@article{KleinertHillermannJablonkaetal.2021,
  author    = {Kleinert, Evelyn and Hillermann, Nele and Jablonka, Alexandra and Happle, Christine and M{\"u}ller, Frank and Simmenroth, Anne},
  title     = {Prescription of antibiotics in the medical care of newly arrived refugees and migrants},
  series = {Pharmacoepidemiology and Drug Safety},
  volume    = {30},
  journal   = {Pharmacoepidemiology and Drug Safety},
  number    = {8},
  doi       = {10.1002/pds.5254},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-244771},
  pages     = {1074 -- 1083},
  year      = {2021},
  abstract  = {Purpose Unnecessary and inappropriate use of antibiotics is a widespread problem in primary care. However, current data on the care of refugees and migrants in initial reception centers is pending. This article provides data on prescription frequencies of various antibiotics and associated diagnoses. Methods In this retrospective observational study, patient data of 3255 patients with 6376 medical contacts in two initial reception centers in Germany were analyzed. Patient data, collected by chart review, included sociodemographic characteristics, diagnoses, and prescriptions. Antibiotic prescription behavior and corresponding physician-coded diagnoses were analyzed. Results Nineteen percent of all patients in our study received systemic antibiotics during the observation period, with children below the age of 10 years receiving antibiotics most frequently (24\%). The most commonly prescribed antibiotics were penicillins (65\%), macrolides (12\%), and cephalosporins (7\%). The most frequent diagnoses associated with antibiotic prescription were acute tonsillitis (26\%), bronchitis (21\%), infections of the upper respiratory tract (14\%), and urinary tract infections (10\%). In case of acute bronchitis 74\% of the antibiotic prescriptions were probably not indicated. In addition, we found a significant number of inappropriate prescriptions such as amoxicillin for tonsillitis (67\%), and ciprofloxacin and cotrimoxazol for urinary tract infections (49\%). Conclusion Regarding inappropriate prescription of antibiotics in refugee healthcare, this study shows a rate ranging from 8\% for upper respiratory tract infections to 75\% for acute bronchitis. Unnecessary use of antibiotics is a global problem contributing to gratuitous costs, side effects, and antimicrobial resistance. This research contributes to the development of stringent antibiotic stewardship regiments in the particularly vulnerable population of migrants and refugees.},
  language  = {en}
}
@article{KleinertMuellerFuraijatetal.2019,
  author    = {Kleinert, Evelyn and M{\"u}ller, Frank and Furaijat, Ghefar and Hillermann, Nele and Jablonka, Alexandra and Happle, Christine and Simmenroth, Anne},
  title     = {Does refugee status matter? Medical needs of newly arrived asylum seekers and resettlement refugees - a retrospective observational study of diagnoses in a primary care setting},
  series = {Conflict and Health},
  volume    = {13},
  journal   = {Conflict and Health},
  doi       = {10.1186/s13031-019-0223-z},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-325869},
  year      = {2019},
  abstract  = {Background Providing adequate healthcare to newly arrived refugees is considered one of the significant challenges for the German healthcare system. These refugees can be classified mainly into two groups: asylum seekers (who have applied for asylum after arrival in Germany and are waiting for the refugee-status decision) and resettlement refugees (who have already been granted asylum status before arriving in Germany). Whereas earlier studies have explored the health status of asylum seekers especially in terms of mental and behavioural disorders and infectious diseases without distinguishing between these two groups, our study aims to evaluate possible relationships of asylum status and medical needs of these two groups with a special focus on mental and behavioural disorders and infectious diseases. Methods In this retrospective observational study, collected data on all asylum-seeker and resettlement-refugee patients (N = 2252) of a German reception centre (August 2017 to August 2018) is analysed by absolute and relative frequencies and medians. Patient data, collected by chart review, include age, gender, country of origin, asylum status, and diagnoses (ICD-10). To describe the relationship between sociodemographic factors (including asylum status) and diagnoses, we used tests of significance and bivariate correlations with Spearman correlation coefficients. All collected data are pseudonymised. Results Of all 2252 patients, 43\% were resettlement refugees. In almost all ICD-10 categories, asylum seekers received significantly more diagnoses than resettlement refugees. According to our data, asylum seekers presented with mental and behavioural disorders nine times more often (9\%) than resettlement refugees (1\%). In the case of infectious diseases, the results are mixed: asylum seekers were twice as frequently (11\%) diagnosed with certain infectious and parasitic diseases than resettlement refugees (5\%), but resettlement refugees were treated twice as often (22\% of the asylum seekers and 41\% of the resettlement refugees) for diseases of the respiratory system, of which 84\% were acute respiratory infections (in both groups). Conclusion This study indicates that patients with unregulated migration more frequently present symptoms of psychiatric diseases and somatoform symptoms than resettlement refugees. A health policy approach within migration policy should aim to enable persecuted persons to migrate under regulated and safe conditions. Trial registration German Clinical Trials Register: DRKS00013076, retrospectively registered on 29.09.2017.},
  language  = {en}
}
@article{LauererTiedemannPolaketal.2021,
  author    = {Lauerer, Elias and Tiedemann, Elena and Polak, Thomas and Simmenroth, Anne},
  title     = {Can smoking cessation be taught online? A prospective study comparing e-learning and role-playing in medical education},
  series = {International Journal of Medical Education},
  volume    = {12},
  journal   = {International Journal of Medical Education},
  doi       = {10.5116/ijme.5ff9.bccc},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-230056},
  pages     = {12-21},
  year      = {2021},
  abstract  = {Objectives: We compared the effect of different didactic formats - e - learning and role-playing - on medical students' knowledge and counselling skills in smoking cessation training. Methods: At a German medical school, 145 third-year students were randomly allocated to attend an online course with video examples or an attendance course with role-playing. Students were trained in smoking cessation counselling according to the 5A's (ask, advise, assess, assist, arrange) for approximately 90 minutes. Practical skills were measured in an objective structured clinical examination (OSCE) and represent the primary endpoint of this prospective comparative study. Additionally, changes in theoretic knowledge were assessed by pre - and post - interventional questionnaires and a final written exam. Results: In the OSCE, overall scores were higher in the attendance group (Mdn=70.8 \% vs. 62.8 \%; U=119; p=.087, n=36), but a statistical advantage was only found in one single counselling sequence ("Assist": Mdn=66.7 \% vs. 51.4 \%; p = .049) and the rating of the standardised patients (M=4.7 vs. 4.2 out of 5 points, t(27.836)=2.0, p=.028). Students' results (n=130) from self-assessment and written exams suggest that both approaches are equally well suited to increase theoretical knowledge. The online course was more time efficient (90 vs. 73 minutes). Conclusions: Seminar and web-based training seem equally well suited for transferring knowledge and skills on tobacco cessation counselling. Considering their particular strengths, these two teaching approaches could be combined.},
  language  = {en}
}
@article{MuellerChandraFuraijatetal.2020,
  author    = {M{\"u}ller, Frank and Chandra, Shivani and Furaijat, Ghefar and Kruse, Stefan and Waligorski, Alexandra and Simmenroth, Anne and Kleinert, Evelyn},
  title     = {A digital communication assistance tool (DCAT) to obtain medical history from foreign-language patients: development and pilot testing in a primary health care center for refugees},
  series = {International Journal of Environmental Research and Public Health},
  volume    = {17},
  journal   = {International Journal of Environmental Research and Public Health},
  number    = {4},
  issn      = {1660-4601},
  doi       = {10.3390/ijerph17041368},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200640},
  year      = {2020},
  abstract  = {Background: Language barriers play a critical role in the treatment of migrant and refugee patients. In Germany, primary care interpreters are often not available especially in rural areas or if patients demand spontaneous or urgent consultations. Methods: In order to enable patients and their physicians to communicate effectively about the current illness history, we developed a digital communication assistance tool (DCAT) for 19 different languages and dialects. This paper reports the multidisciplinary process of the conceptual design and the iterative development of this cross-cultural user-centered application in an action-oriented approach. Results: We piloted our app with 36 refugee patients prior to a clinical study and used the results for further development. The acceptance and usability of the app by patients was high. Conclusion: Using digital tools for overcoming language barriers can be a feasible approach when providing health care to foreign-language patients.},
  language  = {en}
}
@article{MuellerHummersHillermannetal.2020,
  author    = {M{\"u}ller, Frank and Hummers, Eva and Hillermann, Nele and Dopfer, Christian and Jablonka, Alexandra and Friede, Tim and Simmenroth, Anne and Wetzke, Martin},
  title     = {Factors influencing the frequency of airway infections in underage refugees: a retrospective, cross sectional study},
  series = {International Journal of Environmental Research and Public Health},
  volume    = {17},
  journal   = {International Journal of Environmental Research and Public Health},
  number    = {18},
  issn      = {1660-4601},
  doi       = {10.3390/ijerph17186823},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-213134},
  year      = {2020},
  abstract  = {Background: Infections are a leading cause of refugee morbidity. Recent data on the rate of airway infections and factors influencing their spread in refugee reception centers is scarce. Methods: A retrospective, cross-sectional study of de-identified medical records with a focus on respiratory infections in underage refugees was conducted at two large German refugee reception centers. Results: In total, medical data from n = 10,431 refugees over an observational period of n = 819 days was analyzed. Among pediatric patients (n = 4289), 55.3\% presented at least once to the on-site medical ward with an acute respiratory infection or signs thereof. In 38.4\% of pediatric consultations, acute airway infections or signs thereof were present. Airway infections spiked during colder months and were significantly more prevalent amongst preschool and resettled children. Their frequency displayed a positive correlation with the number of refugees housed at the reception centers. Conclusions: We show that respiratory infections are a leading cause for morbidity in young refugees and that their rate is influenced age, season, status, and residential density. This illustrates the need to protect refugee children from contracting airway infections which may also reduce the spread of coronavirus disease 2019 (COVID-19) during the current pandemic.},
  language  = {en}
}
@article{SimonParisiWabnitzetal.2023,
  author    = {Simon, Johanna and Parisi, Sandra and Wabnitz, Katharina and Simmenroth, Anne and Schwienhorst-Stich, Eva-Maria},
  title     = {Ten characteristics of high-quality planetary health education},
  series = {Frontiers in Public Health},
  volume    = {11},
  journal   = {Frontiers in Public Health},
  issn      = {2296-2565},
  doi       = {10.3389/fpubh.2023.1143751},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-313856},
  year      = {2023},
  abstract  = {Aim: The climate and ecological crises are considered fundamental threats to human health. Healthcare workers in general and doctors in particular can contribute as change agents in mitigation and adaptation. Planetary health education (PHE) aims to harness this potential. This study explores perspectives among stakeholders involved in PHE at German medical schools on the characteristics of high-quality PHE and compares them to existing PHE frameworks. Methods: In 2021, we conducted a qualitative interview study with stakeholders from German medical schools involved in PHE. Three different groups were eligible: faculty members, medical students actively involved in PHE, and study deans of medical schools. Recruitment was performed through national PHE networks and snowball sampling. Thematic qualitative text analysis according to Kuckartz was used for the analysis. Results were systematically compared to three existing PHE frameworks. Results: A total of 20 participants (13 female) from 15 different medical schools were interviewed. Participants covered a wide range of professional backgrounds and experience in PHE education. The analysis revealed ten key themes: (1) Complexity and systems thinking, (2) inter- and transdisciplinarity, (3) ethical dimension, (4) responsibility of health professionals, (5) transformative competencies including practical skills, (6) space for reflection and resilience building, (7) special role of students, (8) need for curricular integration, (9) innovative and proven didactic methods, and (10) education as a driver of innovation. Six of our themes showed substantial overlap with existing PHE frameworks. Two of our themes were only mentioned in one of the frameworks, and two others were not explicitly mentioned. Few important elements of the frameworks did not emerge from our data. Conclusions: In the light of increased attention regarding the connections of the climate and ecological crises and health, our results can be useful for anyone working toward the integration of planetary health into medical schools' and any health professions' curricula and should be considered when designing and implementing new educational activities.},
  language  = {en}
}