No abstract

BackgroundTurkey is the country hosting the largest number of refugees from Syria, with currently 3 571 175 million persons. The general health needs of the refugees are being addressed; however, people with intellectual disabilities (IDs), particularly children, are relatively missed. The aim of this study was to identify medical, psychological and social needs of children with ID and their families, among the Syrian refugee population in Turkey, and to define psychosocial and cultural needs for planning of future services.MethodsOne hundred forty‐two children (67.6% men; mean age 90.5 months) diagnosed with intellectual disorders were included in the study. Family Needs Survey, with additional open‐ended and close‐ended questions, was used to evaluate family needs. Items from Developmental Disabilities Profile‐2 were used to evaluate and screen cognitive, motor and language development as well as medical concerns and behavioural problems. Data on sociodemographic characteristics were also collected.ResultsThe highest needs were identified in information and financial needs domains. Other indicated needs were on child care and community services domains. The least indicated items were on family and social support and explaining to others domains. An average of 63.5% of the respondents definitely agreed with the Family Needs Survey items. The overall level of identification of need items was higher than that in some previous studies, indicating the level of unmet needs of the studied population. Family income, parents' employment and parents' education were not significantly associated with unmet family needs. Special education services were unreachable for most of the families in the study.ConclusionsFamilies reported the highest needs in information and financial needs domains. The overall level of identification of needs was higher than that in some previous studies, indicating the level of unmet needs of the studied population. The majority of the parents reported that they had sufficient family and social support, which might be a protective factor for parental mental health. Parents' Turkish fluency was very significantly associated with every domain of unmet needs. Language barriers and translation problems had significant negative effects on families, as confirmed by the answers to open‐ended questions. Another important factor identified was access to service professionals. Special education services, sorely needed for most of the families, could not always be reached. Although the progress of children who had received special education was not very encouraging, it was better than those who did not receive it. The first implication of the study is that increasing Turkish proficiency or providing high‐quality and consistent translation services is vital for this category of children with ID. The second implication is that information and financial needs must be met with priority. Information must be tailored for each child's needs and developmental level. Special education and physical therapy must be more accessible and at higher quality.

Background About 1468 Syrian and Turkish doctors, serving in primary health care, have received the mhGAP training during 2016–2019. As additional training needs were identified, MoH and WHO wanted to understand the usefulness of the training and its impact in responding to the mental health needs of Syrian refugees in Turkey. Methods A five component assessment was done in 2019, consisting of feedback of trainees, assessment of increase in knowledge; utilization of service; compliance to treatment guidelines and service user satisfaction. The purpose was to understand the perception of participants on the training; estimate the knowledge gained—attributable to the training; estimate the increase in mental health cases identified and treated; compliance with treatment guidelines; as well as perception of the services received by end-beneficiaries. Results Results indicate that most of the respondents were happy with the training, but preferred additional mhGAP training as a refresher course in the future. There was knowledge gained due to the training, 9% for the Syrian and 5% for Turkish doctors. The knowledge gained has helped the practicing doctors to be more attentive and increase the numbers of cases diagnosed after the training for almost all groups of diagnoses. Most doctors, observed during practice, comply with the guidelines shared during the training, but improvement is still needed when it comes to prescription and treatment of certain conditions. The average number of mental health cases identified increased by 38 (%27) cases in the year following the training. We observed over 70% compliance with guidelines for 9 out of 12 criteria in question. The results of the patient exit interviews indicate a high level of satisfaction with the MHPSS services provided. About 95% of beneficiaries were happy with the quality of the service, and 92% having their needs met. Conclusions The mhGAP training was found useful. More training should be conducted to fill in the gap in service provision and meet the mental needs of Syrian refugees in Turkey.

The purpose of this study is to assess the impact of a primary health care strengthening intervention on bypassing behavior in Albania, a middle-income country that has experienced substantial structural changes that affect PHC and where bypassing among health care clients is common. The intervention aimed to improve the quality of health care in low-level facilities through improved availability and use of health information, the adoption of clinical practice guidelines, and provider training. The study employs a quasi-experimental research design to evaluate the impact of the intervention on health care utilization. The survey findings suggest that the pilot areas outperformed the control areas with respect to a number of key population-based indicators of health care utilization. For example, in the 2-year period between December 2002 and December 2004, bypassing for treatment of simple acute health problems during the month prior to the survey decreased by 47%, and the percentage of chronically ill health care clients who utilized PHC facilities for treatment in the month prior to the survey increased by 29%. These differences, which are statistically significant at the 10% level or better, suggest that the improved performance in the pilot areas is attributable to the intervention.

Aim of the studyGastric adenocarcinoma is among most frequent among cancers in Albania. Early detection and staging is helped by imaging methods, including CT and MRI. This study provides evidence on the CT and MRI accuracy in detecting and pre-operative staging of gastric adenocarcinoma in 62 patients in a diagnostic clinic in Albania. The correct staging of the gastric adenocarcinoma helps decide on the next treatment options.Material and methodsSixty-two patients with gastric adenocarcinoma, confirmed with biopsy, underwent both CT and MRI examination at a clinic in Tirana during same week. Images were reviewed to determine the TNM classifications and staging using the current AJCC guidelines. Data on age, sex, cancer location and differentiation were also collected and analyzed. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value was estimated for both CT and MRI.Results and conclusionsCT has a higher accuracy than MRI (83% vs. 67%) for T1. Accuracy for T2 was the same (74%). Starting with T3 and upwards, MRI has a slightly more accurate ability to detect and stage the gastric adenocarcinoma (T3: 81 vs. 75; T4: 83 vs. 64). Both the CT and MRI abilities to accurately detect the N classification were the same. Regarding the M classification, the MRI has a slightly more accurate ability to detect metastases (M: 83 vs. 64). Clinicians might benefit from using CT whenever suspect gastric adenocarcinoma patients present first. Decision on surgery requires a MRI to rule out metastases.