation was common: 23% (95% CI 20,3-26,2) reported having headache, 23% (95% CI 19,9-25,8) back ache and 13% (95% CI 10,8-15,6) other pains at least several times a week. Conclusions The overall health of newly-arrived asylum seekers was poorer compared with the general Finnish population and migrant origin populations from similar countries of origin permanently living in Finland. Significant differences in asylum seekers health were found by sex and region of origin. Survey data will be used for developing the national initial health assessment protocol for asylum seekers during 2019. Key messages The TERTTU Survey is the largest population-based health examination survey among newly-arrived asylum seekers in Europe to date. The extensive data gathered over the course of the survey will be used for developing services for asylum seekers at a national level and is of high relevance also to other European countries.

scholarly journals Health of asylum seeker children in Finland: a total population health examination survey (TERTTU)

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
N Skogberg ◽  
P Koponen ◽  
E Lilja ◽  
K-L Mustonen ◽  
F Garoff ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Asylum Seekers ◽  
Sleep Disturbances ◽  
Population Based ◽  
Service Development ◽  
Health Examination ◽  
Assessment Protocol ◽  
Health And Wellbeing ◽  
Healthcare Needs ◽  
Health Examination Survey

Abstract Background There is scarcity of representative population-based data on the health and wellbeing of asylum seekers in Europe, especially children and adolescents. The Asylum Seekers Health and Wellbeing Survey (TERTTU) was launched to inform evidence-based policy-making and development of services. Methods A sample of all first-time asylum applicants was drawn from the Finnish Immigration Services electronic asylum database. Data on 303 children aged 0-17 years was gathered with a standardised health examination (including a dental assessment for 7-17 year-olds) and face-to-face-interview including the Minimum European Health Module and somatic and behavioural symptoms over the past 30 days. Guardians of 0-12 year-olds were interviewed, 13-17 year-olds responded themselves. Participation rate was 72%. Results 62% (95% CI 49,4-73,0) of 13-17 year-olds have had their growth and development monitored compared with 91% (95% CI 83,6-95,6) of 7-12 year-old and 86% (95% CI 79,4-91,0) of 0-6 year-olds. Long-standing health problems were more common among 13-17 year-olds (28%, 95% CI 18,2-39,7) and 7-12 year-olds (25%, 95% CI 16,8-34,2) compared 0-6 year-olds (13%, 95% CI 8,2-19,5). Sleep disturbances were more common among 13-17 year-olds (35%, 95% CI 24,2-47,4) and 7-12 year-olds (28%, 95% CI 19,6-37,5) than 2-6 year-olds (18%, 95% CI 11,3-26,7). Approximately fifth of children aged 7-17 years and slightly more than tenth of younger children had fears and anxieties. Signs of dental caries were found in 46% (95% CI 35,4-55,9) of 7-12 year-olds and in 23% (95% CI 14,1-35,1) of 13-17 year-olds. Conclusions Timely and accurate assessment of healthcare needs is crucial to support and improve the health and wellbeing of children and adolescents. Survey data will be used for developing the national initial health assessment protocol for asylum seeking children and adolescents. Key messages The TERTTU Survey is the largest population-based health examination survey among newly-arrived asylum seeking adults, adolescents and children in Europe, allowing for examining family units. Health information on asylum seeking children and adolescents in Finland, is relevant for service development, also for other European countries.

scholarly journals “Don’t judge me”: narratives of living with FGM

2017 ◽  
Vol 10 (1) ◽  
pp. 4-13 ◽  
Author(s):  
Natasha Recchia ◽  
Julie McGarry
Keyword(s):  
Well Being ◽  
Evidence Base ◽  
Narrative Approach ◽  
Content Type ◽  
Genital Mutilation ◽  
Health And Wellbeing ◽  
E Learning ◽  
The Creation ◽  
The Impact ◽  
Practice Development

Purpose The purpose of this paper is to facilitate a participant led arts-based workshop for survivors of female genital mutilation (FGM) in order to explore their experiences and impact of FGM on health and wellbeing, and to use the artefacts to inform development of an e-learning resource. Design/methodology/approach The study utilised a creative narrative approach which included the sharing of personal stories, the creation of pottery models and the sharing of artefacts. A narrative approach was chosen as the methodology for the study as narratives are now well established within qualitative research as a meaningful way in which the voices of participants take precedence over those of the researcher. Six women who are living with FGM agreed to take part. Findings The composition of the workshop essentially encompassed two main strands: the creation of a persona and sharing artefacts. These are described in detail with supplementary images included wherever appropriate. The authors have not attempted to present the findings of the workshop from the perspective of the researcher but have rather enabled the findings to speak for themselves. Research limitations/implications There is a paucity of studies which have explored women’s experiences of living with FGM and the impact on health and well-being. The findings suggest that there is further scope for research and practice development which examines the impact of education on professional’s approaches to FGM. Originality/value This study and the wider focus towards the impact of FGM beyond the physical or procedural aspects of FGM offer a contribution to the evolving evidence base in this field.

scholarly journals Asylum seekers’ mental health in the Finnish Asylum Seekers Health and Wellbeing Survey (TERTTU)

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A E Castaneda ◽  
E Lilja ◽  
F Garoff ◽  
K L Mustonen ◽  
A Ahmed ◽  
...  
Keyword(s):  
Mental Health ◽  
Survey Data ◽  
Peer Relationships ◽  
National Health ◽  
Asylum Seekers ◽  
Mental Health Problems ◽  
Well Being ◽  
Traumatic Experiences ◽  
Health Examination ◽  
Examination Protocol

Abstract Background Asylum seekers have major health and well-being burdens, including mental health. However, there is a lack of population-based survey data on the health status and service needs of asylum seekers in Europe. The TERTTU-project was launched to fill these information gaps and to develop the current health examination protocol for assessing the health, well-being and need for health care services, including mental health, of newly arrived asylum seekers. Methods As part of the TERTTU-project, systematic, nationally representative data was collected in 2018 by conducting a health examination and a face-to-face interview survey in reception centers in Finland (n = 1087). The sample was drawn from the Finnish Immigration Services electronic asylum database. Mental health was assessed with the HSCL and PROTECT questionnaires (SDQ among the children), along with questions of potentially traumatic experiences. Results 39% (95% CI 35,6-42,6) of the adults had current severe depressive and anxiety symptoms, 50% (95% CI 46,9-53,9) had an increased risk for PTSD, and 83% (95% CI 80,0-85,3) had experienced at least one potentially traumatic event before arriving to Finland. The most common psychosocial symptoms among 2-6 year-olds were behavioral symptoms (49%) and difficulties in peer relationships (37%). Difficulties in peer relationships were also common among 7-17 year-olds (49%), followed by challenges in the emotional domain (42%). Conclusions Potentially traumatic experiences and mental health problems are common among asylum seekers in Finland. Based on the survey-data, a national health examination protocol will be developed in 2019 to improve assessment and identification and to enable systematic health monitoring and evidence-based development of services for asylum seekers. A common health examination protocol will also unify practices across reception centers all over the country. Key messages Potentially traumatic experiences and mental health problems are common among asylum seekers in Finland. A national health examination protocol allows for the early identification of vulnerable groups and individuals.

scholarly journals Barriers and facilitators to surveying asylum seekers: reflections of the fieldwork personnel

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Ahmed ◽  
H a j i Omar ◽  
A E Castaneda ◽  
K-L Klemettilä ◽  
F Garoff ◽  
...  
Keyword(s):  
Data Collection ◽  
Asylum Seekers ◽  
Well Being ◽  
High Response Rate ◽  
Barriers And Facilitators ◽  
System Response ◽  
Service Needs ◽  
Face To Face ◽  
Survey Incentives ◽  
Survey Interviews

Abstract Background There is scarcity of representative data on the health and service needs of asylum seekers in Europe due to numerous practical and methodological challenges in planning and implementation of studies among this population group. Yet such data is acutely needed for development of health system response to meet the needs of asylum seekers. The aim of this study was to examine barriers and facilitators for conducting a population-based study among asylum seekers in Finland. Methods Semi-structured face-to-face individual interviews (n = 7) were carried out with the fieldwork personnel of the Asylum Seekers Health and Well-being Survey (TERTTU). Interviews contained four themes of which two will be presented in this abstract: the recruitment of the survey participants and carrying out the interviews and health examinations of the survey. Interviews of the fieldwork personnel were recorded and transcribed in verbatim. Data were analysed qualitatively using thematic analysis. Results Recruitment was substantially easier in reception centers than in private accommodations. Face-to-face and written information in participant's own language reduced misunderstandings and confidentiality concerns. Certain characteristics of the fieldwork personnel (mature age, female sex, and common cultural background) were facilitators for both recruitment and carrying out the survey appointments. Family and community members' perceptions influenced participation. Reception center personnel's attitudes influenced logistics of the recruitment process and the conduct of the survey. Incentives for participation were perceived both as facilitators and barriers. Conclusions It is feasible to obtain a high response rate among asylum seekers through investing in planning and dissemination of information about the study. Findings of this study can be benefited by other countries planning a survey among asylum seekers. Key messages Challenges in data collection among asylum seekers can be solved with careful planning and flexible fieldwork protocols. Sharing good practices about data collection among asylum seekers on a European level will inform researchers intending to conduct health surveys among asylum seekers and other forced migrants.

scholarly journals Injuries of adult asylum seekers in Finland: results of the 2018 TERTTU-health and well-being survey

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
P Doupi ◽  
N Skogberg ◽  
A Castaneda ◽  
F Garoff
Keyword(s):  
Functional Ability ◽  
Asylum Seekers ◽  
Injury Severity ◽  
Head Injuries ◽  
Well Being ◽  
Service Planning ◽  
Sub Saharan Africa ◽  
Health Examination ◽  
Age Difference ◽  
Sub Saharan

Abstract Background Injuries in refugees and asylum seekers result of accidents, violence or most extremely torture. Research in Finland has shown that many refugees experienced major traumatic events in their former home country, incl. permanent injuries. Our study provides new evidence on asylum seekers, a scarcely studied group. Methods Data was collected by structured face-to-face interviews. Healthcare staff asked adult participants if they had a bodily injury or scar. If yes, they pointed the location on a pictogram. Interviewers inquired if the injury was accidental or result of violence and if it happened before or during the fleeing trip. Injuries were classified as head (incl. brain) injuries, injuries of torso/extremities or other body areas. Results About half (47, 2 %) of 779 adults reported injuries, men more often than women (55,1 % vs. 35,3 %). Frequency was highest in 18-29-year olds. Close to all respondents (94 %) sustained injuries prior to their journey. Over one in five attributed injuries to accident (men 27 %, women 16 %). 16,6 % reported the torso/extremities as injury location, while 9,4 % had head injuries. Violence was cause of injury in over one fourth of cases (28 %). Every third male and every fifth female were violence victims, with no significant age difference. In both genders odds of violence exposure was highest in asylum seekers from sub-Saharan Africa - over 50 % attributed injury to violence. Violence victims had injuries of torso/extremities in 20,5%, and of the head in 15,3%. Head injuries were more frequent in > 40 year-old violence victims of both genders. Conclusions Injuries are common among adult asylum seekers in Finland. Prevalence of violence induced injury, especially in sub-Saharan Africans, is alarming. Training in violence victims’ management is required for professionals receiving asylum seekers. Information on injury severity and functional ability is needed for full impact assessment and service planning (incl. rehabilitation). Key messages Injuries are common among adult asylum seekers and often a result of violence, thus requiring of receiving services’ professionals skills and knowledge in violence victims’ management. Health examination protocols of asylum seekers should include injury severity assessment and impact on functional ability.

Inclusion of Transgender Voice and Communication Training in a University Clinic

2017 ◽  
Vol 2 (10) ◽  
pp. 109-115 ◽  
Author(s):  
Jennifer Oates ◽  
Georgia Dacakis
Keyword(s):  
Training Program ◽  
Clinical Education ◽  
Well Being ◽  
Evidence Base ◽  
Communication Training ◽  
Speech Language Pathology ◽  
Transgender People ◽  
Language Pathology ◽  
Effectiveness Of Training ◽  
Negative Impacts

Because of the increasing number of transgender people requesting speech-language pathology services, because having gender-incongruent voice and communication has major negative impacts on an individual's social participation and well-being, and because voice and communication training is supported by an improving evidence-base, it is becoming more common for universities to include transgender-specific theoretical and clinical components in their speech-language pathology programs. This paper describes the theoretical and clinical education provided to speech-language pathology students at La Trobe University in Australia, with a particular focus on the voice and communication training program offered by the La Trobe Communication Clinic. Further research is required to determine the outcomes of the clinic's training program in terms of student confidence and competence as well as the effectiveness of training for transgender clients.

Positive risk-taking: Mixed-methods validation of a self-report scale and evidence for genetic links to personality and negative risk-taking

2019 ◽  
Author(s):  
Megan Wales Patterson ◽  
Lilla Pivnick ◽  
Frank D Mann ◽  
Andrew D Grotzinger ◽  
Kathryn C Monahan ◽  
...  
Keyword(s):  
Youth Development ◽  
Risk Taking ◽  
Sensation Seeking ◽  
Empirical Work ◽  
Well Being ◽  
Population Based ◽  
Self Report ◽  
Personality Factors ◽  
Positive Behaviors ◽  
Adolescent Risk

Adolescents are more likely to take risks. Typically, research on adolescent risk-taking has focused on its negative health and societal consequences. However, some risk-taking behaviors might be positive, defined here as behavior that does not violate the rights of others and that might advance socially-valuable goals. Empirical work on positive risk-taking has been limited by measurement challenges. In this study, we elicited adolescents’ free responses (n = 75) about a time they took a risk. Based on thematic coding, we identified positive behaviors described as risks and selected items to form a self-report scale. The resulting positive risk-taking scale was quantitatively validated in a population-based sample of adolescent twins (n = 1249). Second, we evaluated associations between positive risk-taking, negative risk-taking, and potential personality and peer correlates using a genetically informed design. Sensation seeking predicted negative and positive risk-taking equally strongly, whereas extraversion differentiated forms of risk-taking. Additive genetic influences on personality accounted for the total heritability in positive risk-taking. Indirect pathways from personality through positive and negative peer environments were identified. These results provide promising evidence that personality factors of sensation seeking and extraversion can manifest as engagement in positive risks. Increased understanding of positive manifestations of adolescent risk-taking may yield targets for positive youth development strategies to bolster youth well-being.

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