Featured Journal Content

Featured Journal Content
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BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 16 December 2017)
Guideline
11 December 2017
Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: a UNHCR clinical guidance
Authors: Giovanni Ostuzzi, Corrado Barbui, Charlotte Hanlon, Sudipto Chatterjee, Julian Eaton, Lynne Jones, Derrick Silove and Peter Ventevogel
Abstract
Background
Populations exposed to humanitarian emergencies are particularly vulnerable to mental health problems, including new onset, relapse and deterioration of psychotic disorders. Inadequate care for this group may lead to human rights abuses and even premature death. The WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), and its adaptation for humanitarian settings (mhGAP-HIG), provides guidance for management of mental health conditions by non-specialised healthcare professionals. However, the pharmacological treatment of people with non-affective psychosis who do not improve with mhGAP first-line antipsychotic treatments is not addressed. In order to fill this gap, UNHCR has formulated specific guidance on the second-line pharmacological treatment of non-affective psychosis in humanitarian, non-specialised settings.
Methods
Following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a group of international experts performed an extensive search and retrieval of evidence on the basis of four scoping questions. Available data were critically appraised and summarised. Clinical guidance was produced by integrating this evidence base with context-related feasibility issues, preferences, values and resource-use considerations.
Results
When first-line treatments recommended by mhGAP (namely haloperidol and chlorpromazine) are not effective, no other first-generation antipsychotics are likely to provide clinically meaningful improvements. Risperidone or olanzapine may represent beneficial second-line options. However, if these second-line medications do not produce clinically significant beneficial effects, there are two possibilities. First, to switch to the alternative (olanzapine to risperidone or vice versa) or, second, to consider clozapine, provided that specialist supervision and regular laboratory monitoring are available in the long term. If clinically relevant depressive, cognitive or negative symptoms occur, the use of a selective serotonin reuptake inhibitor may be considered in addition or as an alternative to standard psychological interventions.
Conclusions
Adapting scientific evidence into practical guidance for non-specialised health workers in humanitarian settings was challenging due to the paucity of relevant evidence as well as the imprecision and inconsistency of results between studies. Pragmatic outcome evaluation studies from low-resource contexts are urgently needed. Nonetheless, the UNHCR clinical guidance is based on best available evidence and can help to address the compelling issue of undertreated, non-affective psychosis in humanitarian settings.

11 December 2017
Individual, collective, and transgenerational traumatization in the Yazidi
Authors: Jan Ilhan Kizilhan and Michael Noll-Hussong
Commentary
Abstract
In recent years, Islamic terrorism has manifested itself with an unexpectedly destructive force. Despite the fact that Islamic terrorism commences locally in most cases, it has spread its terror worldwide. In August 2014, when troops of the self-proclaimed ‘Islamic State’ conquered areas of northern Iraq, they turned on the long-established religious minorities in the area with tremendous brutality, especially towards the Yazidis. Vast numbers of men were executed, and women and children were abducted and willfully subjected to sexual violence. With the aim of systematic destruction of the Yazidi community, the religious minority was to be eliminated and the will of the victims broken. The medical and mental health issues arising from the combination of subjective, collective, and cultural traumatization, as well as the subsequent migrant and refugee crisis, are therefore extraordinary and require novel and wise concepts of integrated medical care.

11 December 2017
Humanitarian and primary healthcare needs of refugee women and children in Afghanistan
Authors: Ariel Higgins-Steele, David Lai, Paata Chikvaidze, Khaksar Yousufi, Zelaikha Anwari, Richard Peeperkorn and Karen Edmond
Abstract
This Commentary describes the situation and healthcare needs of Afghans returning to their country of origin. With more than 600,000 Afghans returned from Pakistan and approximately 450,000 Afghans returned from Iran in 2016, the movement of people, which has been continuing in 2017, presents additional burden on the weak health system and confounds new health vulnerabilities especially for women and children. Stewardship and response is required at all levels: the central Ministry of Public Health, Provincial Health Departments and community leaders all have important roles, while continued support from development partners and technical experts is needed to assist the health sector to address the emergency and primary healthcare needs of returnee and internally displaced women, children and families.

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Child Care, Health and Development
January 2018 Volume 44, Issue 1 Pages 1–171
http://onlinelibrary.wiley.com/doi/10.1111/cch.v44.1/issuetoc
REVIEWS
ISSOP position statement on migrant child health (pages 161–170)
ISSOP Migration Working Group
Version of Record online: 23 JUL 2017 | DOI: 10.1111/cch.12485
ISSOP wishes to express our appreciation toward the countries, communities, organisations, and volunteers who provide humanitarian assistance to migrants. We find it disturbing that some countries refuse to protect the basic human rights of migrants. For the full text version of this position statement, please go to: http://www.issop.org/
Abstract
Greater numbers of children are on the move than ever before. In 2015, the number of forcibly displaced people across the globe reached 65.3 million. Of the more than 1 million migrants, asylum seekers, and refugees who arrived in Europe in 2015, nearly one third were children, and 90,000 of these children were unaccompanied.

Child migrants are among the most vulnerable, even after arriving at their destination. The health of migrant children is related to their health status before their journey, the conditions during their journey and at their destination, and the physical and mental health of their caregivers. These children may have experienced numerous forms of trauma including war, violence, separation from family, and exploitation. They may suffer from malnutrition and communicable diseases including vaccine-preventable diseases. Pregnant women, newborns, and unaccompanied minors are particularly vulnerable groups. Social isolation is a major risk factor for all migrant children that compound other health risks even after settlement in their new home. Lack of health information, language, and cultural differences serve as major barriers to adequate, timely, and appropriate healthcare. In spite the challenges they face, migrant children demonstrate remarkable resilience that can be nurtured to promote good mental and physical health.

Migrant children, irrespective of their legal status, are entitled to healthcare of the same standard provided to children in the resident population, as stated in the UN Convention on the Rights of the Child. It is imperative that the health sector includes informed health workers who are able to identify the health risks and needs of these children and provide culturally competent care. In order to achieve this and promote the rights of migrant children to optimal health and well-being, ISSOP recommends that:
:: Programmes and activities designed to promote and protect migrant child health and well-being must be designed in collaboration with all sectors involved, including the education and social sectors, and should always include the voices of migrant children and their families.

:: Health services should be readily available and easily accessible for preventive, maintenance, and curative care regardless of the child’s legal status. Care should be of the same standard as care provided to the local population.
:: Health information should be provided that is culturally sensitive and readily available in a language that migrant children and families can understand.
:: Medical interpreters and cultural mediators should be available during healthcare encounters, and personnel working with migrants should receive training in cultural competence.
:: Health professionals should not participate in age determination until methods with acceptable scientific and ethical standards have been developed.
:: Professionals working with migrant children and families should have access to emotional support services.
:: Evidence-based best practices in the care of migrant children should be identified and made widely available to health workers.
:: An observatory should be established to study the factors leading to poor psychosocial and mental health in migrant children and youth.
:: Paediatricians and paediatric societies should work to improve the sensitivity of their respective populations towards migrants, asylum seekers, and refugees.